Mental Health Speech This Government has long been charged with the accusation that it is all spin and no delivery and one doesn't have to look far for evidence to support this charge. How can anyone forget the Comprehensive Spending Review when they announced, with all the Labour fanfare, that they would be spending £21bn on the NHS over three years? When analysts looked closely at the figures they calculated that this figure was closer to £5bn. Once again, the Government stand accused today of spinning an issue which is close to hearts of everyone in the audience: the reform of the Mental Health Act. As we all remember, on 12th December 2000, Alan Milburn, the Secretary of State for Health published the long awaited White Paper: Reforming the Mental Health Act. In a statement in the House of Commons, Milburn commended the White Paper to the House, explaining that the "changes amount to the biggest shake-up in mental health laws in four decades. They will strengthen the current law, introduce new safeguards for patients, and improve protection for the wider community." At the time, the Conservative Party questioned whether the Secretary of State's rhetoric matched the Government's action. While Milburn spoke of the desperate need for reform and said that it was a key priority he failed to explain why a Mental Health Bill wasn't in the Queen's Speech. Since the White Paper was published, I, and others, have questioned the Government over when they intend to reform the Act. We have all been given the standard parliamentary brush off - when "Parliamentary time allows." Although we were unimpressed by this less than satisfactory answer, it still came as a shock to us when a parliamentary colleague forwarded a copy of correspondence from the Minister for Health, Jacqui Smith MP, who stated that: "Enactment of any new Mental Health Act is some years away." I hope everyone here today will join with me, and the rest of the Conservative Party, in forcing the Government to sort out their priorities and get the reform of the Mental Health Act back on the agenda. Once we get the Mental Health Act back on the agenda, we can then tackle the deficiencies in the White Paper. Labour claimed that its Draft White Paper on Mental Health last December would tackle the crisis in Mental Health. As groups such as the Mental Health Alliance have pointed out, the truth is that it will not. It is a document primarily about Personality Disorder, and a poorly written one at that. We also have concerns about compulsory treatment. In the White Paper, the Government called for compulsory treatment in the community. We are not against this but seek assurances that it is only to be used in exceptional cases. Ultimately, we believe that it is always better to provide the conditions in which patients consent to treatment. I understand that many people have stopped taking their drugs as they do not have access to modern medicines and treatments. Patients know the terrible side effects of some older medicines all too well. One mother told me recently that her son had permanently lost the ability to speak. Some find the side effects so bad that they would rather endure the mental illness. We now know that modern atypical drugs can remove many of these side effects. Unfortunately, the evidence put forward by the National Schizophrenia Fellowship, the Zito Trust and others, suggests that these medicines are not as widely prescribed as they should be. Sadly, it appears that this is because atypical drugs cost more. But it is important that we should take into account not just the direct financial comparison, but also the wider cost to the taxpayer and to society if those with mental illness do not take their drugs. In addition to the human costs, there are more expensive inpatient treatments, additional welfare benefits and fewer taxes paid. It is time that these effects were properly calculated. As NICE reviews the efficacy of atypical drugs, it is inappropriate that they should have to decide whether these drugs are "affordable". Ministers should make decisions on "affordability". But since NICE is forced by Government to make such decisions, I hope that its calculations of the cost benefit of these drugs are not too narrowly drawn. It is vital that NICE makes the right decision. The final point that I would like to make on this subject is that if atypical drugs are more widely available then I believe the need for compulsory treatment would diminish. However, for those who will still require compulsory treatment, reassurances needed to be made that it will not be administered with anything other than the most effective drug with the least side effects. Compulsory treatment with typical drugs, unless completely necessary for medical reasons, is wrong. We have also said that we will review the sectioning policy. 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. I should also mention the treatment of those with a personality disorder. There is an argument as to whether personality disorder can be treated. In my previous life as a Barrister, I met many described as having personality disorders in the courts, who I am sure could 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. I hope that it reassures you that I will not just focus on the need for a new Mental Health Act. I appreciate that I need to settle a few people's concerns about the Conservative Party's record on mental health. The starting point is to look at the concept of Care in the Community and its implementation. Although, the scheme gave thousands of people their dignity back and gave them control of their lives we now recognise that the scheme did leave some vulnerable people with too little or scant support compared with what they needed. Moreover, the implementation of policy seems sometimes to have lost sight of the principles driving it; in particular, the duty we have to the vulnerable to provide sanctuary - to offer care in a sheltered environment where that is appropriate for the patient. We need to rediscover that concept of sanctuary and work to distinguish it - in our own minds and in the minds of the public - from concepts like "detention" and "restraint". The goal, for the majority of patients, will be care in the community, but there may be many steps along the way to that goal. But where sanctuary and care is required, a doorway will not do instead. Another point that I should make is that we recognise that the number of mental health beds fell dramatically over our time in Government. Unfortunately, they are still falling. Since 1997 the average daily number of available beds for adults with mental illness has fallen by 3,300. In fact the number of 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, if we were elected, we would do so. As many of you here today will be aware, I am fairly new to the position of Shadow Minister for Health with the responsibility for Mental Health. However, it has become painfully clear that there are several issues which need to be championed. Before I became an MP, my only experience of Mental Health issues was 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, 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. 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. The role of community pharmacists should be expanded to include a service to mental health patients, by dispensing a dose of medication at a particular time each day. This builds on a similar scheme for drug users, and would enable pharmacists to use their knowledge in helping patients receive the most suitable medication. It would also provide an early warning system when medicine was not being taken. The Government has promised extra funding for mental health, but there are concerns that money is simply not getting through. For instance, the £10 million scheduled in 2001/02 for Child and Adolescent Mental Health was diverted to main Health Authority allocations. This is by no means an isolated example. The Government makes these grand announcements of money being made available but those who are working on the front line tell me that they are not seeing any changes. This has got to end. 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 recognising the role of advanced directives in which patients set out their treatment preferences for periods of acute illness. Finally, I would like to touch on the issue of the prison service. The current arrangements do not provide an adequate service for those with mental health needs in prison. It is a troubling thought that anyone who is mentally ill and has a brush with the law could find themselves subject to an often Dickensian system at the beginning of the 21st century. Whether patients are within the criminal justice system or not, it is in everybody's interest to make sure that their mental illness is properly treated, and in the right setting. Before the election, we argued that the NHS, rather than the prison service, should manage the prison health care service. It will be one of my jobs to review the policies we made before the General Election but I can assure you that I still believe the arguments behind this policy are valid. We are all now used to headlines describing our NHS as a third world service or in the words of a French Minister, "medieval". So it is even more concerning that it has long been accepted that mental health is the Cinderella service of this failing service. It is even more concerning when one remembers that, at some time, mental ill-health affects 20% of the adult population and four in every one thousand have a severe mental condition. The only way to change this is to solve our health care funding crisis. Mental health resourcing is a part of the wider equation of the National Health Service. We have recognised explicitly the need for broader resourcing of our health services - of spreading the burden, in order to promote better overall health services - to bring this country closer to the quality of service provision enjoyed by our European neighbours. The Government explicitly rejects that approach and by condemning the British people to the limitation of a Health Service that politicians are willing to fund out of taxation, they are condemning them to a second class service. Only by broadening the base of health service resourcing generally can we expect to be able adequately to finance services such as mental health, which by their nature, have to form part core NHS provision. This is a challenge that we will not shrink and which I believe the British people will increasingly recognise as necessary to provide the services they expect and deserve in 21st Century.