Speech Delivered by Oliver Heald MP, Shadow Health Minister, at the Conservative Party Conference Fringe Meeting, hosted by the National Schizophrenia Fellowship on 8 October 2001 Mental Health in the Spotlight National Schizophrenia Fellowship I am delighted to have been asked to speak at this Meeting, so soon after my appointment at the Shadow Health Minister with responsibility for Mental Health and just two days before World Mental Health Day on the 10th. I start with the admission that I am not an expert in this field and hope that it will be possible to work closely with all the organisations concerned with Mental Health. My only experience of Mental Health issues is as a barrister, where I came across many individuals with a diagnosis of severe mental illness. All too often, the alleged offence was relatively minor, but provided an opportunity for the patient to obtain help. They often told me, as did their carers, that they had sought help before ever committing an offence, but had been turned away. I believe it to be true that for a large percentage of those with mental illness, their first experience of treatment is either through the compulsory route of sectioning, or intervention by the Criminal Courts. I would like to explore, during my time as Shadow Health Spokesman dealing with Mental Health, the question of whether this is necessary. I believe that there must be a better way of providing good quality early easily accessible medical care to those in the frightening position of suffering the onset of mental illness. I would like to thank the National Schizophrenia Fellowship and Cliff Prior and Paul Farmer in particular, for giving me an early briefing on their concerns and I hope that we will be able to continue with such a constructive relationship. I agree with them that above all, delivering good quality services is about people: users, healthcare workers, carers, our fellow citizens. In giving an overview of where we are now in terms of mental health provision, the starting point is to look at the concept of Care in the Community and its implementation. The scheme gave thousands of people their dignity back and gave them control of their lives. However, we also need to accept that the scheme did leave some vulnerable people with too little or scant support compared with what they needed. It is essential that we do not compromise Care in the Community by making it available to those who need a more sheltered form of treatment. It is clear that there are many who were left in the wrong communities and were exposed to danger. I think we would all agree that the number of mental health acute beds has fallen to such an extent that some hospitals are now operating at more than 100% of capacity. There is a need to increase the number of acute psychiatric beds and before the recent General Election we pledged that we would do so if elected. There is also a need to enhance the role of Primary Care in the provision of Mental Health. We particularly need to ensure proper GP awareness of mental health problems so that a greater number of people can be treated in a primary care setting. I hope that as Primary Care Trusts develop, it will be possible for some General Practitioners to specialise in mental health and even receive cross-referrals within the Trust. We have also suggested that the role of community pharmacists could be enhanced by their providing a service to mental health patients, by dispensing a dose of medication at a particular time each day to a particular patient. We have also said that we will review the sectioning policy. We do need a new Mental Health Act. The last Mental Health Act in 1983 tried to look ahead to the new circumstances under Care in the Community, but it is clear that it now needs reform. We would like to see it made easier to section someone for a short period of time, but that decisions over long-term detention should be made in a far more robust way. We also believe that the role of the medical practitioner should be enhanced in the sectioning process, so that the long delays which presently occur, whilst waiting for a social worker to attend a police station, can be avoided. We agree with the Government that there is a need for compulsory treatment in the Community to be available under the law, but we would expect it to be used in exceptional cases and not as a rule. We also believe that the interaction between treatment in the community and the sort of drugs which are available to patients, needs to be further examined. I know from my own experience of talking to those patients who have ended up in the criminal justice system, that one of the great problems of the old style of medication is the terrible side effects which it can give, for some people. This involves uncontrolled shaking and a sense of isolation. Some patients find the side effects so bad, that they would rather take the mental illness than the physical illness. Modern atypical drugs can remove many of these side effects. It seems wrong to me to compulsorily treat someone with anything other than the most modern drug which will provide the least side effects. Yet, the evidence put forward by the National Schizophrenia Fellowship, the Zito Trust and companies such as Lilly suggest that this is far from being the case today. Turning to the issue of funding. It is often said that atypical drugs cost a good deal more than conventional treatments and this is true. But, it is important that we should take account, not just of the straight comparison in costs of the drugs concerned, but also the wider cost to the NHS and to other Departments if those with mental illness refuse to take their drugs and require expensive in-patient treatment in hospital on a more frequent basis and if they are unable to work and contribute financially to society. It is time that these effects were properly calculated and a cost benefit analysis made. As NICE reviews the treatment for mental illness and the efficacy of atypical drugs, I hope that their calculations of the cost benefit of these drugs is not a narrowly drawn one, but does take account of these wide effects. The Government has promised extra funding for mental health, but there is a wide perception that the money is simply not getting through. Cancer and heart treatments are said to be the priorities, together with mental health. But there is a mounting concern that the resource issue for mental health is again becoming an issue of priorities within public healthcare spending. In the short period that I have had to start to research my brief, it has become clear to me that there are many new therapies and treatments and some old ones, which are not available to patients when they should be. Clearly it is necessary to establish that each such treatment is genuinely worthwhile, but if talking treatments can help patients, then they should be available. Similarly, if rehabilitation facilities and employment opportunities are genuine ones, which will help patients, they should be available. I would also like to see more recognition in law of the role of crisis cards by which patients can set out arrangements when they feel well for periods when they are acutely ill. All too often, the structure of their lives including such basic matters as the payment of rent, is lost during periods of acute illness, leading to the loss of accommodation and other disasters. Crisis cards enable a patient to set out sensible arrangements to cover such details. I also believe there is much to be said for recognizing the role of advanced directives in which patients set out their treatment preferences for periods of acute illness. If ways can be found of providing early assessments for patients, which avoid the traumas of sectioning or the criminal courts, then they should be available. Mental ill-health affects 20% of the adult population at some time and four in every one thousand have a severe mental condition. We have come a long way in caring for those with mental illness in the Community, but there is still more work to be done. I should also mention the treatment of those with a personality disorder. There is an argument as to whether personality disorder can be treated. Having met many described as having personality disorders in the courts, I am sure that they can benefit from more help. But the Government is suggesting that people who are suffering from severe personality disorders should be detained, whether they need treatment or not, if they are thought to pose a danger. There is a civil liberties issue here. There are many people in society, who might be thought to be dangerous, but they are only imprisoned when they commit an offence and are convicted. It is an important principle that a person should not be imprisoned by Government fiat. We cannot accept the Government's proposals as they stand. The Government has said that a new Mental Health Act is needed. They have said that mental health is a priority. But despite the rhetoric, the signs are worrying: there is no Mental Health Bill in the Queen's Speech, there are concerns about funding reaching the front line, modern drugs are not being prescribed to the extent that they should, and primary and secondary services are over-stretched. I can promise you that as Spokesman, I will be chasing the Government to ensure that it meets its promises in all these areas. The National Schizophrenia Fellowship is providing local services through 355 units, all of which are contracted by the National Health Service. This is a marvelous example of private sector delivery for the National Health Service. It has happened for years. Some may wonder, in the current climate, what all the fuss is about. Of course, the Prime Minister is right to want to see the private sector fully involved in delivering NHS services, and we, as Conservatives, should support him in that. I would like to work with you to learn more about the issues in the Mental Health field. It is the job of the Opposition to ensure that the Government provides the sort of excellent mental health services which patients in this country are entitled to. We will work to achieve success.