Some of my previous policy work from
2002/2001/2000 is detailed below:
-On 25 June 2002 the
Government published a draft Mental Health Bill and there was an opposition day debate in
Parliament. My contributions to the debate are posted below.
-Click here for Early Day Motions:
EDM 1432 THE ZITO TRUST AND A WORLD CLASS MENTAL HEALTH SERVICE 12 June '02
EDM 1345 BENEFITS
FOR PATIENTS RECEIVING LONG TERM IN-PATIENT CARE 20
May '02
-Response to the
Government's statement on the Mental Health white paper - December 2001
-Article for Mental Health Today - December 2001
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Opposition Day Debate on draft Mental Health Bill
Intervention:
Lynne Jones (Birmingham, Selly Oak): Will my right hon. Friend
acknowledge that Government policy will have failed if the use of compulsion does not
decrease in future?
Mr. Milburn: That is what we want. We
must try and are trying to undertake two parallel processes. The first is to deal with the
loopholes in the law that, admittedly, only ever affect a small minority of people and a
small minority of patients, although with huge and sometimes tragic consequences. However,
our effort overall must be to develop services that are capable, in an appropriate way, of
dealing with people's problems without compulsion. That is why we are trying to build up
services in hospitals as well as crisis intervention teams in the community, assertive
out-reach teams and some of the new services that are being made available for young
people with the first onset of psychosis.
25 Jun 2002 : Column 770
Normally such young people, who are among the most
vulnerable in the community, are simply not dealt with at all. They often have to wait
years to be seen. However, we now know that the model that is being rolled out in 18 local
communities across the country works. It can provide quick, interventional services and
makes a real difference to those people. It prevents them from ever requiring
hospitalisation.
As I tried to make clear earlier, the trick is to get the
range of services right. Although the national service framework and the NHS plan are, by
necessity, 10-year programmes—we must build up capacity and change the culture of the
service—progress is under way. Last year was the first year in perhaps decades in
which the overall number of mental health beds in the national health service rose rather
than fell. There are more than 500 extra secure beds and 320 extra 24-hour staff beds.
Such services were never available in the past, but more of them are to come.
Clearly, everything cannot be done at once, because of
staffing and capacity constraints. None the less, a range of services that gets early
intervention into place and ensures that appropriate services for those who need them are
available in primary and hospital care is in place across the country as a whole.
Speech:
Lynne Jones (Birmingham, Selly Oak): Today's debate
has been interesting and enlightening. I agree with many of the comments made by previous
speakers, and congratulate the Conservative party on making mental health the subject of
this Opposition day debate.
There is much consensus between Government and Opposition
on this issue. It was, after all, a Conservative Secretary of State for Health who coined
the term "spectrum of services", acknowledging that there had been a failure to
put adequate services in place in the community. It is sad that the hon. Member for
Woodspring (Dr. Fox) did not acknowledge the failures of the Conservative Government. I
agree with much of the Opposition's motion, but I am sad about its failure to acknowledge
the positive progress that the Government have made. They have made the vision of the
spectrum of services a reality by increasing the number of assertive outreach teams,
improving talking treatments and psychology services and investing in the physical
infrastructure in our acute wards.
There will be considerable investment in new mental health
services in Birmingham. An acute hospital that is not very old is to go. It was provided
in the late 1980s, and when I went there, I was appalled at the lack of therapeutic
atmosphere in the building. It was a very constrained building that had obviously been
subject to a great deal of cost cutting. At last we will get new services; many will be
for in-patients, provided locally rather than at the main hospital base. The Government
are making that investment. The Conservatives are right to say that we have a long way to
go, but it is churlish not to acknowledge that great progress is being made.
I have not yet had an opportunity to look at the draft
Bill, but I welcome its publication. I agree with the hon. Member for Gosport (Mr.
Viggers) that it should be subject to Special Standing Committee procedure. It is now
nearly 20 years since the last major piece of mental health legislation. The draft Bill
represents the opportunity of a lifetime, and we must ensure that we get it right. We must
ensure that we balance the emphasis on public protection—which I think is
over-emphasised—with people's right to receive appropriate care. That right is not in
place at present. Every time we use compulsion it is an indication less of failing in the
individual than of failing in the services provided for people in need.
The Government are initiating a 10-year programme to
build up capacity. Goodness knows, more money is needed, and we must be vigilant in
ensuring that money allocated for mental health services is not diverted to deal with
other pressures. However, no matter how much money we put into services, it is also
essential that we have enough staff with the necessary skills.
We do not have enough staff at the moment. The Sainsbury
Centre for Mental Health has pointed out that in the existing establishment, one in eight
positions is
25 Jun 2002 : Column 789
vacant. If the ambitions of the Government, expressed in the national service framework
and other plans, are to be realised, we shall need an additional 8,000 staff—a 12 per
cent. increase.
Psychiatry is a Cinderella service in more ways than one.
It is not attractive to newly qualified graduates, and we need to ensure that it becomes
more attractive. One reason why people shy away from mental health services is the culture
of blame in our society, which creates problems in many services, including social work.
Because of the stresses and strains on a service, things go wrong—and it is too easy
to blame individual clinicians or social workers for their mistakes. That is not to deny
that bad mistakes are sometimes made, or that there is some culpability. In many cases,
however, people are working against the odds and we should acknowledge that.
We must deal with the blame culture, and we should move
away from too much emphasis on public protection. The only time there is any great
publicity or press interest is when a tragic event, especially homicide, occurs. In that
context, it is commendable that the Opposition have initiated a debate on mental health
when that type of public interest is not current. It is also commendable that they have
adopted mental health as one of their priorities; it is already a priority for the
Government, so there is much consensus, on the basis of which we can move forward.
At the last meeting of the all-party mental health group,
we discussed mental health appeal tribunals. We heard about patients who had to wait more
than 20 weeks for their case to be reviewed by a tribunal. The Royal College of
Psychiatrists has pointed out that the process is extremely staff-intensive. A mental
health appeal tribunal chair told the all-party group about the constraints on the
tribunal service, including the shortage of psychiatrists to serve on the panels and the
fact that the psychiatrists who have to provide reports for the tribunal are
over-stretched.
The White Paper proposed automatic referral to a mental
health tribunal after 28 days of compulsory treatment; my right hon. Friend the Secretary
of State suggested that the Bill would include such a provision. There is concern,
however, that even more psychiatric time will be taken up in dealing with the process, so
there is a danger that there will be even more delays in the system. The Government need
to consider that point.
Although there is consensus among us, omitted from many
contributions to the debate was the need to make the experiences of users of the service
central to its provision. We should have respect for them and involve them in decisions
about their care. A survey carried out by the National Schizophrenia Fellowship showed
that a quarter of mental health service users did not even have the opportunity to discuss
their medication, while 62 per cent. said that there was no discussion of any possible
alternative.
I am pleased to acknowledge the report produced recently
by NICE, which made it clear that the choice of anti-psychotic drugs should be made
jointly by the patient and the clinician. The report also noted that the use of atypicals
should be a primary consideration, and there should be an end to postcode prescribing of
such drugs. Compliance with medication is an important issue, and the use of the more
modern drugs must be more
25 Jun 2002 : Column 790
widespread. Those drugs are not new; they came out 10 years ago, and it is one of the
great failures of our service that they were not taken up.
Advance directives should have higher status; they should
be given statutory recognition. If treatment is to be compulsory, the people who make such
decisions should take into account the wishes of patients, who should have had the
opportunity to express those wishes when they had the capacity to do so. Consideration of
such wishes should be a statutory obligation, and patients should be encouraged to carry
crisis cards.
The social security system is important to the well-being
of mental health service users. I urge Ministers in the Department of Health to ensure
that they have input to the development of services by the Department for Work and
Pensions. Compulsion causes great stress to people who are already suffering from mental
ill health. I draw the attention of the House to early-day motion 1345, which notes the
poor availability of benefits to long-term patients, who receive only about £15 a week.
The chief executive of the mental health trust in my area has pointed out that she has to
use valuable trust resources to subsidise patients who cannot afford such basic needs as
haircuts and shoes.
Carers are important. Too often, confidentiality is given
as an excuse for excluding them. Obviously, if a service user expressly wishes to exclude
relatives, that wish should be respected—although questioned. However, family members
are too often excluded by default, because clinicians and service providers do not discuss
the needs of the whole family with the service user. We must give greater priority to the
involvement of carers. People who suffer from mental ill health, as well as those who
suffer from personality disorders—the distinction is sometimes blurred—have
often experienced trauma in their lives, and family members can help to provide support
and enlightenment.
We need joined-up services. We need good services that
take into account the fact that many mentally ill people also suffer from alcohol or drug
abuse. Too often, services are either not provided at all or are provided separately,
without appropriate links.
More and more health and social services are being
provided through partnership arrangements. However, that means that when people want to
complain about a service, there is no single point of reference. The local government
ombudsman deals with complaints about social services, while the health service ombudsman
deals with complaints about the health service. Will the Government consider appointing an
ombudsman specifically for mental health service users and their carers?
Much has been said about stigma. We will not be able to
give priority to mental health services until we deal with the stigma. The hon. Member for
Woodspring began by saying that in mental health we accepted services that would not be
acceptable in any other aspect of health services, and he is right. Too often, people are
afraid to speak out about their experiences; they hide their feelings under the carpet.
One day, the shame attached to visiting a psychiatrist
will be no greater than the feelings that people have when they visit any other medical
practitioner. People will seek help when they need it. They will be able to talk about
their experiences. Indeed, they will be proud of their
25 Jun 2002 : Column 791
ability to do overcome all the problems
associated with mental ill health in our society. Their family members will not suffer the
stigma of having someone with a mental illness in their families. The Government are
putting in place the policies to achieve that, and we all have a role to play in ensuring
that the day when people can talk about their experiences comes sooner rather than later.
In May and June 2002 I tabled
the following Early Day Motions on Mental Health issues:
EDM 1432 THE
ZITO TRUST AND A WORLD CLASS MENTAL HEALTH SERVICE 12 June '02
That this House notes the
parliamentary launch on 13th June of The Zito Trust report entitled, Looking Forward To A
World Class Mental Health Service; welcomes the fact that this report follows the recent
National Institute for Clinical Excellence guidance which recommends the first-line use of
the modern atypical antipsychotics for people with schizophrenia; recognises that the
report highlights the current postcode prescribing that NICE was in part established to
address; and calls on the Government to ensure that sufficient funds get through to
healthcare professions to ensure that this landmark guidance is implemented in a timely
manner.
EDM 1345 BENEFITS
FOR PATIENTS RECEIVING LONG TERM IN-PATIENT CARE 20 May '02
That this House notes that long-stay
patients receiving free in-patient care, including large numbers of people suffering from
mental ill health, receive only £15.10 per week state benefit; also notes the comments of
the Chief Executive of South Birmingham Mental Health NHS Trust that the trust is
regularly having to supplement this allowance from care budgets to ensure that people's
basic needs for clothing, toiletries, haircuts and other personal items are met, causing a
drain on NHS resources; further notes that this grossly inadequate personal income is
depriving patients of the means to develop greater independence and compromises severely
their social inclusion and integration into the ordinary life of the community; welcomes
the campaigning work on this issue by Derbyshire Patients' Council; and calls on the
Government to raise the amount of benefit that long-stay patients receive to at least
£30.00 per week.
Response to the Goverment's statement on the
Mental Health White Paper Dec 2001
In response to the Government's
statement on the Mental Health White Paper, Reforming the Mental Health Act I
wrote to Alan Milburn, Secretary of State at the Department of Health, in my capacity as
co-chair of the All Party Group on Mental Health (copy of my letter posted below).
I have also tabled Early Day
Motion 128 condemning the stereotypes of people with mental illness portrayed in the
film 'Me Myself and Irene'
Letter to Alan Milburn on the Government's Statement
of 20 December
Alan Milburn MP
Secretary of State
Department of Health
Richmond House
79 Whitehall
London
SW1A 2NS
Date: 21 December 2000
Dear Alan,
Mental Health Statement 20 December
I am writing about your reply to the point I made
during the statement. Whilst I am totally in agreement with your response, it did actually
not address the point I was making which was about the importance of people with symptoms
of mental illness referring themselves for help as quickly as possible. The stigma
associated with mental illness and the fear of compulsory treatment contribute to the
delays in people seeking help.
The White Paper does make the point that good quality
care and treatment is the key to making sure that most people with mental health problems
will never need to fall within the scope of mental health legislation. I was hoping that
my question would have given you the opportunity to reinforce that point and also
acknowledge the danger that the extension of compulsory treatment into community settings
might possibly increase the reluctance to self referral.
I am sure that you would agree that the possibility of
compulsory treatment in the community should not be allowed to reduce responsiveness to a
mentally ill person’s or their carer’s request for care. Many mental health
organisations fear that this could be an unintentional effect. There is also a need to
acknowledge that compulsory drug therapy could involve the use of drugs with greater side
effects, particularly depot injections and this could inhibit future compliance once the
period of compulsion is at an end.
I hope these comments are helpful. I am very pleased
with the progress that is being made in improving mental health services but I am sure you
will agree that we still have a long way to go.
Yours sincerely,
LYNNE JONES MP
Article for Mental Health Today - December
2001
Every family in the land is touched in some way by
mental illness and yet the overwhelming public perception is that mentally ill people are
dangerous and their problems self-inflicted. The only logical interpretation of this
inconsistency is that people bottle up their own experiences, whether as a sufferer or as
a relative or carer, because of the stigma that continues to be associated with mental
illness. Thus is the low priority given to mental illness perpetuated.
We must break out of this cycle. Any reform in
legislation must put at its heart the need to treat people with respect. It is clear, from
the increased use of existing compulsory powers, that the cries for help of so many
sufferers or those close to them are ignored until a person’s condition deteriorates
to the extent that compulsory treatment is required. Those subject to compulsion should be
seen as victims of inadequate services rather than treated as convicts. Respect requires
that service users should have a say in their treatment. Advance treatment directives
should be given statutory status.
We must end the use of ‘confidentiality’ as
the excuse for preventing relatives and carers from being involved. Service users should
be encouraged to include their close family in discussions about their treatment, which
should not just be about doling out medication. Mentally ill people and, indeed, people
suffering from ‘personality disorder’ (the difference is usually artificial),
have often experienced some trauma in their lives, which needs to be understood. Except in
exceptional circumstances, family members are vital to this process and their continued
support must be nurtured. Only if a patient specifically wants to maintain
confidentiality, should next of kin be excluded. Measures need to be introduced to
positively review such exclusion.
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