COMMUNITY CARE DEBATE – 18 March 1998

Dr Julian Lewis: As a new Member, it has been a privilege for me to hear for the first time the hon. Member for Wakefield (Mr Hinchliffe) speaking on a subject on which he has a fine reputation in all parts of the House. If I understood his argument correctly, he said that we should move more in the direction of community care in the long-term treatment of the elderly, much as we have already done in the long-term treatment of the mentally ill.

As some hon. Members present will know, I was fortunate enough to introduce a Mental Health (Amendment) Bill when I was drawn second in the private Member's Bill ballot. I shall refer briefly to three categories of people who are affected by community care for the mentally ill: people who may kill; people who need what might be termed "a periodic MOT"; and people who need a place of refuge.

With respect to his thoughtful speech, the hon. Member for Oxford, West and Abingdon (Dr Harris) was a little too glib when he attributed to shortage of resources the problem of homicides committed by people released from psychiatric institutions into care in the community. I am sure that he does not mean that generally, because it certainly is not true.

It is a little strange that people are prepared to take chances with the lives of citizens by releasing people into the community, knowing that there is a significant risk that they may harm others – often members of their own families. By contrast, if one applies the same argument to the capital punishment debate, it is often said that one must not risk accidentally executing one innocent person, even if it means that 99 guilty people escape the gallows. That shows a slightly different sense of values.

There seems to be a complacency about taking the risk of releasing potentially lethal people into the community, but none about taking the risk of accidentally executing someone who is innocent. I am sure that the families of those who have been killed by people who were wrongly released into the community would have a lot more to say on that subject.

One must not throw the baby out with the bath water as one moves in the direction of community care for people who need a periodic MOT. There are people who suffer acute suicidal depression which cannot be coped with through care in the community alone. There used to be system, which I understand – I am not an expert in this field – was known as "the revolving doors." The idea was that people would be encouraged to live their lives normally in the community as far as possible; but, when they felt a crisis coming on, there would be an institutional facility available for them – to give them an MOT, to give them a service, to get them back on track. Then, perhaps, they would not require any more in-patient treatment for another three or four years. That process could continue steadily for the rest of their lives. I am concerned that the shift towards community care and away from institutional treatment for people who are mentally ill, creditable though it is in general, has deprived such people of the facilities that they need from time to time to keep themselves on the straight and narrow.

I refer now to the people about whom I was concerned when I introduced my private Member's Bill, which, sadly, was talked out in five and a half hours of precious parliamentary time, perhaps to little avail, on 12 December last year – people who need a place of refuge. It is often said that there are insufficient beds for people who suffer acute psychiatric breakdowns. That is not necessarily the case.

The problem is that, as a result of the mass closure of institutions, such beds that remain are not sufficiently compartmentalised between different people with different mental illnesses. Even where a bed is available in a psychiatric unit for someone who is suffering from an acute psychiatric, potentially suicidal, breakdown, the GP, or other medical officer in charge, will not want to recommend that that person takes it if he or she will thus be placed in an environment with seriously disturbed people, which could only harm rather than help his or her condition.

I hope that the Government will think again about blocking the Bill that has been reintroduced in another place by Lord Rowallan. I am pleased to say that it has been given the Second Reading there that it was denied in this House. I hope that the Government will think ahead a bit more about creating a strategy whereby those who, from time to time, need admission to a psychiatric unit can have a bed there to enhance their condition, not to make it worse.