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Wednesday, July 29, 1998 Published at 10:47 GMT 11:47 UK


Dobson outlines mental health plans

Health Secretary Frank Dobson has outlined for the first time the government's plans for the future of community care in a letter to Professor Graham Thornicroft, chair of the mental health reference group, the government's advisory group on mental health

This is the full text of the letter:

With the External Reference Group meeting for the first time tomorrow, I thought it would be helpful to you and your colleagues for me to emphasise the importance which the government attaches to mental health and to outline our mental health policy.

For a start, we recognise the huge number of people who from time to time suffer from one of the many forms of mental illness, the severity of its effects on individuals, their families and carers and the problems posed by the stigma which is often still associated with mental ill health.

People who are mentally ill, their carers and the professional staff responsible for their welfare have suffered from ineffective practices, an outdated legal framework and lack of resources. The present government is determined to improve all these aspects to bring about a dramatic change for the better in the treatment and care of all those who are mentally ill.

Care in the community has failed. Discharging people from institutions has brought benefits to some. But it has left many vulnerable patients to try to cope on their own. Others have been left to become a danger to themselves and a nuisance to others. Too many confused and sick people have been left wandering the streets and sleeping rough. A small but significant minority have become a danger to the public as well as themselves.

In place of this, I want to see a system in which both patients and public are safe and sound - a system which provides both security and support to all who need it. This cannot be achieved by going back to locking up mentally ill patients in long-stay institutions so they are out of sight and out of mind. That was harsh and harmful. But the present system which can leave people with problems off the books is letting down both patients and the public.

What we propose is a third way. This will involve a much better support for patients and carers, including: a 24-hour crisis helpline; 24-hour crisis teams to respond to emergency needs; more acute mental health beds; more hostels and support accommodation; home treatment teams; improved mental health training for GPs and others in primary care; extra counselling services in health centres; clear and authoritative guidance from the National Institute for Clinical Excellence on the most effective drugs and therapies; and a new National Service Framework for mental health covering both health and social care providing guidance on the level and balance of services needed in each locality.

Matching this support will be greater security for patients and public. This will include: specialist secure units in each NHS region; accommodation in every locality to provide short-term round-the-clock nursing care and supervision; assertive outreach teams to keep tabs on people who have been discharged and make contact with people who shy away from getting help; and changes in the law to enable carers and professionals to respond promptly and effectively to the needs of mentally ill patients.

This latter aspect will be the outcome of a review of the Mental Health Act which I am setting up. As you know, the law on mental health is based on the needs and therapies of a bygone age. Its revision in 1983 merely tinkered with the problem. What I want now is a root and branch review to reflect the opportunities and limits of modern therapies and drugs. It will cover such possible measures as compliance orders and community treatment orders to provide a prompt and effective legal basis to ensure that patients get supervised care if they do not take their medication or if their condition deteriorates.

So the changes in practice we are seeking will be backed up by changes in the law. They will be helped by extra funds for mental health which form part of the Comprehensive Spending Review settlement for the NHS and local authority social services. Extra funds will be available for modernisation of services. These will need to be both clinically and cost effective and targeted on evidence-based outcomes.

I hope this outline of our plans will prove useful to you and the others who have agreed to serve on the External Reference Group charged with developing the National Service Framework. Your task will be to take the components of this approach and using the latest available evidence establish what should be the appropriate balance of services in each locality and what range of specialist services should be provided at a regional level to support those local services. Your recommendations should take account of the different needs of rural and urban communities as services may need to be shaped differently for each.

I also hope that our decision to give the same priority to the development of the mental health National Service Framework as we have to heart disease will show how seriously we take the need to transform the present inadequate arrangements for the treatment and care of people suffering from mental illness.

Frank Dobson

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