The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, it is always instructive and never less than a pleasure to listen to the noble Baroness, Lady Murphy, on the subject of mental health. Mental illness and its consequences affect us all, directly or indirectly. We know that one in four of us will experience mental ill health over our lifetime, and that one in six of us has a common mental illness at any one time. Underlying this is the overall financial cost of mental health which, as noble Lords have pointed out, is staggering—an estimated £105 billion a year to the economy as a whole—and the costs of treatment alone are expected to double in the next 20 years.
This is why we launched our mental health strategy, No Health without Mental Health, on 2 February. To support it we are making around £400 million available for expanding talking therapies through the improving access to psychological therapies programme. This will build up the essential skills base of the NHS and mean that we can start offering talking therapies across a wider range of mental illness and to a broader range of people. I was grateful for the supportive remarks of my noble friend Lord Alderdice in this context.
The noble Earl, Lord Listowel, was right to stress that early intervention is essential. We know that half of those with lifetime mental health problems first experience symptoms before the age of 14. That would be part of my answer to the noble Baroness, Lady Murphy, who voiced disquiet that by focusing on the mental well-being of the nation we were doing so at the expense of those with very serious mental illness. We know that early intervention is important. Also, 25 per cent of older people have symptoms of depression. Those are good reasons why this strategy encompasses the whole population. The strategy acknowledges the dimensions of the problem by covering the full age range of society.
It also makes clear an expectation of parity of esteem between mental and physical health services. Improved mental health and well-being is associated with a range of benefits, from improved physical health and life expectancy to better educational achievement and reduced health risk behaviours. The prerequisite for achieving this is to build the awareness and understanding of mental illness and mental well-being across society. We also need to tackle stigma and discrimination, and we have put this at the heart of the strategy.
Yet to shift public attitudes substantially requires a major and sustained social movement. Already Comic Relief, the Big Lottery Fund and the major anti-stigma campaign, Time to Change, which is led by Mind and Rethink, aim to inspire people to work together to end the discrimination surrounding mental health. We know from discussions with voluntary and private sector organisations that there is an appetite for an even more ambitious programme. We will give this social movement our full support and active participation.
I should make it clear that mental health is a priority across government; this is very much a cross-government strategy. Of course it is easy to set out principles but the big question is how do we make it happen, especially at a time of financial challenge. A number of noble Lords have asked that pertinent question. The ingredients for success will be leadership and collaboration across the country, drawing on the skills and insights of clinicians and partner organisations and involving service users as much as possible to shape services in line with local needs.
The new NHS architecture will provide a clear opportunity to support mental health and drive improvements in care. The three outcomes frameworks—for the NHS, public health and social care—will entrench mental health needs in service priorities and provide clearer accountability for results. At the centre will be Public Health England, which will build up the evidence and expertise around mental health interventions.
Finally, at local level we have GP consortia, driving up standards by bringing resource management together with clinical management for the first time. There is undoubtedly a need to build up the skills and awareness among GPs and we are working with the Royal College of General Practitioners to do so. I do not in the least quarrel with the noble Baroness, Lady Murphy, on that point. However, there are already many GPs with a real interest and expertise in mental health issues. Good commissioning of services must involve collaboration, so that GPs and mental health professionals communicate with and—above all, perhaps—understand one another. Again, I hope that the strategy can be a catalyst for these conversations to take place.
The noble Lord, Lord Touhig, expressed his doubts about the ability of consortia to commission mental health services, as did my noble friend Lady Barker and the noble Baroness, Lady Thornton. The intention is that commissioning GP clusters will commission most mental health services in the same way as they commission other services. However, they will not be doing this on their own; they will do so in line with guidance from both NICE and the NHS commissioning board. I say in particular to my noble friend Lady Barker that we are indeed working with the Royal College of General Practitioners, the Royal College of Psychiatrists, the Association of Directors of Adult Social Services and the NHS Confederation to develop guidance and support for GP consortia in commissioning effective mental health services. In addition, there will be opportunities for third sector and for-profit organisations to provide specialist commissioning advice on mental health to GP consortia.
My noble friend Lord Newton asked what mechanisms will be in place to see all this through. First, the Cabinet sub-committee on public health will oversee the implementation of the strategy. Secondly, we will establish an advisory group for mental health, composed of key stakeholders such as service users and those who care for them. This advisory group will work in partnership in realising the improvement of mental health outcomes for people of all ages. Between 2011 and 2012, the advisory board will identify actions in the transitional year to deliver the mental health strategy. Thereafter, and once the NHS commissioning board and Public Health England have been created, the board will become a focus for all stakeholders to discuss the details of how implementation of the strategy will take place and review progress. The board will advise on improved indicators for tracking progress against the mental health objectives that could be used locally, by the NHS commissioning board and potentially in future iterations of outcomes frameworks. Plans for the all-important structures that need to be there for implementation of the strategy to be successful are already in place.
My noble friend Lord Newton, the noble Lord, Lord Patel of Bradford, and the noble Baroness, Lady Thornton, expressed fears that the £400 million is not strictly speaking ring-fenced and therefore might not be protected. The answer to that is that the NHS operating framework mandates an annual expansion of IAPT services in line with our commitment. PCTs are currently drawing up their plans for next year to implement the operating framework. The plans that we have seen so far are consistent with the Government’s commitments to expand talking therapies. We will hold strategic health authorities to account for managing their delivery. Additionally, we are in the process of making sure that, through a range of communications, PCTs, managers and commissioners are aware of the importance of IAPT and the mental health strategy generally.
Lest there be any doubt, I should say that the £400 million is additional money. It was announced with the publication of the cross-government mental health strategy and is part of the 2010 spending review settlement for the department. It is in addition to the £173 million announced in the spending review in 2007, which is in primary care trust baselines for April 2011.
A number of noble Lords, in particular the noble Lord, Lord Layard, referred to funding cuts that are in prospect. I just say to the noble Lord that, as I am sure he knows, the NHS budget as a whole is protected; it is not going to be cut. I have already referred to the NHS operating framework as a mechanism to ensure that these plans are delivered. Of course, mental health services cannot be exempt from the need to make efficiencies, but any efficiencies made must be based on robust evidence and, more importantly, mental health services must be given parity of esteem with physical health services. That is the answer to one question posed to me—when decisions are made on how to save money. The mental health strategy points to ways in which efficiencies can be made while also improving quality through the programme.
My noble friend Lord Alderdice referred to the lack of focus on suicide and self-harm. We will be publishing a separate suicide prevention strategy soon.
The noble Lord, Lord Patel of Bradford, spoke powerfully about black and minority ethnic issues. On the question of Count Me In, the Care Quality Commission expects to publish the census report in April this year. Incidentally, the census was never intended to continue indefinitely; the mental health minimum data set has the potential to be an even better way in which to monitor what is happening. I understand that the data are to be collected quarterly rather than annually. The noble Lord also asked me whether GP consortia would be subject to the Equality Act, and the answer is yes.
The noble Earl, Lord Listowel, focused in particular on services for young people. One of the first things that we need to do is to develop agreement on the nature of the requirements for psychological therapies in children’s services and the best way in which to meet them. Officials have already held preparatory meetings to do this, and we are in the process of setting up a team to take this forward. It is very important that we get consensus on the way ahead, because we cannot simply use adult psychological therapies programmes as a one-size-fits-all template. The Government have increased the funding available for CAMHS to give an even greater flexibility to those at a local level, investing funds to expand access to psychological therapies for children and young people. That will enable the development and initiation of a stand-alone programme to extend access to psychological therapies, building on learning from the IAPT programme.
The noble Baroness, Lady Greengross, referred to the other end of the age spectrum and older people, and suggested that the strategy does not say quite enough about that dimension of the issue. The mental health strategy talks about the problem of depression among older people and recognises that only one out of six older people with depression discusses their symptoms with their GP. It sets out the importance of early intervention, such as befriending programmes, which can be very helpful in tackling the social isolation associated with depression. In the public health operating framework, we are consulting on indicators that are very relevant to older people’s mental health. The mental health strategy also sets out the importance of ensuring that psychological therapies are accessible to older people as the programme rolls out nationally.
My noble friend Lady Barker referred to community treatment orders. Our view is that they are potentially useful, but we need to be certain, as she rightly said, that they are being used properly in patients’ interests and do not undermine confidence in the Mental Health Act. She was right that the coalition parties expressed doubts about CTOs when we were in opposition. We intend to keep the use of these orders under review, and I would be happy to write to her with further details on that.
The noble Baroness, Lady Hollins, referred to research. The Department of Health, through the National Institute for Health Research and the Policy Research Programme, has invested significantly in mental health research and will continue to support high-quality mental health research. The NIHR will also continue to work with research councils and other funders to co-ordinate research efforts consistent with the recently published MRC review of mental health research. We are increasing spending on health research in real terms over the next four years.
The noble Baroness, Lady Thornton, referred to the closure of the National Mental Health Development Unit. We are clear that at a time when the NHS budget is under pressure, we need to find efficiencies so that we can invest in front-line services. We are working with the Royal College of General Practitioners and the Royal College of Psychiatrists to produce robust guidance for GP commissioners, as I have already mentioned.
I firmly believe that this strategy represents an unprecedented opportunity to improve support, to prevent illness and to make mental health issues a more accepted part of everyday society and everyday life. We intend to put every possible effort into making that happen.