Liam Fox: We are shamed by our treatment of mental illness

The way a society treats those least able to play a full role is a measure of how civilised it is

It may come as a surprise to some that the Conservative Party should have chosen to put mental health at the top of its health agenda. It is not a focus group concern, nor is it easily packaged in soundbites. There are, however, compelling reasons why it needs a much higher profile.

The way in which a society treats those least able to play a full role in it is surely a measure of how civilised that society is. Sadly, both as an MP and, before that, as a GP, I have come to believe that we accept a level of care for those with mental illness that we simply would not accept for those with other types of illness. If you walk from Westminster up the Strand in the heart of London and see people, many of whom will suffer from mental illness, sleeping in the doorways of some of our wealthiest institutions then, there you will see a policy failure that a humane society should not tolerate.

What will also surprise many is the sheer scale of the problem. One in four of us will suffer from some sort of mental illness in our lifetime. Yet unlike countries, for example, in Scandinavia, there remains a stigma attached to mental illness in this country. Only by dispelling the ignorance that is the basis for fear can we remove the stigma that is too often a barrier to seeking help in the first place.

We must also foster a sense of proportion in the debate and move away from an obsession with the mercifully few incidents of severely ill patients harming members of the public. The vast majority of those with mental illness pose no threat to anyone but themselves – they are more likely to be the mum with postnatal depression, the elderly relative with Alzheimer's, the child with a behavioural disorder or the granny whose depressive episodes are put down to "getting on a bit".

Sadly, too many politicians seem to pay more attention to the potential dangers psychiatric patients pose, and issues surrounding their compulsory treatment, than to the far more important issue of what is the most appropriate treatment for all patients. It seems that our policy is currently more dictated by lurid headlines than patient needs, and the Government seems likely to push further down this route in the next few days.

For those trying to provide a decent environment for the treatment of mental illness, the situation is bleak, with widespread shortages of staff and acute- and day-beds, gaps in community provision and a lack of step-down care for those returning to the community.

It is a situation made worse by the knowledge that while funds are earmarked in the health budget, they all too often fail to reach those in need. Cutting the mental health allocation is an easy way of balancing the budget. The mentally ill are least likely to complain, make a fuss or write to the papers.

Even organisations like the highly respected Saneline, which answers 1,000 calls a week from distressed people, is under threat for the sake of £1m a year, a fraction of the Government's own advertising budget.

We cannot have a meaningful debate, however, without taking a hard look at recent policy developments. The concept of care in the community, removing people from the unacceptable asylums of old, was introduced with agreement right across the political spectrum. But has it been the great success promised?

We certainly cannot ignore the fact that care in the community has provided many thousands with an opportunity to experience a quality of life far better than they would have experienced inside restrictive institutions. Nor can criticism be laid at the door of medical, nursing and voluntary staff, who have made a Herculean effort in the face of the greatest difficulties.

But the pendulum has swung too far and too fast. Many, including myself, now feel that care in the community was implemented too quickly, often with inappropriate patient selection, and in too many places there was too little investment in training, finance and related areas.

There has been, at times, too little care, scant support, and a form of community care that has exposed the vulnerable – both patients and the public – to danger. But perhaps the greatest failure of all can be seen in the scandal of mental illness in our prisons.

The incidence of mental disorders among the prison population far exceeds that in the population as a whole. Facilities often amount to little more than sick-bays with limited primary care cover. Prisoners are thus less likely to have their mental-health needs recognised and are at an increased risk of suicide. The number of suicides in 1999 – 91 – is almost double 1990's figure of 51.

Whether patients are within the criminal justice system or not, it is in everybody's interest to make sure that their mental illness is properly treated, and in the right setting, before they are released from custody with a treatable condition. With New Labour's obsession with celebrity, glamour and the good life, many feel that the vulnerable in our society now have no champions left.

Ensuring a decent level of care for all those with mental illness should not be about what the focus groups want to hear.

We should do it because it is the right thing to do. That is what politics should be about.

The author is the Conservative spokesman for health