MENTAL HEALTH: CARE OF THE YOUNG

§ LORD AMULREE

My Lords, I am pleased that the noble Lord, Lord Grenfell, has put down this Motion on the Order Paper to-day. I do not propose to follow him entirely in regard to the training and teaching of the mentally handicapped child. I should like to begin by going one step further, and to come to the training of the young mentally ill person for some kind of trade or industry, because I think that at the present time, with modern industrial development, there is far more possibility than hitherto of bringing the psychologically handicapped person into the normal run of the world. This would not only be of benefit to the patient or the person himself, but also to the benefit of the community and of industry.

There are one or two particular types of mental disease which are peculiarly suitable for training at the present time. With the growing mechanisation and simplification of some parts of industry, there are now coming into being a large number of what one might call purely stereotyped jobs which the mentally normal worker may find rather difficult to do, because of the strain of doing this stereotyped work, but which some of those suffering from forms of mental disease, in particular those suffering from various forms of schizophrenia, as it is called, can do extremely well. That, I think, is partly because there has been a great deal of improvement in the treatment of these patients in hospital, so that many of their more trying signs and symptoms can be coped with. Indeed, it looks as though there is a great deal of evidence coming along now that much of these trying signs and symptoms have been due to the fact that the patient was taken away and locked up.

127 So one would like to see more of what I think has already started, certainly in one or two hospitals in this country and in some foreign countries, particularly I think in Denmark. I have in mind schemes under which workshops are attached to mental hospitals, where there can be trained staff, rather on the lines suggested by the noble Lord, Lord Grenfell, to supervise the training of the mentally sick people, and where there would be no earnings rule imposed upon them, so that, provided the work which was turned out was reasonably good and up to standard, they would get the rate for the job in the ordinary way. Supposing one were to get that occurring, there is no reason why the patients should not have their money to spend. In this way they could be encouraged, particularly the younger ones, to spend money on clothes, cameras, bicycles, and so on; and this would tend to bring them more and more into a normal kind of world, rather than leave them in the difficult world in which, up to the present time, they have been kept.

If we are going to do this kind of work on any scale, there will have to be a greater amount of liaison, co-operation and integration between the work of the local authorities, should the patient be discharged from one of these hospitals. There would be no reason at all, if the patient was a satisfactory worker, why he should not have a start. But there must be a great deal of linking between the local authority and the Regional Hospital Board or the management committee—the hospital authority in general. One has found in the past that there has been some difficulty in regard to handing over records and notes from one side to the other. I think that is one thing that we have to break down in order to obtain a perfect sense of co-operation and freedom between the two.

§ LORD TAYLOR

My Lords, before the noble Lord leaves that subject, is he aware of what has been done at Richard Thomas and Baldwin's factory at Scunthorpe, where mentally handicapped people are operating blast furnaces successfully? It is a most magnificent piece of work.

§ LORD AMULREE

That is exactly the kind of thing one wants to see going on 128 more and more throughout the country. I am grateful to the noble Lord for drawing attention to that particular example, for I am sure that if such work can be carried out in one place it can be repeated in a great many more. The fact that that example has been mentioned by the noble Lord, Lord Taylor, should encourage more people to go in for the same kind of thing.

I should like to take advantage of the general terms of Lord Grenfell's Motion and say a few words about elderly people and their problems because, from the Ministry point of view, they are similar to the younger people to whom the noble Lord's Motion specifically refers. I do not think I shall stray too far from the terms of the Motion, and I trust that your Lordships will give me your indulgence to say a few words on this subject.

The passing of the Mental Health Act 1959 made an enormous change in the position of all the age groups coming under its ambit, because the doors of the mental hospitals were at last opened. These hospitals were no longer places to which one sent people, particularly the elderly suffering from degrees of senility or senile dementia, so that they could be locked up and put away. In those days, if one found a thing that one did not like, one shut it up and put it away and then forgot all about it. The same thing happened with mentally defective children and mentally decayed old folk.

These big hospitals, however, are extremely unsuitable for patients of all kinds, whether young, middle-aged or old. Generally, they are not in the centres of population, but are kept some distance away; and although the patients, whether children or the old, receive a certain amount of care and attention, they are more or less cut off from their families, and from their friends and visitors. In this sphere it is extremely important, both for the young and for the old, that contacts with home life should be kept up. They provide one of the few links which the old have with the world, and if the link is broken it leads, in many cases, to a rapid rate of deterioration which probably need not have occurred. The same consideration applies to young people. Therefore, I consider that patients, old or young, should not go into mental hospitals unless they have some kind of disease for which treatment is possible. 129 In the case of the elderly, they should not go to mental hospitals unless they suffer from some depressive condition for which mental treatment is possible and desirable, or from some kind of persecution feeling, which again is not uncommon, and for which some kind of treatment is possible. In short, I believe that nobody should go into a mental hospital at present unless he has a disease which requires proper, skilled treatment.

If this does occur, there needs to be a very close working ararngement and co-operation between the physician in charge of the geriatric department—and this would apply to pædiatric wards and to normal adult wards—and the physician in charge of the psychiatric department. One wants to bring these two branches of the profession as closely together as possible, rather than keep them apart as separate entities. Indeed, some authorities in the geriatric field think there is value in creating special psycho-geriatric departments for patients. I am not at all sure that that is necessary. It may be necessary in some cases, but it seems to me that it is a way of coining a new word, making something new out of something which is not necessarily so—a not uncommon trait, I am afraid, in my profession. I think the noble Lord, Lord Taylor, will agree that we rather like to make up new words from time to time.

Those are some of the points I should like to bring out. They have a bearing on mentally sick patients, whether they be young or old. There is one point I would mention in relation to treatment. If one is going to have wards in general hospitals where mentally deranged or mentally disturbed patients are going to be taken into care, then it is of great advantage if some of the nursing staff have received special training in the care of people suffering from mental diseases. They will not be so surprised and perplexed by the curious things which mentally deranged patients can do. I should like to see people being moved from the mental hospitals, and the mental hospitals gradually being run down and made part of the general hospitals, providing that there is a sufficent number of nursing staff trained in this work to look after them.

The local authorities have a very big part to play in the care of mentally sick 130 people, both young and old. The old get transferred or placed in a variety of accommodation, some of which in some authorities can be extremely good and in other authorities, as in the case of children's accommodation, it can be extremely bad. When one visits institutions of this type one sees that they were built in the old days of the Poor Law, probably at the end of the 19th century. The authorities have done a great deal to improve them and make them more comfortable, but all their efforts cannot make them up to date. Therefore, one would like to see some change in this direction as soon as possible. One point which has always struck me when dealing with elderly, senile types is that it is extremely important that local authorities should arrange for them to be given some simple physiotherapy and simple occupational therapy. There was one place in which I was involved where we managed to provide physiotherapy, but it was merely because somebody came along and did it on a voluntary basis in their spare time. The effect was quite startling. One would like to see forms of treatment for these patients, just as for mentally handicapped children.

There is, after all, a great deal in common between the care of mentally handicapped children and the care of mentally handicapped elderly. The only difference is that the elderly have not so long to live, whereas the children have a long time to live and therefore need more special care taken of them. The greatest improvement can be achieved by a far closer co-operation than there has been in the past between physicians in charge of psychiatric departments and physicians in charge of general departments, and with the officers of the local authorities whose job it is to care for these people when they go back to the community. Therefore, I would support the noble Lord in what he has said, although I approach the matter from a rather different point of view.

§ LORD NEWTON

My Lords, the noble Lord, Lord Amulree, and I are old comrades in debates of this kind. I would join with him in thanking my noble friend Lord Grenfell for moving 131 his Motion and giving us the opportunity to have this debate this afternoon. I should also like to express my admiration for the tremendous wealth of detail in my noble friend's speech. He has made a very large number of suggestions, some large and some small, but all of which, I think, are seriously deserving of consideration. I certainly cannot comment on all of them, but I shall, of course, try in my speech to make some observations about some of them.

It is exactly four years and one week since your Lordships' House last debated the working of the Mental Health Act, then at the initiative of the late Lord Feversham. Some of us who took part on that occasion have been speaking, or will be speaking, this afternoon, but I fancy that all of us will be conscious that we miss Lord Feversham's exceptional knowledge and humane approach to these matters. Although the 1959 Mental Health Act clarified and slightly extended the powers of the local authorities, it is principally concerned with the procedures for detention and compulsory admission to hospitals. During this last week-end I re-read the 1962 debate, and I found that, on the whole, with the exception of the noble Baroness, Lady Wootton of Abinger, and myself, those who spoke concentrated on standards of provision, care, education and training of the mentally disordered. Admittedly, at that time the Act had been in operation for only a very short time, just a matter of months, but, on the whole, all those who commented on it seemed to think that in practice it was a good Act. That was certainly my view then, as it still is to-day, and I do not have any suggestions to make for amending the Act. But I shall be interested to hear whether any other noble Lords and Ladies who speak this afternoon have any.

In the course of the 1962 debate some fears were expressed about the increase since the inception of the Act in the number of readmissions to psychiatric hospitals. But I think this increase was largely due to new ideas about medical treatment and there was no reason to suspect something sinister such as encouragement by the Act of superficial assessment of patients or of inadequate treatment. Since then, of course, the 132 number of re-admissions to hospital has gone on growing every year. There were something like 80,000, I think, in 1964as against about 56,000 in 1960. That is a pretty sharp rate of increase, but I do not myself think that it is sufficient to give cause for alarm. It may be that the noble Lord, Lord Champion, will wish to say something about this in his speech. If he does not, we probably can take it that he agrees with me that there is no cause for alarm.

I am sorry that we are not going to be treated to the benefit of the wisdom of the noble Baroness, Lady Wootton of Abinger, this afternoon. I mentioned this to her before this debate, because in the 1962 debate she made some very penetrating observations about the tendency—which I think she considered to be a regrettable tendency—on the part of both public opinion and the law to widen the concept of mental disorder. Particularly she suggested that, although very few psychopaths compulsorily detained under Part IV of the Act had been kept in hospital for more than a very short time, nevertheless it might be safer and wiser if all diagnosed psychopaths were dealt with under Part V of the Act instead of Part IV, and so came before the courts of law.

I did not give the noble Lord, Lord Champion, any notice that I was going to talk about this subject, and I do not expect him to be able to give me an answer this afternoon. But I think it would be very interesting if we were able to know how many diagnosed psycopaths, compulsorily admitted to hospital under Part IV, have, since the inception of the Act, been detained for more than six months, and how many for less than six months. The point of that is that one does not want eccentric people to be compulsorily admitted to hospital just because they are eccentric and nothing else, any more than one wants the plain "bad hats" to escape the due processes of law by being compulsorily admitted to hospital as psychopaths under Part IV of the Act.

May I come on now to the question of hospital provision for the mentally disordered? In May of this year the Minister of Health presented to Parliament Command Paper 3000, which is a Blue Book containing a revision of The Hospital Plan for England and Wales 133 which was first published in January, 1962, and which I had the pleasure of introducing to your Lordships in a debate in this House on February 14, 1962. We were originally promised this revision before the end of last year, and we have waited for it a long time. There is a lot that I could say about it, and may do one day, but this afternoon, obviously, I must confine myself to the bearing which it has upon mental health.

There are two points about it which I welcome without reservation. The first is that it is still the intention to base the Hospital Service of the future on a network of district general hospitals which will include units for active psychiatric and geriatric treatment. This seems to me a good thing, not only because it will help to end the invidious distinction between mental and physical illness, and encourage the recognition that both types of illness are equally susceptible to appropriate treatment, but also because eventually it will—if I may put it like this—speed up the running down of the largest old-fashioned mental hospitals, about which the noble Lord, Lord Amulree, just spoke and whose views on this matter I very much share.

Secondly, I am very glad (I have discovered this from reading this Blue Book) that the Minister considers that there is no reason, at any rate at the moment, to doubt that the need for mental illness beds will fall to 1.8 per thousand of population by about 1975. This forecast, which was based on a statistical exercise, was embodied in the 1962 Hospital Plan and it came in for quite a lot of criticism. Some people said that it was just a bit of financial cheeseparing by a mean Government. Others said that, even if it were an accurate forecast, it ought not to have been announced because it was likely to be bad for the morale of those who worked in mental hospitals. For my part, I am glad that the forecast still stands, because it is yet another guarantee of the eventual redundancy and disuse of our old and very large mental hospitals

It is very easy to wax eloquently indignant—and many professional writers on the subject do—about these old institutions: the sweetly cloying smell, the starkness, the overcrowding, the atmosphere redolent of outmoded ideas and so on. Fortunately, these institutions 134 which we call mental hospitals are devotedly served by high-minded, though often frustrated, people—and nobody can be happy about them. But they do present a formidably expensive problem, and it is no good pretending otherwise. That is one reason why I am saddened by the revised Hospital Plan.

May I consider some of the things in it? It says: The expectations of the original Plan could not possibly have been fulfilled. My Lords, I do not accept that. What I am prepared to accept is that the expectations of the original Plan cannot now possibly be fulfilled, which is a very different matter. The Blue Book also says: A somewhat greater provision of resources over the coming years has been assumed in revising the programme than in the original Hospital Plan"— and my noble friend Lord Grenfell, I think it was, referred to that. My Lords, that is so, but I do not for a moment think that this greater provision of resources is sufficient to make up for the decline in the purchasing power of the pound that has taken place in the last four years or for the decline in the purchasing power of the pound which is likely to take place in the years to come.

The Blue Book says that it may be misleading to set starting dates for building projects, and it does not set them. I personally would much rather set starting dates and miss them than not set them at all, for this reason, if for no other: that the publication of starting dates is an extremely good stick with which to beat the Treasury when the time comes for those starting dates to be implemented; and, again, published starting dates are a splendid spur to the planning staff—the architects, and so on—of the Regional Hospital Boards to get on with their work. Again—and this is the last quotation I want to make—the Blue Book says: It would hardly be appropriate to publish in this paper, and thus give an illusory permanence to, the detailed programmes as they now stand". What do those words mean? What they mean to me is that the Hospital Plan of 1962 has in 1966 been turned into a non-plan, into a pious hope by the political Party which has always believed in the importance of detailed planning. I 135 do not blame the Minister of Health for this. The trouble is that the economic condition of the country is such that he is not allowed to enter into firm commitments at all.

§ LORD TAYLOR

My Lords, the noble Lord, Lord Newton, has based his case on an attack on the large mental hospitals. I think that is very unfair and very wrong, because in fact a great number of these large mental hospitals are extremely good institutions, first-class institutions; and I would say, as a generalisation, that any mental hospital in this country, any psychiatric hospital, with less than 1,000 beds will be found quite first-class, without rival throughout the world. It is the 2,000-bedders which are so awful, and they are the ones we aught to be tackling.

§ LORD NEWTON

My Lords, it was the very large ones about which I was talking. I think there are too many of them. I do know quite a lot about them, and I ask the noble Lord to accept that I entirely agree that a lot of them are very well run; but I do not take back the general criticisms which I made earlier about those larger hospitals.

May I now leave the hospital side of the picture and come on to the community care of the mentally disordered? This is a phrase which a year ago the noble Lord, Lord Amulree, told us he did not like. It certainly is not an elegant phrase, I agree, but it is difficult to think of anything better with which to describe all the health and welfare services, both statutory and voluntary, which are available outside the hospitals. That was why that phrase was used in the title of the Blue Book published in 1963 which contained the long-term plans of the local health and welfare authorities. I noticed with some interest that in the title of the revised version of this Blue Book (Command Paper 3022), which was presented to Parliament only last month by the present Minister of Health, the same phrase is used. As I was one of the authors of the introductory chapters of the 1963 Blue Book, I have studied the revised version of June, 1966, with considerable interest and with some despondency.

The original purpose of the 1963 Blue Book was twofold: first, to enable com- 136 parisons to be made between the long-term plans of the individual authorities; and, secondly, to enable the Minister to comment upon the standards of provision envisaged not only by individual authorities but also by all the authorities as a whole. Now when one looks at the revised version (I hope the right reverend Prelates will not mind my talking about the "revised version" of this Blue Book) it is apparent that, although staff numbers have been improving in the last few years, in almost every case, and notably in the case of health visitors, mental health social workers and teachers in training centres, the targets have not been hit. This is a serious matter, but I do not propose to abuse the Government about it this afternoon, because I know well enough—too well, in fact—the problems of manpower in all spheres of the National Health Service.

On the other hand, I well recall the abuse that descended upon my head in the series of debates which we used to have in your Lordships' House about different manpower aspects of the National Health Service. The noble Baroness, Lady Summerskill, the noble Earl, Lord Longford, and the noble Lords, Lord Stonham and Lord Taylor, used to take it in turns to berate me about this particular shortage or that particular shortage. Sometimes they would all set about it together; and sometimes, for good measure, the noble Lord, Lord Amulree, would join in, too. I confess to your Lordships that I was sorely tempted to re-read those debates and to select some appropriate passages and epithets to hurl back this afternoon at the noble Lord, Lord Champion.

§ LORD CHAMPION

I never said anything.

§ LORD NEWTON

No—and the trouble is that the noble Lord, Lord Champion, is just about the last person in the world at whom I should wish to hurl anything, let alone the past words of his noble friends. However, my Lords, if later speakers in this debate choose to take the Government to task about staffing shortages, that will be quite all right with me.

But even more serious than the staffing situation in the local authority field is the clear warning—and the language of the warning in the Blue Book is very strong indeed for a Government publication— 137 that some local health and welfare authorities are not setting their sights anything like high enough, in the numbers, both of staff and of buildings, which they are planning to provide for the care of the mentally disordered. This point was extremely well emphasised, I thought, by my noble friend Lord Grenfell. He gave some interesting instances of this, and I could give more, but I think that both of us have by now said enough between us to bring this matter home. In a moment I want to come back again to this point, but before I do so there are just two other matters on which I should like to touch briefly.

The first is that I should like to pursue the suggestion of my noble friend, Lord Grenfell, about the need of counselling services for the parents of young, severely subnormal children. I do not see why these services should not be provided in ordinary children's welfare clinics or, if the clinics are not big enough, even in training centres. I recall seeing a session going on in a clinic in which there were a number of mothers of severely subnormal children and their children, and while the children were playing together the mothers, if they wished, were able to have private discussions with the medical officer in charge, who was fully qualified to give advice. The mothers also had the opportunity to give each other counsel, to talk about their own experiences, their own successes and failures. The doctor told me afterwards that these sessions were becoming a great success. I cannot see why the same sort of sessions should not take place all over the country. I hope that possibly there may have been some developments along those lines in recent years.

The other matter I should like to touch on is the vexed question of whether the time has come when severely subnormal children (that is to say, those trained in training centres) ought now to be trained in some sort of E.S.N. school, run by the local education authority rather than by the local health authority. I used to think, and say, that it did not very much matter where the training took place or who provided it, so long as the training was good and so long as the teachers were good. But one cannot ignore the fact that there is a growing body of informed opinion that the time has now come to make the change. I do not know whether 138 the noble Lord, Lord Champion, would wish to say anything about the Government's thinking on this subject. I have not warned him that I was going to raise this point. My mind is still open on the question. The only thing that really matters, I think, is that what is best for the children should be done, and not what is best for the feelings and susceptibilities of their parents.

Finally, my Lords, I should like to offer two suggestions, which I hope are practical and comparatively easy suggestions, for helping to eliminate quality variation in the standards of local health and welfare authority provision for the mentally disordered. According to the Blue Book (Command 3022) the Minister is proposing that his officials should have discussions with the laggard authorities. That is probably as good a way as any of trying to deal with quantitative efficiencies—that is to say, of trying to improve those situations in which an authority is obviously not planning to have in the future enough staff or buildings. But what about the qualitative variations in the standards of provision as between authority and authority which, as we all know, exist?

My two suggestions are first that there should be set up a small mental health inspectorate on the lines of the inspectorate of schools. It could be quite small and therefore it would not have to be expensive. I think that that would contribute a great deal: that such men and women could do a great deal to iron out disparities in standards of provision. The second suggestion is that there should be another Parliamentary Secretary in the Ministry who is a Member of this House, who would concentrate on travelling round the country visiting hospitals and local authority establishments, and who would have the freedom to do so. In my opinion it is absolutely essential that when you have an enormous, centrally-run organisation like the Ministry of Health, which spends a tremendous amount of the taxpayers' money, the Ministers responsible should be able to get out and about and see what is going on on the ground. I am sure that the present Minister, Mr. Robinson, and his Parliamentary Secretary travel as much as they can; but it is only in the nature of things that two Ministers, both of whom are Members of the other place, 139 cannot possibly do as much travelling and visiting as could three Ministers, one of whom is a Member of this House and who, therefore, enjoys much more freedom from the daily turmoil of Parliamentary activity.

When I was one of the Parliamentary Secretaries I did a great deal of visiting. It does not take long to learn to judge differences in quality of provision. If necessary one can have a quiet word in the ear of the chairman of the responsible committee, or even, perhaps, in the ear of the chairman of the council. That is something far easier for a Minister than for a civil servant, because the officials concerned normally deal with the medical officer of health. There are at the present time seven Ministers at the Foreign Office, five in the Home Office, the Board of Trade and the Department of Education and Science, and four in the Ministry of Housing. In the Ministry of Health there are just two. I think that something could and should be done about that.

I do not expect that the noble Lord, Lord Champion, will wish to say anything about either of these two suggestions, but I commend them to Her Majesty's Government as serious and practical suggestions which, if implemented, might make for a considerable improvement in the working of the Mental Health Act, which is something that all of us, wherever we sit in this House, want to see.

§ BARONESS HYLTON-FOSTER

My Lords, as is customary on these occasions, I ask for your indulgence. Over the years I have been fortunate enough to have considerable experience in listening, but to-day I have got my "L" plates up, and I am conscious of it. I am very grateful to the noble Lord, Lord Grenfell, for allowing me to bring to your Lordships' attention this afternoon the place of voluntary work in the mental health service, With the introduction of the National Health Service Act in 1946 it was thought by some that it covered everything and that there would be no place for the voluntary worker. But it soon became plain that this was not so because, as your Lordships may remember, the hospitals started forming their leagues 140 of friends to provide for the patients amenities which were not covered by the National Health Service. We then had, thirteen years later, and have now, a Mental Health Act. I have read the Act carefully and I cannot find in it any real mention of the place of the voluntary worker yet to-day I think it is recognised that, without the help of these voluntary services, much of the mental health service could not continue. I must now declare my interest, again as is customary: I have all my life been connected with voluntary work of one kind or another and, of course, in particular with that of the British Red Cross Society.

My Lords, mental health concerns us all. We all have it; it is either good or bad and, with the stresses and strains and speed of modern life, the bad seems to have increased. Therefore I think it very important that it should be talked about openly as is any other form of illness; and this is what the noble Lord, Lord Newton, has just been saying. What is the best way of setting about securing mental health? Surely, by educating people about it and helping them to be less frightened about it. That is where voluntary societies come in; and, with your Lordships' permission, I should like to give just a few examples of what they are doing.

All over the country voluntary societies are working with, and under, the local medical officer of health's department in various ways, such as in mental health education campaigns; visiting families who have had a pateint discharged from hospital to see how they are getting on and what supplementary services are needed; setting up clubs for the mentally sick to help them to return to normal life later; running weekly créches for mentally subnormal children. This relieves parents and gives them an opportunity to do their shopping or to do other jobs, while at the créche, through skilled play therapy, the children are taught so far as possible to deal with matters of their own toilet and feeding, and things like that.

Escorts are provided for adults, and also mentally retarded children to child guidance clinics. Beauty therapy inside the mental hospitals is provided in order to restore the self-confidence of women patients, and the London Association of 141 the National Association of Special Education has asked for help in activities for mentally handicapped children. My Lords, may I just add about this that the aim and object of these activities is to try to give children something to do, so that they may feel they are contributing and are not all their lives on the receiving end. These are just a few examples of what the voluntary societies can do and are doing.

Much more help could be given if there were more volunteers, and surely with the coming of the shorter working week and increased leisure this is the moment for Her Majesty's Government to give a lead and encourage people to come forward to offer their services. But. my Lords, alas, far from giving a lead we get the selective employment tax. I welcome the fact that this tax is to be refunded; nevertheless, it still has to be collected and the money loaned free of interest to Her Majesty's Government. Voluntary societies are saving the taxpayer a great deal of money by providing many free services, and it is really most disappointing that this was forgotten and that their work was not recognised from the start by making it plain that this tax did not apply to them. That is why I felt it necessary to try to draw the attention of your Lordships to-day to the place of voluntary work in modern society.

§ LORD BRAIN

My Lords, it is my privilege to be the first to congratulate the noble Baroness, Lady Hylton-Foster, on her maiden speech—a speech of such warm humanity—to which we have just listened. I am sure we all look forward to hearing her on many future occasions. I should like also to thank the noble Lord, Lord Grenfell, for having brought forward this Motion. I am particularly interested, as I was a member of the Royal Commission which laid the foundation for the Mental Health Act. The noble Lord, Lord Grenfell, has given us a very comprehensive review of the whole subject, and I propose to deal only with some particular instances.

A great deal has been said already by noble Lords about the need for more activity on the part of local authorities in the foundation of community hostels to enable the mentally subnormal to go out into the community. Noble Lords may have seen only last Sunday the figures 142 published in a letter in the Observer by the statistical information officer of the National Society for the Mentally Handicapped, in which he quoted the Minister of Health as saying that in eight years' time there would be 2,000 places in community hostels. Today there are 700 places. The letter went on to point out that there are now 30,000 children in hospital with a waiting list of 4,000, and clearly, a proportion of those will be suitable for training in such community hostels. One might point out also that we have an expanding population, so that inevitably these figures will increase.

One must draw the conclusion that not only are the present facilities inadequate but the plans for the necessary expansion of future facilities appear to be also inadequate. What this means in terms of human happiness will be clear to those who have had the privilege of seeing what can happen to these subnormal people when they go out and are trained, and find a job which they can do and realise that there is a place for them in the community. I think those who have seen such people before and after this will have been astonished that such a change has been possible.

I should like to say a little about the need for better education for those already in hospitals. This point has been touched on by noble Lords, particularly by the noble Lord, Lord Amulree. There are units in existence, about which I shall say something in a moment, for short-term training, but there is a comparative neglect of long-term education of patients in mental hospitals. As has already been said, there are a number of patients with schizophrenia who are capable of benefiting from education. There are brain-damaged, epileptic children who also could profit from some education and training. I believe it is the local education authority which has the power and the duty to provide this education for those needing a long-term stay in a mental hospital; and here again I believe that there is great need for developing this service. It is an expensive service—special training is needed for the teachers—but it contributes substantially to human happiness.

The short-term units are developing, but perhaps not quite quickly enough. 143 They were the subject of a recommendation to hospital authorities by the Ministry of Health in a Memorandum in 1964. They are designed to provide for a wide variety of children. Some are mildly mentally subnormal. Others have normal intelligence but experience emotional difficulties. Some are mentally ill but are still able to receive educational training.

My Lords, such units, I believe, need to be especially built. It is not enough to try to make do by adapting some existing buildings. Such converted buildings severely limit the possibility of what can be achieved. The practical problems of the management of these difficult children call for specially designed buildings. Moreover, the work is extremely exacting, especially for the teachers and the nursing staff concerned, and they cannot be expected to undertake this work and remain at it if they have to struggle with bad physical conditions as well as with the natural problems involved in the work.

Then there is the rather small but very difficult problem of the intractable delinquent adolescent—a small minority but a considerable problem; and again there is no adequate provision for these. If two or three happen to get into an approved school it can call for a disproportionate amount of work from the staff and provide a very disruptive influence. The natural tendency is to call upon a psychiatrist. Unless there is evidence of mental illness or some disorder like epilepsy or some physical disease of the nervous system, there is little that a psychiatrist can do. There are a number of psychiatrists who feel that once a diagnosis has been made and serious illness excluded, these people constitute a social rather than a medical problem. I am not going now into the question of by what means they should be sent to an institution, but there is, certainly among psychiatrists, a feeling, first, that there is not enough provision for this difficult problem, and, secondly, that residential accommodation is required, and that there is a case for putting it under the Home Office rather than under the Ministry of Health.

Lastly, I must say a little about nursing. I should like to echo what the noble Lord, Lord Grenfell, said about 144 the magnificent work done by those who nurse the mentally subnormal. I have known many of these devoted people. But one has to remember that it is increasingly hard nowadays to get staff for such hospitals and such patients. It is an odd and unexpected side effect of exiling policy that if you provide hostels and get back into the community the high-grade subnormals, who otherwise create a worse problem in your hospitals, so that hospitals are left with a larger proportion of the heavier cases, the lower-grade subnormals, there is less variety in the nursing and a heavier task for the nurses and doctors. This, however, clearly has to be faced.

I will not say much about conditions in the older mental hospitals, because the point has already been made. I would, however, emphasise the fact that we have to take into account the conditions in which the nurses work. The better the conditions, the more likely we are to get and retain nurses. At present we depend in these hospitals to a large extent upon nurses from overseas. We value their help very much, but we should clearly like to see far more of our own nurses going into this particular form of work. I should like to urge the need for better residential accommodation for nurses, particularly married nurses. They have to work, as the noble Lord, Lord Amulree, has said, in difficult conditions, sometimes away from major centres; and, therefore, all possible facilities, residential and otherwise, which can be provided should be provided and need to be provided if we are to maintain and retain the services of these nurses who have done such good work in the past and are doing it still.

§ THE LORD BISHOP OF COVENTRY

My Lords, I am glad that two Lords Spiritual are taking part in this debate, because the Church has always been deeply concerned about the maladjusted minority of our community, and must always continue to be thus concerned. We live at a time when it appears to be rather an amusing hobby to make it appear that the nation is going downhill rapidly and that our problems and failures are far more numerous than our successes and achievements. I believe this to be not only untrue but psychologically dangerous. Nowhere is this less true than 145 in the field of the care for mental sub-normality, where there has been a quite remarkable advance in effective treatment of this problem during the past ten years.

Of course, we know that mental sub-normality is a major problem. Indeed, it has been estimated that one in every 100 persons in this country is mentally subnormal. But things have changed for the better in almost every single aspect of this problem. Advances have been made in research, in the training of qualified teachers, in the training of mentally subnormal children to take their full part in public life, and, not least, indeed almost most important, in the attitude of the public and of parents towards this tragic mental condition. In the four years from 1959 to 1963 the number of subnormal children and adults receiving training increased by just over 45 per cent.; and that number has gone up steadily since then. Current expenditure by local authorities on their mental health services rose during those years from less than£4 million to over£9,750,000, an increase of over 100 per cent.

Of course, we know that this increase is not universal, and the noble Lord, Lord Grenfell, has quite rightly called our attention to the wide disparity in the handling of this problem by different authorities. I am one of those who would strongly underline his plea that the Government should make a survey as soon as possible to ensure that every local authority is helped to be raised to at least a minimum standard below which they ought to be ashamed to go: because, alas! as has been pointed out by the noble Lord, there are authorities that are not doing nearly enough in this respect. Nevertheless, the fact remains that there has been, on the whole, a major advance during the past decade.

First, as I said earlier, there has been a remarkable advance in research. When the Mental Health Research Fund was founded, a little over a decade ago, the total money spent on mental health research was probably not more than£50,000 per year: the current psychiatric budget of the Medical Research Council is over£500,000. But, even so, it is necessary to get things into proportion. One Polaris submarine would finance all the research that has ever been done in this country or is likely to be done over 146 the next decade. Nevertheless, despite the comparatively small amount of money raised for mental research, compared, shall I say, with the equally vitally important area of cancer research (none of us would want to see that lessened but all of us would want to see the other raised), there have been some remarkable successes, and diagnosis at birth of children suffering from certain serious diseases has led to complete cure. Even in the tragic field of Mongol children, through right diagnosis, the story has been one of partial success. It should not be forgotten that these advances alone would justify the amount of money spent in this all-important field of research into mental subnormality, and it should challenge the country to set aside a still higher proportion of its budget for this vitally important work.

Secondly, there has been considerable advance in the training of staff. The National Association for Mental Health has made an immense contribution to the pioneering training of teachers of the mentally subnormal. It is estimated that there are about seventeen courses for psychiatric social workers. There are possibilities of new types of courses in colleges of advanced technology; and I am led to understand that some of the new universities are interested in planning courses for psychiatric social workers. All of this, of course, is only the beginning of the beginning, but there are large numbers of people employed in teaching the mentally handicapped who have not had the opportunity to take a formal training. No praise can be too high for these people. I am very glad that the noble Baroness, Lady Hylton-Foster, who made her admirable maiden speech to-day, drew our attention to the important work that continues to be done by voluntary workers in this as in so many other fields.

Thirdly, there has been a marked advance in the adaptation of these mentally sub-normal children to the public life of the country. Ten years ago a high proportion of these mentally subnormal children were allowed to languish for long periods of time, and sometimes for life, in a hospital. To-day this situation is changing, and quite a high percentage, as we have heard from a recent speaker, are now being trained to take their part in industry. And even though in some 147 cases little can be done to raise them above a low standard of educational ability, a great deal can be done in what is known as "socialization"—helping them to learn the rules of society so that when they emerge from their home or their training institution or hospital they are not considered odd, nor are they allowed to regard themselves as odd, for they have learned the rules and are able to comport themselves in such a way that they are no longer gazed at or treated as strange objects of wonder.

This advance in adaptation to public life must, of course, be accompanied by an equal adaptation by the public and by the parents of these mentally subnormal children. In this field a great deal of education still remains to be done, and if this debate has no other effect—and it will have many—one hopes that it will have an effect in this respect. For the public must be helped to adjust themselves to these children, or to adults with children's minds, so that the public no longer regard them as patients, treating them as diseased people, but learn the difficult art of coming alongside them, helping them to feel wanted, and to feel that they have a part to play in the public life of the nation. And of course this is particularly true of parents. We have all known parents who have been so shocked, bewildered, and even infuriated, by the arrival of a subnormal child that they have in some cases, disowned it, with tragic results (I heard only last week of a child who had died of a broken heart because its mother had disowned it at birth), or known parents who, quite a long time afterwards, are ashamed of their child. This attitude is, of course, tragic and disastrous.

At the other end of the scale there are parents who are sentimental and possessive, cosseting their mentally subnormal child and refusing to allow it to be trained and adapted to normal life. In my own city of Coventry, as in many, if not most, other areas of local authority, a child can be taken over for training almost at birth. Schools have been set up to deal with infants, juniors and seniors, so that they can pass in training from one school to another. Hospitals are also available for those who are unable at that moment to go to schools of training. It is an interesting fact that 148 to-day in hospital only about 10 per cent of patients are certified: all the rest are voluntary patients. Here again, throughout the country one sees a quite remarkable success story (and I should not like it to be felt that there has not been success), for a high percentage, after five or six years of hard work by the staff, are helped to adjust themselves to life.

I want to say a further word about the part the ordinary citizen can play in helping the subnormal child to be readjusted to normal life. In an age of increasing specialisation, it is sometimes thought that only the expert (with a capital "E") can help to bring a solution to a problem, but in this particular sphere a good neighbour has an important part to play. It is possible that, in the automated world towards which we are moving, people may well have more time to learn the difficult art of being good neighbours. Of course, I hasten to add that the good neighbour and the mere enthusiast will never take the place of the skilled, trained, social worker. Nevertheless, it remains a fact that the neighbour who cares, and who has a little time to spare for a subnormal child, who interests that child in some hobby and takes time to ensure that the hobby is learnt through patient and unhurried example, repeating a few things again and again, until "the penny drops" is worth his or her weight in gold.

This good neighbourliness, which was a marked feature of the village—or, indeed, let us face it, of the old slum world which, thank God! is now disappearing—needs to be developed in the new tower blocks of flats and in the new affluent suburban life which is the background of so many people's lives to-day. At the moment, this good neighbourliness is normally to be found only among the more unusually responsible, religious or talented groups. Yet it needs to be inculcated from the earliest days among normal schoolchildren, so that they emerge from school with a sense of responsibility, shorn of all sentimentality, for those less well adjusted than themselves. This development of the good neighbour will not diminish the professional social worker's load; nor will it make the slightest difference to the present tragic shortage of trained 149 teachers. But it can, as has been pointed out, make possible the step within community care, from care in the community, to care by the community. I would say a further word about the parents' part in the rehabilitation of mentally maladjusted children. It happens all too often, as I have already pointed out, that the mother and the mentally subnormal child are for the time being, at any rate after birth, incompatible, each upsetting the other, so that a vicious circle is set up. At that point it is advisable that parents should allow their children to be brought to a hospital, allowing the child time to settle down to the new life without too much parental visiting. Often this has a quite dramatic effect, with immediate improvement in things like toilet habits, excessive food fadism and restlessness. But once the child has settled down in hospital it is important that parents should begin once again to visit their child, otherwise the gap between child and parent will have become so wide that it will be very difficult to bridge.

To this end bodies like the Nuffield Provincial Hospitals Trust has built a parents' hostel attached to at least one hospital, consisting of flatlets in which the children can live with their parents for a few days, or even a week or two, during which time they are slowly introduced to, and absorbed into, hospital life. The mother can have periods of well-earned rest, mingled with visits to the hospital with increasing frequency. Thereafter, the hospital becomes a sort of family centre, where not only mothers are welcomed, but brothers and sisters, and even fathers. Furthermore, in this curative process brought about by the right relationship between the handicapped child and its family there is a place for the less mentally handicapped patient to look after the more severely subnormal patient. In the process of so doing the less severely handicapped patients are themselves greatly helped to be adjusted to life. They become "big sisters" or "big brothers", and in many cases the mental health of the "big sisters" has improved even more than that of the children whom they are looking after.

In all these ways the handicapped child to-day is being no longer regarded as incurable, a person to be ashamed of, 150 a dead loss to the community. On the contrary, the mentally handicapped child is being regarded increasingly as a potential citizen of value to the community who, by the right treatment of trained workers, untrained good neighbours and family, can begin to play his part as a responsible citizen in the world tomorrow.

I would add one last word, my Lords. This work should be undertaken, not merely to make the mentally maladjusted and handicapped child into a responsible citizen, so that he can pull his weight in the nation's life, important though that is, but also because a child is a person, of immortal value and significance, no longer to be tucked away out of sight (and, therefore, too often out of mind), but loved and cared for, developed and trained, just because that child, like every other child, is of value to God and of immortal value in itself.

§ LORD SEGAL

My Lords, I hope that the right reverend Prelate will forgive me if I do not follow him in the excellent speech that he has just made. I should like to add my word of thanks to the noble Lord, Lord Grenfell, for having given us the opportunity of debating this most important subject. We know his own close interest in the welfare of the mentally handicapped and of the many years of devoted service he has given to this work, not only as treasurer of the National Society for Mentally Handicapped Children, but also for the Carshalton Group of Hospitals, which in itself is a highly specialised group, in many ways an example to the rest of the country. I should like to relate my remarks more particularly to the role of the voluntary bodies in the working of the Mental Health Act. Perhaps at this stage I may add my words of congratulation to the noble Baroness, Lady Hylton-Foster, on her excellent maiden speech, and particularly to congratulate her on having chosen this subject for her speech. She, too, referred particularly to the role of the voluntary bodies, and I think it is of help to survey their particular work more from the national angle.

As we all know, the whole approach to the problem of mental illness has changed radically during the last twenty years. The conception of the mentally sick 151 person as someone quite apart, to be segregated from the rest of the community and condemned to virtual isolation behind locked doors, has now been entirely discarded, and the straitjacket and padded cell have almost taken their place with the thumbscrew and the rack as mediæval instruments of torture. Instead, mentally sick persons are now regarded as intimate members of our community, who need to be helped and healed and enabled to return to their homes at the earliest possible opportunity. They have assumed at last their rightful place in our sympathy and understanding. We have accepted their claim to be given sheltered work, to keep them fully occupied, both mentally and physically, and to be regarded as useful, self-respecting citizens.

Enormous advances have been made recently in the treatment of mental illness, especially by means of the new, valuable drugs, which can soothe their fears and allay their anxiety. Terms of opprobrium and contempt, such as "idiocy" and "lunacy" have now largely been eliminated and have given way to a new terminology which reflects no sense of shame on patients who are mentally ill. They are no longer incarcerated in asylums as outcasts from the community, but attend hospitals as out-patients, secure in the anchorage of their own families and their own homes. The asylums have now become almost completely out of date, as grim relics of the Victorian era. They stand condemned by the progress of medicine and the growth of human understanding. Perhaps even more striking is the community of interest which these patients find in helping one another. They are tending to be drawn away from introspection and self-pity towards a degree of extroversion and a realisation that they have become members of a wider community. All these new advances in the treatment of mental illness had to be given concrete form, and the Mental Health Act, 1959 repealed all our previous legal enactments and swept away most of our earlier misconceptions of these vast and urgent problems.

But if enormous advances have been registered in our treatment of the mentally sick, there is one aspect of mental illness which has lagged woefully behind. 152 I refer to the treatment of our mentally handicapped children. To some extent this is inevitable. Where manifestations of mental handicap are apparent from birth or develop in early childhood, they cannot be expected to respond readily to treatment. That is where the factor of their prevention is so vastly important; and this leads us inevitably into the field of research. Grateful as we are for Government assistance in this direction, the hard fact remains that only 8 per cent. of the Medical Research Council's annual budget is directed towards research into mental disorders. There is no aspect of mental illness more agonising to a parent than the thought that so little is known about its causation and prevention, and I feel an enormous field is still open to us to make further advances in this direction.

On the other hand, one of the most heartening facts about our approach to this problem is the rapid growth of the many voluntary organisations now working in this field, and the great assistance that they are rendering to the Government, to the local authorities, and to the community at large. It is greatly to the credit of successive Governments that they have never ceased to pay their tributes on many occasions to the magnificent work done by these voluntary bodies. The latest tribute is to be found in the recent White Paper on The Development of Community Care (Command 3022), presented by the Minister of Health only last month, and one passage especially deserves quotation: Reference is made in the following paragraphs to the wide and varied contribution made by voluntary bodies of all kinds. These play an invaluable part, not only as pioneers of untried measures but as providers of essential services. The training of the mentally subnormal, the accommodation of the elderly, and the mentally or physically handicapped, the running of social clubs and centres for all these groups, and friendly visiting in the home, these are outstanding examples of the help that voluntary bodies can give and local authorities must, and do gladly, take account of that help in making their own plans. Of many voluntary organisations, I should like to make special reference to the work of two with which I am particularly acquainted. Foremost is the National Association for Mental Health, a pioneer body which has grown out of the early organisations, founded when this type of voluntary work was in its infancy. Its 153 activities now range over the whole vast field of mental health. It recruits among its members doctors, research students, social scientists, mental health social workers and teachers of the mentally handicapped. As has already been said, it organises training courses to qualify teachers for the special work of teaching the mentally subnormal. It administers residential homes for elderly persons who need mental care. It issues an excellent periodical Mental Health; and it organises a special advisory service which is staffed by trained social workers who advise all who are faced with the problems of mental illness. It is linked with 54 local associations, carrying on its work in all parts of the country, and maintains the closest contact with mental health organisations all over the world. Naturally enough, it is handicapped severely by lack of funds and of suitable premises to carry out its beneficent work.

Secondly, there is the National Society for Mentally Handicapped Children, with which I happen to be closely connected. This is a vast organisation whose membership consists almost entirely of the parents of mentally handicapped children. It is a model organisation of its kind and serves as a guiding example to the movements for the welfare of mentally handicapped children in other countries. I have been amazed at the sacrifice and the devotion which these dedicated parents bring to bear in trying to help the problems of other parents similarly affected. From very small beginnings this national society has, in the short space of barely ten years, grown into a huge organisation comprising over 360 branches and with a membership of well over 30,000. It has launched out into pioneer ventures of industrial training centres, holiday homes, training schools for teachers, advisory bureaux and many other activities. These are fields also dealt with by Government agencies, by local authorities, by the National Association for Mental Health and other bodies.

But there is an especial merit that this similar work should be carried out on the initiative of the parents of mentally handicapped children themselves. Through their own deep personal involvement, they bring to bear a special sympathy and understanding which is a vital element in the progress of this work. It is work which cannot be done in the same way by 154 other agencies. For example, those parents whose children are away in hospital are constantly urging that more humane influences should be brought to bear, that children should be treated as individuals, helped to evolve their own personalities, encouraged to wear their own distinctive clothes and to take a pride in their personal appearance; helped to utilise their leisure time in a creative way, given a chance to broaden their education, and to develop their latent artistic and individual skills. These parents are anxious to de-institutionalise these hospitals and to humanise them in every conceivable direction.

There is just one question I should like to put to my noble friend the Minister who is to reply, and upon his sympathetic understanding of this question a very great deal depends. Why is it that the saddest parents I meet are nearly always those whose mentally handicapped children are in hospital? If only those 30,000 children to whom reference has already been made, or even if only some of them who are really not hospital cases at all, could be taken out of hospital and placed in a few more specially-run homes and hostels, given better individual care and education and a deeper understanding! As has already been said, no praise can be too high for the present hospital staffs who struggle bravely, often under the most appallingly antiquated conditions. But everything is loaded against them—the buildings, the huge obsolete wards, the shortages of staff, the enormous amount of work and the poorness of the pay. We are all fully mindful of the difficulties. I merely wish to point out the long, long road we still have to travel and the vast amount of work that still remains to be done.

And may I also say this? These parents face their problems with a cheerfulness and heroism that is an example to the rest of the community. They spare no sacrifice of time and money and energy to help one another. They emphasise the spiritual values in their own lives and in the lives of these children who so desperately need their help. We plead very much to-day, and very rightly so, for our old-age pensioners. But think of those elderly parents of pensionable age who have mentally handicapped children on their hands and who have worked so hard throughout their lives and sacrificed 155 so much to help these children entrusted to their care. We, as a community, should pay our tribute to these parents who have done so much to help one another, and to ease the burden on our own consciences. Speaking for myself, I can only say that I have felt personally drawn rather less to the professional and scientific bodies than towards these parents' organisations, because I feel that they supply a real need in our community that no other organisation, governmental, local authority or professional, can ever hope to supply. They are especially deserving of our gratitude and our generosity.

Naturally enough, with all their rapid growth, despite their steadily increasing income, the demands being made upon them are now becoming greater than ever. I have been appalled to realise the devotion of their workers in cramped overcrowded premises almost bursting at the seams. There is a crying need to-day for some public-minded benefactor to endow in our midst a Mental Health Centre where these organisations can expand to meet the heavy demands now being made on their services from all sides. I know of no more urgent need in our community to-day, nor one more richly deserving of Government aid or public benefaction.

Think of the plight to-day of young parents who suddenly find their child is growing up under the severe handicap of mental retardation. To whom are they to turn? First to their own doctor. He may or may not be able to render help or advice. Quite often, with a shrug of the shoulders he says that nothing can be done. But these parents will go to almost frantic lengths to help their children. They turn to the local authorities, to the local branch secretary of the National Society for Mentally Handicapped Children. They come into contact with other parents who, in their turn, help and advise them in every possible way.

But I should like to see established in London a Mental Health Centre to which these parents could turn, to be helped at once with the fullest information and the best available advice. This centre would house our parents' organisations and other mental health bodies in a way that would allow them full scope for expan- 156 sion and enable them to carry out every branch of their rapidly increasing activities. Not only in the field of treatment and research, but in the field of education much more can be done. New trends in education, new methods of instruction, the use of electronic aids, such as that of the recently introduced "talking typewriter", all these should be exploited and developed as fully and speedily as possible.

The urge from the parents pleading on behalf of their own children is powerful and insistent. They constitute something far better and finer than a mere pressure group. They are themselves deeply involved. By their own sacrifices and devotion they are an example to the whole of our community. They are determined to press on with their efforts until the last mentally handicapped child in our country has been given the opportunity of attaining its own birthright of human dignity, self-respect and creative achievement. To-day tuberculosis has become an almost forgotten disease. May I urge upon the Government to strengthen the work of these voluntary organisations and many others of a similar character, to assist them in every possible way, so that by their own unique contribution to these problems they can help to eradicate the scourge of some types of mental illness present in our midst.

§ BARONESS ELLIOT OF HARWOOD

My Lords, I think we are all greatly indebted to the noble Lord, Lord Grenfell, for raising this matter in your Lordships' House to-day, and for giving so many people the opportunity of saying something about a subject which I think does not divide this House at all but is one in which we are all deeply interested. I would also add my word of congratulations to the noble Baroness, Lady Hylton-Foster, on her altogether admirable and charming contribution to this debate, and to the noble Lord who has just sat down, whose speech was most moving and whose appeal for help for those working in the voluntary organisations is one that I echo fully. I think we are deeply indebted to those people who for many years now have struggled to build up these really splendid groups of voluntary organisations working in this field.

I also speak, if I may (I have done so in your Lordships' House many times), 157 as a member of a local authority charged with the duty—and a very responsible and difficult one it is—of administering the Mental Health Act 1959. The problem is a very large one. I do not think that anybody has quoted the figures this afternoon, but some of your Lordships' may know them—they are of a very formidable size. In 1964 there were approximately 587,297people who were mentally ill. Of those, 180,056 were in hospitals and 399,241 were in the community. These are very large and very disturbing figures, and they give some idea of the challenge given by the Mental Health Act—and a very great Act it is—to those who are struggling on local authority committees to try to administer it.

We are speaking particularly this afternoon of children and young people. Here also the figures are most distressing, though not of quite the size that I quoted just now. During 1964, 6,400 adolescents were admitted to hospitals for the mentally ill. There were only 157 beds, in only 7 special units, for the psychologically ill adolescents, and probably each adolescent would require something like six months' treatment in hospital. There were also only 370 beds for mentally ill children. This represents about 3 beds per million for the adolescent population, and only 8 beds per million for the child population.

In this circular which I have here, issued in 1964, the Ministry of Health urged that there should be at least 20 to 25 beds per million for the short-term treatment of children, and 25 beds per region for long-stay cases. This is approximately, in all, 1,500 beds, compared with the existing 370. Twenty to 25 beds per million for adolescents represents approximately 1,000 beds, as compared with the existing 157. However, the increase since 1964 has been of only 36 beds. In my opinion, this is a great challenge to the Minister of Health and to the Health Department. Of course, they are enormously hampered by a shortage of staff and training facilities and, as I think Lord Grenfell mentioned, by the low salaries paid to teachers who are instructing the mentally ill and those who are nursing the mentally sick. Therefore, whatever our political opinion, whatever our views, this is something which is a real challenge to the whole community; and we must work in every 158 possible way we can, whether it is in local government or in the voluntary organisations, to see if we cannot really make a real step forward to meet these problems and these shortages of staff and accommodation.

The question of hostels has been raised. So far as I know, there are no hostels for mentally disturbed adolescents to live in while going to work outside. Of course, such hostels would need trained staff. But if we could get such hostels going, through either local authorities or voluntary organisations, I am sure that we should be doing something to help the young, who in my opinion should not be in hospital if they can be employed, even in a humble capacity, in the community. One noble Lord (I think it was the noble Lord, Lord Brain) has referred to the letter which Mr. Tudor Davies published in the Observer. I, too, was enormously impressed by the figures he gave. They stress strongly this problem which I have mentioned at the beginning of my speech.

The noble Lord, Lord Segal, raised a point about which I have always felt tremendously strongly; namely, the inadequate amount of money that we have for research into mental illness. Thirty-five per cent. of mental illness is either schizophrenic or manic-depressive. As has been said, new methods have been discovered in recent years for treating this kind of illness. And again far too little money is available for this purpose. The noble Lord, Lord Segal, gave the figure. But 8 per cent. of the Medical Research Council's budget is far less than has been spent in the past, certainly on the magnificent work that has been done on tuberculosis research, and also that which is being done to-day. I entirely agree with Lord Segal that we do not want to see any reduction in that work, or on the work that is done on cancer research. But if we calculate that one out of every nine girls aged six to-day will enter a mental hospital at some time in her life, and that one out of every fourteen boys aged six years to-day will probably do the same, it shows the absolutely desperate situation which lies behind this question of mental illness and research into it.

As Lord Segal has said, I am sure the research has helped the medical profession to cure tuberculosis and to create 159 the position where sanatoria are now closed or used for other purposes. I should like to see as much power, as much money and as much desire put behind research into mental illness as was put behind tuberculosis research and is behind cancer research to-day. It is essential that we get public support for this, that we increase the great funds that are being raised for research into mental health, because I am sure that herein lies the best way to arrest the increase in the incidence of mental illness to-day.

I should like to pay my tribute, as did Lord Segal and others, to the National Association for Mental Health. They have done a perfectly marvellous job, both with the public and with the patient. More people to-day look on this illness like any other illness, and in the recent campaign which culminated in the Mental Health Week I think we had something of quite outstanding importance. It was supported by 32 voluntary organisations. It was a costly business for them, since they had no help from the Ministry except moral support. I should like to urge upon the Minister that he might realise that a campaign of this kind, doing something which is vital to him as well as to the voluntary societies, is something to which he might well give some financial support on future occasions. It must have benefited him and the local authorities and the medical profession as much as it did those who inaugurated it in order to explain to the public about mental health and what the National Association for Mental Health and its 32 supporting organisations means at this time. The B.B.C. and I.T.V. took part.

I should like to make one comment about the B.B.C. film which appeared on "Panorama". Looking at it and studying it, I found it to be unnecessarily depressing. In one of its shots of a mental hospital it showed a long, gloomy corridor, overcrowded wards and an atmosphere of Edwardian or even mid-Victorian institutional treatment. I am sure many of your Lordships know, as I do, mental hospitals of to-day which are not in the least like that. Even though some of their exteriors are of the Edwardian or Victorian age, inside they have been reconstructed; they are cheerful, they are 160 gay, they have modem colouring and modern furniture. I was in one, The Dingleton Hospital, in my own county of Roxburghshire, only on Monday. I have also been many times to the Crichton Royal, in Dumfries.

There is nothing depressing about these places. There is nothing which gives you the feeling of people not being cared for. There are no locked doors. There are wonderfully beautiful gardens. People walk in and out. People who are not patients are welcome to come and visit in a hospital of that kind, just as people are welcomed and cared for if they are patients. I do not think that the "Panorama" programme which the B.B.C. put over in regard to a mental hospital (I have forgotten which hospital it was; it may not have been named, but, in any case, it was an old-fashioned hospital) was anything but a great mistake. It gave people the wrong impression. We want to give to people the impression that mental hospitals are up to date and modern, and are as anxious to be welcoming in their appearance as any other kind of hospital. The noble Lord, Lord Segal, made the same point, and it is absolutely true.

I should like to speak for a few moments about a voluntary organisation with which I am closely associated, the National Society for Autistic Children. This is a small organisation only five years old. It was formed as a result of the many developments which have taken place in the treatment of mental health and which are so very encouraging. Due to research, experiment and experience, it has been possible to break down the various types of mental illness which at one time were described generally as subnormality or as "ineducable". Research and work carried out both inside and outside hospitals have led to this break-down, so that there are now many new definitions available and this is most encouraging. It means that one can look at all these different types of mental illness and know that they can be cured.

The small society with which I am associated has been formed because so many doctors and people working with this type of child have discovered ways of teaching them and bringing them into a normal life. This Society has been 161 in existence for only five years, and it is estimated that there are about 5,000 autistic children. This is a withdrawn, mental condition. In the past when children could not speak and when they showed signs of great mental disorder they were often designated as uneducable. This is now proved to be quite untrue because, with skilled teachers and with parental care and love, these children can be and are educated. Only the other day I had the privilege of opening a small new school in the Borough of Ealing devoted to the teaching and training of autistic children. I was enormously impressed with what is being done. Although it is a tiny unit it is a pioneering unit which will show to anybody who cares to see it what can be done for this type of child.

One very important matter in connection with the Mental Health Act 1959 is the great importance of the diagnosis of children who suffer from mental disorder. I am speaking of Scotland because in my local authority in Scotland I was chairman of the education committee and I have had something, although not as much as many noble Lords, to do with this question of educating or not educating mentally disturbed children. In Scotland the assessment of children is done by an educational psychologist in cooperation with the medical officer of health and also the director of education. I understand that in England the question of educational diagnosis by an educational psychologist is not compulsory. The diagnosis is done in the main by a medical officer, who may of course be a highly skilled mental specialist; on the other hand, he may not. There is a case for seeing whether it would not be better for the assessment of children of this kind to be done through an educational psychologist in the first instance with the assistance of a medical officer, rather than to leave it entirely to a medical officer. I am not suggesting for one moment that he may not be highly competent to do this, but he may not be since the educational standard and I.Q. of children is something which educational psychologists are trained to assess, and medical doctors are not necessarily trained in this way.

In Scotland the duty of the education authority is to provide special classes for any child who is educable, and the duty 162 of the health authority to provide help to the severely handicapped who are perhaps non-educable. I think the same applies here in England. There is nothing like enough accommodation for either of these categories. A definition which defines specifically many categories of handicap should, I hope, in the long run, do away with a general label like "subnormality" which is sometimes put upon children and which depresses everybody, particularly the parents. The autistic child has in the past been labelled in that way, but through long study and by adopting different methods of teaching he can be brought a long way along the road to normal development. The classification of "uneducable" is hard to overcome, and the National Society for Autistic Children have spent many years doing some hard fighting, on the part of their professional workers and parents, to win the right of an educational trial for these children. I would suggest to the Minister that in this year of 1966 no mental condition should be called incurable. Therefore, it is vital to get the educational department to assess the child.

Just as there is a shortage of nurses and teachers, ther