Mentally Ill People

– in the House of Commons am 7:14 pm ar 16 Mawrth 2000.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Kevin Hughes.]

Photo of Mike Wood Mike Wood Llafur, Batley and Spen

I thank you, Mr. Deputy Speaker, for the opportunity to initiate the debate this evening.

Estimates vary about the prevalence of mental health problems in our society, but something of the order of between one in four and one in six adults will suffer from mental illness at some time in their lives; that is illness ranging from so-called mild depression through to schizophrenia. That means that in a constituency such as mine, for instance, between 11,000 and 16,000 people are directly affected by at least one bout of such illnesses during their lifetime.

A recent survey conducted by MIND found that 90 per cent. of respondents had household incomes of less than £10,000 a year. Most people who use mental health services live in poverty, with over 80 per cent. being economically inactive. The Government's own national service framework for mental health states that unemployed people are twice as likely to suffer depression as those who work. It could just as easily have highlighted how much more predisposed they are to self-harm, up to and including taking their own lives. For that group, loss of benefits—and, often, just the threat of that loss—can have disproportionate consequences.

The issues thrown up by such illness and poverty are wide-ranging and profound, and they pose some of the most difficult problems which I and, I suspect, most other right hon. and hon. Members become involved in through constituency casework or surgeries.

In my area of north Kirklees, we are fortunate to have a mental health service that is as good as anywhere in the country's. Last year, for instance, it received from the Prime Minister the first NHS Nye Bevan award for joint working between mental health and social services. However, even here, mistakes occur, and people fall through the net.

In the belief that care is not just about health, but about all aspects of a person's life—including housing, employment and, crucially, income—I want to draw on the experiences of three of my constituents and how they, as mentally ill people, fared in the very specific area of accessing and sustaining a claim for benefits. Those people were entitled to the benefits, just like any other citizen, but were denied them because, I would contend, our benefits system is far too inflexible, and is often inadequate, especially when confronted by the myriad problems that the mentally ill present.

I would like an assurance from my hon. Friend the Minister that the matter is being treated seriously within the Department. I would like also a possible outline of the practical steps that are being taken to improve the kinds of situation that I am about to describe, and I would like to know that the Department is doing this work in liaison with other relevant agencies.

Constituent H is a paranoid man, living alone, who lost his job due to his illness. He quickly became so ill that he could not or would not leave the house, and therefore could not make a claim for benefits. The Benefits Agency was eventually convinced by his family to send a home visitor whom, of course, the man would not admit to his home. Having gone to those lengths, the Department contended that there was nothing more it could do.

In the end, after months of keeping him, the man's extended family could afford to do so no longer and, essentially, had to abduct him from his own home, frogmarch him to the benefit office and guide his hand as he applied for the benefit for which he was so obviously eligible and which he now receives. Surely in such a case—where there was ample medical evidence of the man's condition and its prognosis—it should not have been necessary for the family to have to act in that way to access resources that were needed to care for him.

The second of my constituents, Miss C, suffers from depression. Her benefit was ended owing to a periodic review of the so-called all-work test. She received an initial letter that baldly stated that her benefit was under review, which had a profoundly adverse effect on her already frail mental health. As I said earlier, MIND found that just the threat of loss of benefit does harm, but at one of MIND's day centres close to my constituency some 80 per cent. of the people who attend have had that experience.

Miss C was eventually convinced to undertake the required medical or review. However, like many people suffering from mental illness, she cannot articulate well the problems that her illness poses for her in her daily life. So-called medicals or reviews that exclude carers and that are conducted quickly and brusquely—so quickly and brusquely that the claimants cannot do justice to themselves—would, I am sure, be condemned by the Minister, but they happen, and often to the mentally ill. That exacerbates the fact that the tests are designed more for those suffering a physical illness than a mental one. The answer to the standard questions, "Can you dress yourself? Can you feed yourself?", might well be yes for a mentally ill person, but the person asking the questions would not necessarily understand the amount of supervision that might he needed to get the mentally ill person to eat, or how much motivation might have to be generated to ensure that the person gets dressed.

I realise that the Government intend to replace the all-work test, but whatever comes next must be run by people who have a much greater insight into, and much more training in, the problems of the mentally ill if we are to see the real improvement in service that is needed. I would like to make a bid for the process to be predicated much more on helping people, some of whom have very profound problems, than on cutting corners or saving money.

Sadly, each year in England alone, some 4,000 people commit suicide. My third constituency example is just such a case and shows how mental illness plays a part in many of those—often preventable—deaths. My constituent, Mr. T, died in tragic circumstances and his death and the inquest featured extensively in the local and national media. At this point, I wish to place on record my thanks for the intelligent and sensitive way in which my local papers, not least the Batley News, dealt with those sad and harrowing circumstances. That was of enormous comfort to his family, most of whom now live in New Zealand, who still suffer from the shock of their relative's death and have many unanswered questions about how and why their loved one died in such circumstances. In passing, I realise that it is not the responsibility of the Minister, but their shock was compounded when they were required to pay more than £235 for a transcript of the inquest, which they wanted to learn what lessons had been learned from his death.

Mr. T was an honours graduate in his forties who had suffered from schizophrenia for some years. He was hospitalised late in 1998 under the mental health legislation for reasons of self-harm. He was starving himself, and his weight had dropped from 16 stone to under 10 stone. During his period in hospital, his benefit was stopped and it was either not restarted on discharge or stopped again soon after. Because we have no access to the transcript, we cannot know for sure.

Within a matter of months, the man had starved himself to death with 9p in his pocket. When his body was discovered some weeks later, a scribbled note that lay nearby suggested that he believed that the authorities had killed him. If the hospital had notified the Benefits Agency of his discharge, or if there had been sufficient liaison between the two about the severity of his illness, my constituent would at least have had available to him the cash that was his due. It is stating the obvious to say that care in the community failed that man.

I believe that the policy introduced by the previous Government was developed for the wrong reasons, and then not properly resourced. However, the failings in what is fundamentally the right policy for mentally ill people have to be remedied quickly if more lives are not to be lost so needlessly.

At the inquest, the coroner was appalled by Mr. T's death, and suggested that there should be special DSS rules for those suffering from mental illness. I am sure that all hon. Members would welcome that, but in the meantime it might be possible to encourage relatively minor changes in staff attitudes, and to alter departmental procedures. Both could happen much more quickly, and have some effect.

We certainly need the introduction—perhaps I mean the reintroduction—of much greater discretion for staff in local DSS offices. Ministers in the Department, too, would have to have greater discretion, as too often they seem unable to intervene to right an obvious wrong in individual cases.

Not before time, society is beginning to accept the need for extra provision to improve access for citizens with physical disabilities. At most benefit offices these days, a ramp to the front door is a standard feature, but where are the ramps for people suffering mental illness? That illness is just as debilitating and life-limiting as the more obvious—and possibly more acceptable—physical illness.

Finally, I should like to place on record my thanks to organisations such as the Mental After Care Association. MIND, and my local authority welfare benefits office—especially to that office's first-rate staff members Lisa Drake and Robert Finnegan—for the help that has been extended to me in presenting this debate.

Photo of Angela Eagle Angela Eagle Parliamentary Under-Secretary (Department of Social Security) 7:27, 16 Mawrth 2000

I should like to thank my hon. Friend the Member for Batley and Spen (Mr. Wood) for the opportunity to respond to the very important issues that he has raised this evening. He will know that not all the matters that he raised lie within the remit of my Department, but I shall make sure that I pass on the important observations that he has made.

My hon. Friend referred to three cases in his speech. One was especially tragic as it resulted in a death. I should like to begin by expressing my sorrow at the case and offering my sincere condolences to the family of my hon. Friend's constituent who died. It is clear that his constituent suffered because of a failure by the Department of Social Security and other agencies to provide the support that any of us would expect to be available for a person in the circumstances that my hon. Friend described. It is my intention to see that the necessary steps are taken and the relevant loopholes closed to ensure that that tragic circumstance will not be repeated, and that the lessons will be learned.

I know that my hon. Friend has been corresponding with the chief executive of the Benefits Agency and Her Majesty's coroner about this case. I am pleased that, as a direct result of that tragedy, new procedures have been created and adopted locally. They will shortly be adopted nationally by the Benefits Agency when it deals with people who have a history of mental illness. I will come to those new procedures in a moment.

However, I do not think it appropriate for me to discuss on the Floor of the House the details of an individual's claim for benefit. My hon. Friend raised the matter in a very proper way, and I should be more than happy to talk to him outside the Chamber about the specific people and events mentioned in his speech. In addition, there are some general comments that I can usefully make with regard to the issues raised in the debate.

It goes without saying that those who suffer any form of mental illness require special help when dealing with large, complex organisations—for example, when they want to establish their entitlement to benefit with the DSS. As my hon. Friend has pointed out, it is sometimes difficult to identify those who have a severe mental illness. Such illnesses can fluctuate and it is not always obvious who requires extra help, so I would like to explain some of the measures that the Department has undertaken to address the problems that this vulnerable group faces when claiming benefits.

The DSS and the Benefits Agency recognise that people with mental health problems must be treated sensitively. We are working closely with voluntary groups at a national and local level to address this issue in a practical and effective way. The Department tries to take into account the specific needs of people with mental illness.

Many of the measures that are in place to deal with these people have been developed in conjunction with the mental health lobby and make use of its experience and expertise. As a result of consultations with such organisations, many arrangements are in place to make the claims process easier. For example, people can request assistance from a third party to help complete claim forms for benefit or for support when being visited by Benefits Agency staff. The Department has worked with the Royal College of Psychiatrists and welfare groups on the design of the all-work test questionnaire and the format of the test for people with mental health problems.

Specialist training is given to staff who visit people receiving disability living allowance as part of the periodic inquiry process. The aim of the inquiry is to ensure that all clients are receiving the correct amount of benefit. This can be particularly helpful to those who have a mental illness and, because of their difficulties and the complex nature of our benefits system, may not have explained their complete circumstances when making the original claim. In addition, we have appointed Pauline Thompson from the Disablement Income Group to help us deliver the training for Benefits Agency staff who visit these clients.

We try to identify those with severe mental illness early on in the claims process. Whenever appropriate, we will exempt people with a severe mental illness from having to undergo a medical examination to establish whether benefits are payable.

At a local level, we have developed close links with local authorities, welfare groups and voluntary organisations. These are valuable in helping us to assist many of the vulnerable groups to which we pay benefits. My hon. Friend has referred to cases in which such arrangements do not yet exist or have broken down. Despite this, there are many instances of good local liaison between the DSS or the Benefits Agency and non-governmental organisations, helping people to receive all the benefits and support to which they are entitled.

Photo of Ms Audrey Wise Ms Audrey Wise Llafur, Preston

I am grateful to my hon. Friend the Member for Batley and Spen (Mr. Wood) for initiating the debate. His presentation concentrated on adults with mental health problems. May I draw the Minister's attention to issues relating to children and young people? Most people working in the field worry that problems among children and young people are increasing. Their families can be plunged into poverty because of the extra tasks and problems involved. Has she considered any special problems that might arise in relation to children and adolescents?

Photo of Angela Eagle Angela Eagle Parliamentary Under-Secretary (Department of Social Security)

Obviously, I am prepared to do so and to take on board my hon. Friend's comments. If she has more specific instances that she wants to discuss with me—again, not on the Floor of the House—I will be happy to listen to her and see what lessons can be learned.

As a direct result of the awful circumstances described by my hon. Friend the Member for Batley and Spen, Calderdale and Kirklees district Benefits Agency has adopted some new procedures. It encourages people to seek advice and advocacy support if they receive letters of requests that they do not understand. It has established a close liaison with the social services department. Where Benefits Agency staff know that a social worker has been assigned to a claimant, they are encouraged to keep in contact with that social worker. It has appointed a liaison officer to improve connections between the Benefits Agency and the psychiatric unit at the local hospital. It has instigated a new procedure to ensure that no decision will be made to withdraw benefit without the case being referred to a manager. I am pleased to say that new procedures will be adopted nationally by the Benefits Agency.

My hon. Friend may also be aware of the ONE service that is currently being piloted. All personal advisers involved in ONE have been given disability awareness training, including on mental illness issues, to help them provide an appropriate service to people who come into contact with the ONE service, including those who have particular mental health problems. Many of the key disability organisations, such as MIND and the National Schizophrenic Fellowship, were consulted when the training programme was being developed. Those groups have also helped to draw up guidance for personal advisers.

I believe that many benefit recipients with mental health problems will welcome that new personalised help, which is being piloted in 12 areas. We can create a system that will be less daunting for many people who can find the current system frightening, confusing or a source of anxiety. The personalised service will also be central to the new agency announced earlier today by my right hon. Friend the Prime Minister.

The Department of Social Security provides incapacity benefits to a large number of people with mental health problems. Procedures for doing so have been well developed and are generally regarded as successful. There is no room for complacency, of course. The issues raised by my hon. Friend demonstrate that work remains to be done in dealing with particular difficulties that people with mental illness may present to the DSS and other systems, such as social services departments, local help and health services. We must go further to ensure that people with mental health problems receive the service to which they are entitled. They must not fall into gaps between provision, being handed on from one institution to another with no one taking responsibility.

I believe that we can work to reduce the chances of another tragedy of the sort that befell my hon. Friend's constituent. The Benefits Agency's decision to ensure that the changes made in Calderdale and Kirklees are established nationally will go some way to achieve that end. We shall continue working until we close all the loopholes.

Photo of Andrew MacKinlay Andrew MacKinlay Llafur, Thurrock

On a point of order, Mr. Deputy Speaker. I apologise for troubling the House so late, but I seek your assistance. I was this evening due to receive a battery of replies to written questions on the conduct of the Metropolitan police, the security services and a gun runner to Sierra Leone. The answers were not available for me in the Members' Lobby. I have since discovered that they are available for journalists in the Press Gallery, and that, although I had telephoned the Minister's private office for them, they are in the Library. I have access to them, but the person most entitled to them would have been denied them had I not ferreted around, and, indeed, trespassed in the Press Gallery where I am not supposed to go. Could the matter be looked into? All hon. Members are disadvantaged when Ministers' offices are tardy in this way.

Photo of Alan Haselhurst Alan Haselhurst Deputy Speaker and Chairman of Ways and Means

The hon. Gentleman must know that the Chair cannot control the answering of parliamentary questions. He will be aware, however, that Madam Speaker has made plain her strong view that Members should receive good service, and that it needs to be improved following some recent instances. I am sure that what the hon. Gentleman has said will have been heard by those on the Treasury Bench. We must hope that the matter will be rectified. I am grateful to the hon. Gentleman for drawing it to the attention of the House.

Question put and agreed to.

Adjourned accordingly at twenty-one minutes to Eight o'clock.