The Prime Minister believes that existing policies are "not working as well as they should" and have led to a "growing public fear of the mentally ill".
And while the policy of closing the old Victorian asylums is "clearly right" the hospital closure programme "may have gone too far", Downing Street says, with too few replacement places available in 24-hour staffed accommodation to care for those who could be a risk to themselves or others.
The Prime Minister's concern was expressed in a letter from 10 Downing Street to Stephen Dorrell, the Secretary of State for Health earlier this year. It appears to have followed a number of high profile murders by former psychiatric patients. They included the case of Wayne Hutchinson who killed two people and injured three in a six-day period, and that of Martin Mursell who murdered his stepfather and almost killed his mother in a frenzied knife attack.
It also reflects reports from the Royal College of Psychiatrists that bed occupancy rates are running at more than 100 per cent, with the beds of patients out on leave immediately filled by others. This forces premature release into the community.
The letter has produced a review of the way mental illness is funded across the health and social services divide. But it may also strengthen Mr Dorrell's hand in this year's public spending round. In February, the health secretary announced a programme to provide 5,000 places for the "new" long-stay mentally ill by providing, in effect, new small-scale asylums in 24-hour nursed accommodation. He did, however, provide little extra cash to fund or run the 400-plus homes needed.
Mr Major, however, has made clear his belief that some patients "want and require" a higher level of care and of "genuine asylum" than the community can easily provide - but there appears to be a shortage of the necessary 24-hour supervised accommodation.
The letter identifies "poor coordination" between health and social services as a key barrier to delivering good quality services and says the Prime Minister "is attracted to the idea of creating separate mental health authorities who would control all mental health spending".
The Department of Health yesterday confirmed that a report on "removing obstacles" that prevented health and social services working together has been commissioned and is due to go to Mr Dorrell at the end of this month. A spokesman was reluctant to confirm that it included the option of creating new mental health authorities but psychiatrists and managers whom the department's review team consulted have confirmed that the idea is under consideration.
John Bowis, the Health Minister, has visited Kirklees where the health and local authority social services have already created a separate fund run by a joint management board to buy "seamless" care for the mentally ill - an approach Mr Bowis has been commending to others. Philip Cotterill, Kirklees's chief social services officer, said he was personally against creating a new authority but that it was clear the idea was under consideration as one of "a whole range of options".
Dame Fiona Caldicott, immediate past president of the Royal College of Psychiatrists, said there was a good case for the move. Although Mr Dorrell has given mental health high priority since he took over, she said, its share of NHS expenditure had declined in recent years. A separate authority would help ensure that funds for the mentally ill were not diverted into more glamorous NHS causes "as has happened often over the years". And, while joint working with social services had worked well in some places, it depended on local councillors' seeing mental illness as a high priority.
In Northern Ireland, health and social services have long been run as one body. Making the change in England, however, would involve taking cash not just from the NHS but from local government which would be likely to resist the idea.
Dame Fiona welcomed Mr Dorrell's plans for new asylum-style homes. But she warned that "in many places it is going to need additional money if it is going to happen". The department's own study of the idea warned "it is hard to avoid the conclusion that an element of pump priming will greatly facilitate the transition". The department puts the cost of homes between pounds 275m and pounds 400m to build, with running costs of more than pounds 175m a year.Reuse content