Faced with the prospect of a rebellion by Tory backbenchers Mr Rifkind

Faced with the prospect of a rebellion by Tory backbenchers, Mr Rifkind said the Government did not want to do anything that would damage the World Service. No secure bed could be found for him for a week, during which time he had to be kept heavily sedated and barricaded into the seclusion room – treatment the staff and commission agreed was “inhumane”.The commission says that while many long-stay patients have successfully transferred to Care in the Community, “there remains a core of patients unable to make the transition and for whom community care is arguably the least preferred option This reality can be lost in the pressure for change”.. The commission highlighted the case of a martial arts expert who became highly disturbed on an ordinary psychiatric ward He was put into seclusion but smashed the door He was only restrained when the police arrived. Other factors in the crisis, according to the commission, which acts as a watchdog for patients detained under the Mental Health Act, include:t An underestimate of how many beds were needed to allow for the occasional relapses that people discharged from long-term care suffer;t Discovery of previously undetected cases by new community teams;t Too few 24-hour nursed beds outside hospital for patients who cannot cope on their own;t Homelessnesst Premature discharge in order to free beds, which produces “revolving door” admissions, where patients suffer early return to hospital.The result is a more disturbed mix of patients on wards where growing numbers are formally detained. The total still stands well below the 2,000 places that the Butler report calculated were needed 20 years ago. More medium secure beds are being provided – numbers are due to rise from about 700 to 1,000 by March and 1,200 by December in a pounds 45m programme.But both the Mental Health Act Commission and the Royal College of Psychiatrists fear that few of the places will be available to support local services. NICHOLAS TIMMINS

Public Policy Editor
Health managers claim that “gridlock” in the secure beds designed to take the most disturbed and potentially violent offenders has contributed to the dangerous pressures on acute psychiatric wards.It is one of six factors that have led to what the Mental Health Act Commission has called a “crisis” in mental health services which it says has worsened over the past two years.The diversion of mentally ill offenders from prison to hospitals has led to the three tiers of locked wards – medium secure, and regional secure units, and the special hospitals such as Broadmoor – “silting up”, increasing the difficulty of exchanging patients between them.At one end of the system, approaching a quarter of Broadmoor’s 450 patients could be discharged to a less secure environment if space was available, Liz Hill, clinical unit manager at the special hospital, says.At the other end, ordinary acute wards are having to handle growing numbers of seriously disturbed patients because they cannot be moved up to more secure accommodation.

But reports suggested that in some cases cover for such patients was missing. Mr Dorrell has admitted that there are now a series of reports, including national accounts from bodies such as the Audit Commission and local ones, of tragic incidents involving mentally ill patients “which show quite clearly that further urgent work is needed to deliver good mental health services across the country as a whole”.He said there needed to be a continuing focus on providing the full range of care, including in-patient care and longer-term professional staff provision for those with the most pressing needs.. It will give patients specific rights to treatment in the community, and lay duties on health authorities to provide the services.Mr Dorrell underlined his concern in a review of the National Health Service in a speech last week at Manchester Business School. “A modern mental health service needs to provide a spectrum of care, including acute hospital space, as well as sheltered support, community mental health teams and facilities to deal with crisis care.”When those services are all properly provided, and the links with social services all work properly, we deliver a high-quality service. But there are too many examples of breakdown and too many areas where some part of the jigsaw is missing,” he said.In highlighting “variations” in national care for the mentally ill, Mr Dorrell said the public had been led to believe that it was the Government’s policy to close all acute mentally health facilities and treat all patients in the community, but “that is not and never has been an accurate description of our policy”.A comprehensive care plan for dealing with psychiatric patients in the community should have been in place by the end of last month.

I can short- circuit it in the way I have done by returning to December 1990.” It is understood the couple were considering the offer last night The case continues.. COLIN BROWN

Chief Political Correspondent
Doctors’ leaders who are due to meet ministers tomorrow to demand better security in surgeries are also pressing police chiefs to agree that they should be allowed to examine violent patients in police stations instead of on practice premises.Doctors are worried about the threat of attacks both from mentally ill patients who have been released into the community and from drug addicts.The British Medical Association will put pressure on Stephen Dorrell, Secretary of State for Health, at a meeting tomorrow, arguing that family doctors are in the front line in dealing with potentially dangerous patients.The BMA is not pressing for guards to be appointed to all GP surgeries but it has asked the Government to consider creating high-security surgeries with protection for doctors where selected patients could be treated.Officials at the Department of Health are considering the BMA’s proposals as ministers prepare to face renewed criticism over the release of mentally ill patients into the community.Mr Dorrell, who is meeting the BMA to discuss the renegotiation of their contract, will announce details shortly of a new patients’ charter for the mentally ill. That, amounting to about pounds 10,000, would be offset by a claim for loss of earnings on Mrs Verity’s part for about the same amount.Mr Mitchell said: “My counter-claim still stands for the full figure, but so the plaintiffs don’t have the full interest on their accounts. Lloyds Bank would credit the couple with the pounds 77,529 won at the earlier hearing which would then pay off all the loans and leave a mortgage debt of pounds 27,000 pounds, plus the interest to date. They argue that they owe nothing.Gregory Mitchell, counsel for the bank, said the couple owed pounds 150,000 on loans, including the mortgage on a failed property speculation and interest. However, when making their statement of claim in the last case, the couple demanded interest only up to December 1990, instead of the present day.Mr Mitchell said the bank, in its turn, was now prepared to return to December 1990 when the interest was lower on all outstanding accounts.