(11 years, 6 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Paul Burstow (Sutton and Cheam) (LD)
I beg to move,
That this House has considered the matter of mental health.
There can be no health without mental health, and, above all else, I hope that today’s debate communicates that clearly and powerfully in the country and in this House. I start by thanking the Backbench Business Committee for recommending this most important of subjects for a debate, and the Government for finding the time to make it possible. Undoubtedly, there is a lot to debate on mental health, and I am grateful to my two colleagues—one on either side of the House—who have joined me in seeking this debate. I refer to the hon. Members for Bridgend (Mrs Moon) and for Broxbourne (Mr Walker), who hope to catch your eye, Mr Speaker, and contribute as we proceed.
Last year the House had a remarkable, moving debate on mental health, which was very personal for some hon. Members. It demonstrated that mental health is not an issue of “them and us”, but affects all of us. One in four of us may experience a mental health problem at some point.
Yasmin Qureshi (Bolton South East) (Lab)
I congratulate the right hon. Gentleman on securing the debate. Recent World Health Organisation figures predict that by 2030, depression will be the leading cause of diseases around the world, physical and mental. People can lose years of their life, as mental illness undermines their physical health too. Would the right hon. Gentleman agree, therefore, that mental health must be at the top of the Government’s agenda?
Paul Burstow
I certainly would. The fact that a large number of hon. Members are present, hoping to contribute to the debate, that the Backbench Business Committee advocated the debate, and that the Government have given the time suggests there is cross-party consensus that mental health has for far too long been hidden in the shadows and not awarded sufficient priority. The cost to our society of mental ill health across England, Scotland and Wales amounts to over £116 billion a year, but that does not adequately capture the human cost—the misery—that arises from it. Given that the burden of mental ill health is about 23% of the burden of all disease in our country, it is surprising that for so many years it has not been tackled with the necessary vigour. So I agree absolutely with the hon. Lady.
Mr Gareth Thomas (Harrow West) (Lab/Co-op)
Does the right hon. Gentleman accept that, in addition to the need for continued investment in the so-called medical facilities and services that are part of treating mental health, there is a need for continued investment in the so-called talking therapies, and the opportunity to invest and grow the social services’ response to mental health services as well?
Paul Burstow
I am grateful to the hon. Gentleman for that question. He is absolutely right that access to talking therapies—begun as a result of Lord Layard’s initiatives before the general election, which the coalition Government continued to support and which is being rolled out—is very important in enabling people to recover socially, get back into work and get on with their life. At the best performance rates, as many as half the people that go through talking therapy services recover, and that can make a huge difference to them, their families and the figures I was talking about earlier. I shall return to the subject of talking therapies in a moment.
Last year I took part in the debate from a slightly different position—I spoke from the Dispatch Box. I was able to report some important progress. We had a new mental health strategy. We had the continued roll-out of talking therapies, which the hon. Member for Harrow West (Mr Thomas) just asked about. Groundbreaking work was being done to reinvent child and adolescent mental health services from the inside out, to offer access to talking therapies for children and young people. We had the flowering of a new movement to establish social recovery as a goal for mental health, with the establishment of recovery colleges channelling the lived experience of mental illness into practical learning and skills, and resilience to enable people to get on with their lives.
There was the good news that the Government had backed financially the task of Time to Change, the charity sponsored by Rethink and Mind, really motoring to tackle issues of social stigma in our country. Reports since then show that the first phase of that programme has materially altered public views about mental health in this country, but the programme needs to be sustained.
Jeremy Corbyn (Islington North) (Lab)
The right hon. Gentleman makes a good case for supporting Mind and other mental health charities, which do a very good job in changing attitudes to mental health. Is he not concerned, however, that many health authorities throughout the country are cutting funding to non-governmental organisations—voluntary organisations that do very good mental health therapy work, often on a contract basis? They are being cut, and therefore the opportunities for support for people going through crisis are reducing, not increasing.
Paul Burstow
Yes, I am concerned. The picture is complex. The figures show that spending on adult mental health services over the past couple of years overall has reduced by about 1%, which is not good, but deeper analysis of those figures shows that about half of commissioners have increased their investment and the other half have reduced their investment, so the picture is more complex than it first appears. None the less, it is concerning that services are being withdrawn where they involve providing peer support or reaching into harder-to-reach communities, particularly black and minority ethnic communities, which often get left behind and often are most prone to being subject to the most coercive parts of our mental health system. So I agree with what the hon. Gentleman said.
In the debate last year I was delighted to be able to signal the Government’s support for the Mental Health (Discrimination) (No. 2) Bill, which was introduced by my hon. Friend the Member for Croydon Central (Gavin Barwell). It is a rare thing—as we heard earlier in the business statement, only about 10 Bills last year which were introduced as private Members’ Bills made it on to the statute book. It was great that that Bill made it on to the statute book, and I congratulate my hon. Friend and all those involved in taking it forward.
I have referred to the mental health strategy for which I had some responsibility. At its heart is the radical—I might even say revolutionary—idea that there should be parity of esteem between physical and mental health. That idea is gathering momentum. We have seen the Government place that notion in the mandate for NHS England as a driving force for the way the Commissioning Board takes its responsibilities forward. It is increasingly on the lips of policy makers and service commissioners. But the recognition that there are critical interdependencies between physical and mental health still has a long way to go.
There are more than 4.6 million people in this country living with long-term physical and mental health problems, and far too often their experience of the NHS is that they are broken down into their constituent diseases, rather than being treated as a whole person. As a result, their physical health needs are treated in one place—in many cases, in many places—and their mental health needs, if they are identified at all, are dealt with in another.
Mr Robert Buckland (South Swindon) (Con)
I pay tribute to my right hon. Friend for introducing this welcome debate, which I hope will become an annual debate. He is making a very important point about the experience of service users and the lack of integration in dealing with their needs. Does he agree that we should be aiming for a well-being-based approach with a single point of entry, which will allow people to be signposted to appropriate services? That means local authorities, the health service and the third sector genuinely coming together in an integrated way.
Paul Burstow
The hon. Gentleman makes an important point about the need for a greater focus on well-being. It is one of the reasons why I am so pleased that the Care Bill which was introduced in the House of Lords last week has as its first and clear mission for our social care system the promotion of well-being, and it goes on to stipulate what that means in practice. It is about control and people’s ability to lead ordinary lives—the lives they want to lead in their communities. That must be at the heart of an approach to mental health that sees the whole person, rather than trying to treat them in constituent parts of the presenting conditions.
The point about failure to join up services is key. All too often, long-term physical health problems overshadow mental health problems. The results of that are all too clear—slow, and in some cases no, recovery and people living with long-term physical health problems that could have been better treated in the first place. The cost in wasted resources in our national health service is about £10 billion a year and up to a further £3 billion on medically unexplained symptoms.
Mike Crockart (Edinburgh West) (LD)
My right hon. Friend talks about the need for all services to be involved, starting with social care and local authorities. Does he agree that the process needs to start even earlier and move into education and training, enabling teachers to recognise when illnesses start to show themselves? One in 10 children aged between five and 16 now suffer from mental health problems, including eating disorders and self-harm—the types of problems that will blight their lives for decades afterwards.
Paul Burstow
I entirely agree. That is one reason why the Government have committed to the talking therapies service for children and young people that has so far been rolled out. I am meeting head teachers in my constituency tomorrow to discuss how we can ensure that they commission the right mix of services to support children and young people, not least because conduct disorders, for example, cost society hugely and hold young people back from realising their potential, academic or otherwise. That is undoubtedly the case with integration, which is a key theme of tackling these issues more effectively. That is why I welcome the fulfilment of the commitments made in last year’s care and support White Paper, which my hon. Friend the Minister announced earlier this week, regarding integration pioneers and the new integration framework.
Work on mental health must be embedded in physical health services, which must be embedded in mental health services. When we consider that people with severe mental illness die, on average, 20 years younger than the rest of the population, and that that is due mostly to physical health problems, we begin to understand just how profound that diagnostic overshadowing of mortality can be. It is a scandal and it needs to be addressed. I am delighted that the Government are taking many steps to tackle it.
Dame Anne Begg (Aberdeen South) (Lab)
The right hon. Gentleman is rightly concentrating on health services and how they can help mental health and well-being, but does he share my concern that other parts of Government, such as the Department for Work and Pensions, are exacerbating many people’s mental health problems through the way work capability assessments are being carried out, and that those people are having new mental ill health episodes as a result of the trauma of having to go through an Atos assessment?
Paul Burstow
Yes, and that issue, which I know is of concern to Members on both sides of the House through their constituency casework, for example, was raised in last year’s debate. Although some steps have been taken to try to improve those processes, they still do not seem to me to capture fully the important differences in dealing with mental health and, as a result, can exacerbate mental health problems. There is more to do in that area and I look forward to the Minister picking up on that issue. Given that the Cabinet committee that had co-ordinating responsibility for the mental health strategy, which is a cross-government strategy, is no longer in place, I wonder how tackling those sorts of issues will be co-ordinated in future.
It is worth noting that there are a considerable number of working-age people with a history of schizophrenia, for example, who are able and—I stress this point—willing to work. Indeed, Rethink’s schizophrenia commission identified employment rates in that group as being about 8%, with a range of 5% to 15% across the country, compared with the obviously much higher rates for the general population. Individual placement and support schemes, which are some of the most effective forms of employment support for people using mental health services, really can achieve remarkable transformations in people’s ability to take up employment. I hope that the Minister can say something on how such issues are being addressed with DWP colleagues, because that is where a cross-government strategy really should be making a difference, rather than simply addressing direct NHS provision.
Paul Burstow
I will give way one last time, but then I really must conclude.
Mr Thomas
I am grateful to the right hon. Gentleman for giving way a second time. Will he underline the importance of mental health trusts such as Central and North West London NHS Foundation Trust, which serves my constituents, working with the local voluntary sector such as the Mind groups in Harrow and Brent? Will he therefore encourage his Front-Bench colleague to look with particular interest at the letter I am about to write to him, raising the concerns of Mind in Harrow and in Brent about the trust’s failure to work properly with the services it is providing?
Paul Burstow
I note that the Minister paid close attention to that intervention and I am sure the hon. Gentleman will enjoy the exchange of correspondence on the matter.
I want to discuss the health care aspects of parity of esteem. Curiously, not all general hospitals have 24/7 access to a mental health liaison service offering immediate support, yet we know that when that works well it can make a big difference to the quality of care, help to reduce the length of stay in hospital, especially for older people, and generate savings four times greater than the cost of running the service. There are good examples of where this has been done, particularly in Birmingham, and it is odd, given such obviously compelling evidence, that it has not yet been taken up more widely.
The Minister of State, Department of Health (Norman Lamb)
I completely agree with my right hon. Friend. There is some very good practice, including RAID—rapid assessment interface and discharge—at Heartlands hospital in Birmingham, but there are too many places where there is a complete absence of such services. The starkest aspect of the lack of parity of esteem is that there is a good emergency service—it may be under pressure but it is there—for people with physical health problems but not for those with mental health problems. That has to be addressed.
Paul Burstow
I am grateful to the Minister. Perhaps in his own speech he can say a little more about how we might better incentivise this change. Despite the compelling economic and medical benefits, these services are still not being provided widely enough.
James Morris (Halesowen and Rowley Regis) (Con)
The more fundamental point is that a significant proportion of the money that is spent on mental health services in the national health service—about £14 billion—is focused on acute services. If we were to shift, say, 4% of that budget into community-based solutions and early intervention, that might have a much more dramatic impact on our ability to tackle the underlying problem.
Paul Burstow
The hon. Gentleman makes a good point. Indeed, that has been part of the approach taken in the talking therapies strategy, which is about moving the resource to where it will make the most difference at an earlier stage, and helping to promote recovery in the first place.
The Minister said that the emergency service is a stark example of where parity of esteem has not been achieved, and I want to give another example. The Royal College of Psychiatrists and its president, Sue Bailey, have been looking, on behalf of the Department of Health, at the whole issue of parity of esteem and what practical steps could be taken to address it, and it has recently published work on that. How can it be right, for example, that a recommendation by the National Institute for Health and Clinical Excellence on the availability of a drug is a must-do for the NHS but a NICE recommendation on the availability of therapies is not? This means that evidence-based non-pharmacological treatments that are clinically effective and cost-effective are often left unimplemented. I hope that that bias will soon be brought to an end.
The same can be said for access standards. There has rightly been uproar when even small changes occur in the amount of time people wait to attend accident and emergency departments. NICE has said that a person experiencing a mental health crisis should be assessed within four hours, yet only one in three people is so assessed. I am puzzled by the decision not to set a 28-day access standard for therapy, because the NHS constitution should embody parity of esteem, and that is a tangible way it could do so. Having said that, I take heart from the revised NHS constitution handbook, which said albeit it in a footnote:
“The Mandate indicates that we will consider new access standards, including waiting times, for mental health, once we have a better understanding of the current position. We need to do this work and consider carefully the implications of introducing any new standards, before we can make any firm commitments in this area.”
Why on earth is this problem still not being understood? Why do we need yet more reviews? Will the Minister give an indication of the time scale?
Norman Lamb
We clearly need to understand the scale of the problem of access. It is a bit shocking that we do not know the figures across the country for the number of people waiting and how long they are waiting. The mandate of the commissioning board requires that it must establish that and then set access standards. That is really important work, because there is a legal obligation to seek to meet the requirements of the mandate.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Can I help the right hon. Gentleman? We said that he would have 15 minutes, but we are now on 20 minutes and other people are waiting to speak.
Paul Burstow
Thank you, Mr Deputy Speaker. I was looking at the time and at my notes and thinking that I should conclude so that other hon. Members can contribute fully to the debate.
My final point concerns the power of data and the difference they can make. Will the psychiatric morbidity survey, which is due to be repeated in 2014, be repeated? I draw attention to the value of the cancer intelligence network, which has demonstrated the power and effectiveness of nationally co-ordinated data. Given that, as I have said, mental health accounts for 23% of the total disease burden in this country, it really would make sense to have a mental health intelligence network to bring together all the relevant data. I hope the Minister will address how that might be achieved.
In conclusion, estimates put the cost of poor mental health in England, Scotland and Wales at £116 billion, but the right combination of public health, sustained effort to tackle stigma, easy access to psychological therapies for all ages, and good community and crisis care could make a huge difference to that figure. More importantly, it could deal with and reduce the suffering experienced by people with mental problems as a result of our past failures. I hope the Minister will respond positively to this debate, and I am grateful to the other Members who wish to take part in it.
Mrs Madeleine Moon (Bridgend) (Lab)
It is a privilege to follow the right hon. Member for Sutton and Cheam (Paul Burstow). The House will recognise the work that he has done in bringing this issue not just to our attention, but to that of the wider public. I also pay tribute to the hon. Member for Broxbourne (Mr Walker), who has done fantastic work in this area, and to my hon. Friend the Member for North Durham (Mr Jones). [Interruption.] My hon. Friend moves away from me just as I am commending him.
I want to consider mental health issues in the armed forces, because there is an urgent need to address some myths and problems. The armed forces also have wonderful examples of best practice that are not generally appreciated and have not been dispersed throughout wider mental health services.
Looking back in time, there were 80,000 cases of shell shock or battle fatigue during the first world war. The British Government, realising that they had to do something because of problems in getting troops to the front line, started looking at mental health. Changes in mental health treatment started because the military needed to deal with mental health problems.
Jeremy Corbyn
My hon. Friend is making an important point about the experience of the first world war. Does she recognise that there was a great deal of discrimination against and abuse of ordinary soldiers who suffered mental health trauma as a result of the first world war, whereas some of the officers who suffered it got therapeutic treatment in special homes around the country? There was an enormous difference between the approach taken to soldiers and to officers.
Mrs Moon
My hon. Friend is correct. Craiglockhart hospital and the work of Dr Rivers are a prime example of the excellent treatment that was given to some officers. Many people continued to cope with post-traumatic stress disorder, which we now recognise. It was not identified as a condition at the time, although it is detailed in some post-war journals. We have, however, moved forward.
To return to my original point, the military is often at the cutting edge—it needs to be—of looking at mental health problems. Post-traumatic stress disorder has risen up the mental health agenda in the armed forces, mainly because of statistics from the United States. The US Department of Veterans Affairs estimates that post-traumatic stress disorder affects 11% of veterans of the war in Afghanistan and 20% of Iraq war veterans. By contrast, the figure for the UK—these statistics are taken from a 2010 edition of The Lancet—is 4%, while 19.7% reported more common mental health disorders and 13% reported alcohol abuse.
I want to consider the issue of alcohol abuse in the armed forces and its impact on mental health problems. The Ministry of Defence has spent a lot of time providing services, raising awareness and developing programmes such as TRiM—trauma risk management—which I will look at later, and there is far greater understanding of mental health problems among the military. Much of that is thanks to the excellent work of and collaboration between the MOD and King’s college London. I draw Members’ attention to “King’s Centre for Military Health Research: A fifteen year report”, which was published in 2010 and sets out the stunning work that has been carried out. It talks about the roll-out of TRiM. The unit has helped to raise the awareness of most common mental health problems among military personnel, including depression, alcohol misuse and post-traumatic stress disorder, although that is not the most prevalent. The unit found that pre-deployment screening was not effective in picking up problems and that mental health problems did not necessarily apply only to those whose problems had been indentified before they were deployed. Who will be affected by deployment cannot be predicted.
John Glen (Salisbury) (Con)
In the hon. Lady’s investigations into this critical area, has she discerned any difference between the ways in which reservists and regulars are treated with respect to screening and treatment? If she has, does she think that that needs to be addressed?
Mrs Moon
I thank the hon. Gentleman for his intervention. When he was on the Defence Committee, he took a particular interest in this area. As I will explain later, reservists are particularly vulnerable. That is more of a problem in the US because they are deployed for longer and have less support once they are home. However, it is a major issue that we must address in the UK as we increase the percentage of reservists in our armed forces.
The work at King’s college London highlights the importance of adhering to the Harmony guidelines and the negative impact of changing tour lengths during tours. The Secretary of State for Defence announced in a statement yesterday that we are extending the tour length for two brigades that will be deployed over the next two years. That has implications and we must ensure that King’s college London is involved in tracking the changes that it brings.
Rehman Chishti
The hon. Lady is talking about the research undertaken by King’s college London. Experts at Imperial college London have said to me:
“Mental Health Services and research are a UK success story. We have produced world leading research in many areas which has led to new treatment approaches which have improved patients’ lives”.
Will she join me in paying tribute to all the researchers and academics in our country who have done so much to improve the quality of care for patients?
Mrs Moon
The hon. Gentleman is right that a number of universities are doing excellent work in this area. The centre at Oxford has done wonderful research, as have Bristol and Manchester. I have referred several times to King’s college London because of its expertise in defence medicine. I am not denigrating the work that is taking place elsewhere; I am merely highlighting the importance of the work at King’s college London.
The King’s college London research has looked at the importance of decompression, whereby serving members of the armed forces have the opportunity to spend time together and take part in physical activity before they reach home. That has made a huge difference in the mental health outcomes of serving personnel.
Interestingly, the research has identified the groups that are most at risk of problems. They are not those who have served for the longest or most frequently in the armed forces. They are the early service leavers—those who leave the service shortly after their initial training. The risk is higher among those who fulfil combat roles. We forget how small a percentage of our armed forces is made up of people who go out through the gate and pursue combat roles. That work is of great benefit to the military, but it is also important that it is sustained and utilised in our wider understanding of mental health.
I want to talk briefly about TRiM, which is about trauma resilience. It was developed and utilised by the Royal Marines. It trains individuals to identify signs of distress within their own units and within themselves. It means that problems can be identified early on, and help provided quickly. Interestingly, the trauma and resilience handbook that is given to serving personnel and their families provides advice on looking after themselves, talking about their experiences, and how to deal with returning home—coping skills such as dealing with anger and alcohol, combating stress, and sleeping better. It provides tips for spouses, partners, families, friends and parents of returning serving personnel, as well as for the returning reservist. It is a prime example of how we help prepare people for what they are going to experience. We do too little in this country to prepare people for the risks of mental health problems. We do not tell people; we are not educating our young people in how they can identify within themselves, or within their families and friendship groups, some of the risks they will inevitably face in times of difficulty throughout their lives.
I am pleased that the work of TRiM has gained traction elsewhere and been adopted by many other organisations and employers. Even a cursory internet search demonstrated that a number of organisations are using TRiM to help their employers, in particular the blue-light brigades. The police force and Departments including the Foreign and Commonwealth Office frequently train their officers in TRiM.
US research into factors predicting psychological distress among rape victims has shown that initial distress was a better predictor of subsequent psychological functioning than other variables, as well as in the treatment of rape and other types of post-traumatic stress disorder. The use of TRiM and post-traumatic stress disorder management is extending into areas that we had not previously recognised would impact on the general mental health of people in the wider community.
Another area in which the military has taken time to expend its capabilities is the Big White Wall—an online 24/7 early intervention service for people suffering from mental distress. It is free for serving personnel veterans and their families, and as of December last year, 2,500 members of the armed forces community were registered. Seventy-five per cent. of members talked about an issue for the first time on the Big White Wall, 80% managed their psychological distress, and 95% reported an improvement in their well-being as a result of using that service.
There is consensus that reservists are more likely than other serving personnel to experience mental health problems as a result of their service, which is thought to be because when they return from tour they return to civilian life, away from the support network that a regiment offers. Academics at the King’s Centre for Military Health Research, in conjunction with others, conducted a five-year study of 500 reservists who worked in Iraq, which showed that they were twice as likely as regular soldiers to suffer from post-traumatic stress disorder.
Current drives to recruit 30,000 reservists as part of the Future Reserves 2020 programme mean that we will need further research in that area. A number of Members will have an interest in this issue, because reservists come from across the country and live and work in all our constituencies. The most recent figures Combat Stress could give me showed that it had received 1,558 approaches from veterans from Iraq, 123 of whom were reservists. From Afghanistan it had received 752 approaches, including 55 from reservists. With the discharge of large numbers of serving personnel as a result of cuts, I am concerned that high levels of alcohol misuse within the services may be transferred into their civilian life. Service personnel are not a group that readily seek help, and much remains to do in relation to mental health. Our wider society and its services must be ready for the discharge of large numbers of serving personnel into our communities.
Every hon. Member who speaks today will no doubt be aware of the difficulty of working with general practitioners and of making them aware of the mental health services that are available. One problem is that GPs see few veterans. There is a heavy reliance on individuals to make their GP aware of their military service. In 2011, the Royal College of General Practitioners issued guidance to GPs on how to meet the health care needs of veterans, but the onus is on the GP to be aware of it. According to the last figures I have, only 320 GPs had accessed an e-learning package on help to identify veterans with mental health problems. We need to work to increase that number.
Our police forces need to be helped and supported in understanding how often they will come across veterans. Figures show that they are coming across veterans who are dealing with alcohol problems and having episodes of self-harm, which in military terms means looking for fights in which they will receive physical injuries. Alarmingly, a recent independent commission on mental health and policing showed that the Met police have a particularly poor record of dealing with people in mental distress. A quarter of calls to the Met police each year—600,000 calls—were linked to mental health. We need to tidy up the link between mental health and the police.
Norman Lamb
The hon. Lady makes important points on people in the armed forces and veterans. Is she aware of Lord Adebowale’s valuable work and report on the link between police and mental health, which was published last week? It was commissioned by the police and dealt with how to improve the way in which they operate. It is good news that the police were prepared to commission Lord Adebowale’s report and are prepared to listen to his advice.
Mrs Moon
I am very aware of that research; the point I was about to make comes from it. The problem is that we often use the police as our first line in dealing with people with mental health problems, but they are not trained and equipped to carry out that role and function. We must do something about that. Otherwise, the person with the mental health problems is often dealt with as a disruptive element, and treated as if they are someone violent and aggressive, rather than someone who has a mental health problem. We must deal with that problem.
Words and anecdotes can be dangerous, particularly in the military. Research was published this week by the Defence Analytical Services and Advice agency on Falkland veterans. It found that 95 veterans had taken their own lives since the end of the conflict. That figure is lower than previously assumed, although each death is a tragedy for the individual and family involved. The research showed that, of the 26,000 mobilised, 255 died in conflict and 95 took their own lives, but 455 died of cancer. We sometimes forget that our armed forces community has problems we need to address that are not necessarily mental health problems.
Mr Kevan Jones (North Durham) (Lab)
I agree totally with my hon. Friend that each of those 95 people taking their own lives is an individual and family tragedy. My problem is that, in opposition, the Conservatives, including the Prime Minister, took the figure used prior to the research and quoted it freely, like confetti, to try to discredit what the Labour Government were doing for veterans’ mental health.
Mrs Moon
The repeating of such figures is the dangerous part as it places the perception in people’s minds. More dangerously, it goes into the minds of veterans, who then think, “I have served. I will have a mental health problem and post-traumatic stress disorder,” when the opposite is true. It is incumbent on all hon. Members to ensure that our work and the facts we share come from academically proven research. A study by Lord Ashcroft suggested that 92% of the public believe that all veterans will have a mental health problem, but research suggests that the opposite is true—that 90% do well.
We have had a 15-year report from the King’s Centre for Military Health Research, but we need a 20-year report showing the impact of the draw-down from Afghanistan and the increased numbers of veterans in the community.
In this debate on mental health, words can be dangerous—they can harm and create impressions in vulnerable minds. They can make people believe they have a problem they do not have, or that they have a problem that they can survive and grow from. Military mental health is robust. The transition to civilian life, alcohol misuse and reservists are risks that we must take seriously and tackle. The MOD will need to work more closely with the Department of Health. As people leave the armed forces and become civilians, civilian society organisations need to be equipped and ready to help. As civilians, we face the same problems together.
Mr Charles Walker (Broxbourne) (Con)
It is a pleasure to follow the hon. Member for Bridgend (Mrs Moon), who made an important speech on the mental health of military veterans who serve this country so bravely in many theatres.
I am in the Chamber because this debate is extraordinarily important. I could spend this Thursday knocking on doors in my constituency and pressing the flesh. If I was lucky, I might meet 100 people, but by being here, I can represent the interests of many thousands of people. That is why the Chamber of the House of Commons is so important. I hope that, this afternoon, I speak up for the interests of many thousands of my constituents who suffer directly from mental health problems and illness, and many thousands in their families who support them.
We have come a long way in the past year. In June 2012, we had a great debate in the Chamber. Many familiar faces who took part in that debate are in the Chamber this afternoon. In a sense, the lid has been lifted. People now feel much more confident speaking not only of their own mental health experiences, but of mental health in general, and the hopes, aspirations, fears and expectations of their constituents.
Although I have been involved in mental health for about seven years as vice-chairman and now chairman of the all-party group on mental health, I have met an enormous number of organisations in the past year. I have written a few of their names down on a piece of paper. I will not read them all out—that would not look too good in Hansard tomorrow—but I will focus on two or three special people I have met.
Daniel Macnamee from Changing Our Lives has suffered from psychosis and has been very unwell for significant periods. He is well at the moment and recognises the signs when he is about to become ill, so the process and his drug therapies can be managed. Daniel is doing extraordinary things. He is an advocate for people with mental health problems and who are ill, including within hospitals—people who have been either detained or who are there of their own volition.
Andy Sawford (Corby) (Lab/Co-op)
The hon. Gentleman mentions a constituent who becomes aware before he has a psychotic episode. In that situation, he would want acute and crisis services. Is the hon. Gentleman aware of Mind’s work on that? It recently surveyed all primary care trusts, which are now clinical commissioning groups, and mental health trusts about their acute and crisis care services. Does he agree that we ought to ensure that such services are available to people such as his constituent and my constituents?
Mr Walker
I thank the hon. Gentleman for that information. I have campaigned alongside Mind for many years to ensure that people have such services. We talk about support within the community, but it is variable and people’s experience of it is variable. If we are to get things right when people go into crisis or feel a crisis coming on, they need to be confident that the support they require will be there for them. That is why having a crisis plan is so important: people’s wishes can be respected. We too often talk over the heads of people with mental health problems, unwellness or illness—however we define it. We need to be aware of their wishes, because have an absolute obligation to their welfare and to respect their wishes.
Daniel, from Changing Our Lives, is not a constituent; he is just one of the most inspirational people I have met in the 45 years I have tottered along this mortal coil. He is a wonderful man and I am full of admiration for what he is doing.
A couple of days ago, I met Liz Johnson from UK Changes, who works in Staffordshire to ensure that people with mental health issues can remain and keep a foothold in the workplace. For those who are out of the workplace due to illness, her organisation provides mechanisms to help them get back in. The organisation has some reach and I strongly recommend that the Minister meets its representatives. I know there is a drive to ensure that people who have suffered from mental health problems have the opportunity to re-engage with the labour market. One great sadness is that the chance of being in work for those with a diagnosis of psychosis or schizophrenia is approximately 8%. A 92% unemployment rate is unacceptable.
Dame Anne Begg
Generally, people with mental health issues have been in work—they are not young and may be in middle age—but have fallen out of it. Does the hon. Gentleman agree that there needs to be a lot more work done with employers to ensure that an episode of mental ill health does not lead to people being sacked and becoming unemployed? Employers need to be much more sympathetic, helpful and understanding to keep people in the job they already have.
Mr Walker
The hon. Lady makes a fabulous point. Many organisations are doing that at the moment. The Work Foundation launched a report in the House of Commons a couple of months ago, and I was delighted to be able to speak at that event. Some people who had been excluded from the labour market for many years but are now in work spoke at the launch downstairs in the Churchill room. It was moving and uplifting. Good news stories tend to be uplifting and we need to have more of them. There is still a lot of disappointment and sadness in this area, and that is why we have such an obligation in this place to work with all Governments to improve outcomes and ensure we get things right.
Rehman Chishti
Like every other hon. Member here, I pay tribute to my hon. Friend for the work he has done on this issue over many years. Does he agree that the current NHS approaches are too focused on fighting fires, and that more investment in community and preventive care would improve quality and potentially reduce costs, a view shared by an expert from Imperial college?
Mr Walker
I agree with my hon. Friend. We need to ensure that the systems are in place in local communities to provide people with the support they require. Care in the community is a great concept if that care exists. It exists more in some places than in others.
I will not read out all the names on my list, but they show that civil society is alive and well. They are not statutory organisations; they are founded and run by people who wanted to reach out and do something about a problem that was relevant and prevalent in their community. I am full of admiration for them.
Ian Austin (Dudley North) (Lab)
I am grateful to the hon. Gentleman for giving way; he is being very generous. Like other Members, I pay tribute to him for his work on this issue. Before he moves on, I want to touch on the important point about employment. A constituent has written to me to say that employers need to be far more open to the idea of encouraging their employees to talk about these issues and support them in times of need. The loss to companies could be greatly reduced if they were able to support employees through times of mental fatigue and mental illness. Does he agree?
Mr Walker
Absolutely. A lot of good points are being made this afternoon and that is another one. BT and Legal & General are doing a huge amount of work on this. BT does it because it is a decent employer, but also because it wants to hold on to some of its top performers who make a difference to the business. It therefore makes sense to support people and ensure they can stay in work.
We have a fabulous civil society doing wonderful things. The great thing about the area of mental health—it is not all doom gloom; far from it—is the diversity of provision. There are a lot of people out there thinking about different ways of doing things, ways that work for the particular communities they serve. That is to be applauded and promoted. We need to support organisations that provide services that meet the needs of specific groups and their community.
Jason McCartney (Colne Valley) (Con)
I thank my hon. Friend for lifting the lid off the whole issue of mental health. The more times we talk about it in this Chamber, the more we can break down the stigma. It does not surprise me that he has such a long list of wonderful people and local organisations that are doing great things. I met representatives of the State of Mind campaign, which is running in rugby league. It is not a particularly well paid sport, but the campaign is helping young men who suffer from mental health issues. Will he continue, with me and other Members, to support those organisations and the wonderful people who are breaking down these stigmas?
Mr Walker
My hon. Friend makes a fine point. I want to touch, at the end of my speech, on resilience and the terrible tragedy of suicide among young men and women, so I will come back to that.
I remain terribly concerned about psychosis and schizophrenia. I mentioned a few minutes ago that anyone with a diagnosis of psychosis or schizophrenia is likely to be unemployed. If one is not unemployed at the time, one will end up unemployed. Life expectancy, which has already been mentioned today, can be up to 20 years shorter than for someone who does not have that diagnosis. That is not acceptable in a civilised society and should not be tolerated. I have spoken about this before in an Adjournment debate and I want to revisit it because it is so important.
My concern, having talked to people who care for loved ones with schizophrenia—sons, daughters, mothers or fathers—is that sometimes the NHS is more interested in managing the illness than with the overall health needs of the patient. Symptoms are managed down so that patients do not make a nuisance of themselves and take up time, but when one stands back and looks at them, one sees they are desperately unhappy. It does not matter if they are smoking 70 or 80 cigarettes a day, because they are not making a nuisance of themselves. It does not matter if they weigh 20 to 25 stone, because they are not making a nuisance of themselves. It does matter, however, because that patient is slowly killing himself or herself and we have to address that.
I know that the Minister and other colleagues share my concerns, but as a civilised society we just cannot allow this to continue. Yes, progress is being made in the advancement of drug therapies, but not fast enough in mental health. We still have treatments that were breakthroughs in the ’70s and ’80s, but we have not moved on to the 2010s and beyond. The hon. Member for Bridgend rightly said that we have to be very careful about the language we use today and not frighten people. I do not want to frighten people and I hope that she does not think I am, but I get terribly moved when a constituent, who is very ill and being cared for in hospital, writes to me and tells me that once every other week he is held down on the bed and has an eight inch needle injected into his backside. I just think that that must be terribly demeaning, distressing and awful—I am sorry, I am a bit upset about it. We need to get to a place where that does not happen anymore. It will take time, but we need to get there.
Norman Lamb
I pay tribute to the work my hon. Friend does on mental health, and the extent to which he argues the case for a fair share of resources and attention to be given to it. Does he agree that it is important for clinicians, who he was talking about earlier, to listen to loved ones and family members to hear their perspective? Of course there is the issue of confidentiality, but sometimes clinicians hide behind that and are not prepared to listen to those who know the patient best of all.
Mrs Moon
I wanted to follow up on the same issue as the Minister. In preparing for this debate, I received many e-mails from people who had to become experts in the condition in the hope of protecting a family member from exactly the sort of abuse that the hon. Gentleman is talking about. The fear that carers feel when a loved-one comes into contact with the health services, which should be there to protect them and aid them in their passage through their illness, should not exist. That fear should not add to the trauma of their treatment. That is something we have to address.
Gloria De Piero
I wanted to intervene because people were talking about family members. I have a close family member with a severe mental illness. It was a big part of my childhood and early adulthood, and remains a big part of my life to this day. It is so important that we have this conversation. It is not something that people share or talk about because of the stigma that surrounds it. Instead, people internalise it, deal with it and become their own expert, so I would like to thank the Backbench Business Committee for returning to this important issue. It is time to talk and time to change, and I thank the hon. Gentleman, along with Rethink and Mind, for their work in this area.
Mr Walker
I know that the hon. Lady is an expert on these matters. I was going to say in response to the hon. Member for Bridgend that there are experts in this place. I did not want to identify the hon. Member for Ashfield (Gloria De Piero), but, to her enormous credit, she has identified herself. She is a fantastic representative of her constituents, and it is a delight to have her here today.
We have to make progress on drug therapies. Lord Stevenson of Coddenham, who is known to me and the hon. Member for North Durham (Mr Jones) very well, is doing enormously good things in this area. He has established a charity with a significant budget to look into new treatments, pathways and the brain. The charity is called MQ, its chief executive is Cynthia Joyce and I commend its work to the Minister. I would also like to thank my hon. Friend the Member for Loughborough (Nicky Morgan), who cannot speak today because, according to some bizarre convention, Whips cannot speak in the Chamber, which is a great sadness, because I wish she could. I also thank my hon. Friend the Member for Halesowen and Rowley Regis (James Morris), who has done much in this area, and of course the hon. Member for North Durham, who has become a great friend over the past year and is a fellow musketeer in these areas.
I said that I would touch on suicide. We need to build mental health resilience in our schools. That should start at a very young age. It is a great tragedy that many young men and girls decide to end their lives in their teens and early 20s. It is a public health issue, and we need to address it.
Jeremy Corbyn
I compliment the hon. Gentleman on his speech and on his work on this subject. I am glad that he has raised the issue of suicide. Like me, he must be shocked by the number of suicides and attempted suicides within our prison service and by the number of prisoners clearly suffering mental health problems but not receiving the care and support they need. Does he agree that we need a much better regime of training and support on mental health issues for all prisoners?
Mr Walker
I absolutely agree with the hon. Gentleman. It is a great sadness that we shut down and cleared out the asylums only to put too many of those people in our prisons. They go in ill and they come out even more ill and more addicted. It is a disgrace and something we need to address.
I thank colleagues for being here today. I know that the call of their constituencies is hard to resist, but they will be congratulated by their constituents for taking part in this debate. I commend the work of the all-party group on mental health. We have done a lot of work on mental health, schizophrenia and ethnic minority mental health. I see that my hon. Friend for Taunton is here—no, it is not Taunton, but? [Hon. Members: “Totnes.”] Well, it begins with a T for crying out loud. What’s a T among friends? I thank my hon. Friend the Member for Totnes (Dr Wollaston) for her great work. I thank you, Madam Deputy Speaker, and the Backbench Business Committee for allowing the debate to take place, and I thank the Minister and his predecessor, the right hon. Member for Sutton and Cheam (Paul Burstow), who was also a fabulous Minister, for giving the matter such attention and focus. They are to be lauded and applauded.
Mr Kevan Jones (North Durham) (Lab)
It is a pleasure to follow the hon. Member for Broxbourne (Mr Walker), whom I would call my hon. Friend.
I congratulate the Backbench Business Committee and the sponsors of this debate. Remarkably, this is the second debate on this subject in less than a year. I think we should have one every year in order to raise issues that affect many in the House and many of our constituents. Our last debate was on 14 June 2012, when I spoke about my depression and the hon. Member for Broxbourne spoke about his struggle with mental illness. We were both a little wary about what the reaction would be, but it has been nothing but positive, to the extent that he and I have become the Eric and Ernie of the mental health conference circuit. I leave it to you, Madam Deputy Speaker, and the House to discern which of us is Eric and which is Ernie. I have received well over 1,000 e-mails and letters, and I think one was negative, but so what? As I said last time, if people did not like me before I spoke last year, they are not going to like me now.
The most remarkable thing for me is that some people I thought I knew well have told me about their own mental illness. I want to pick out three. I will not name any individuals, and I pick them out only to demonstrate that mental illness and depression are equal opportunity conditions. It is not determined by social status, education or what someone does in life. The first was a chief executive of a large council whom I have know for many years. If she was here today, hon. Members would think her a confident and forthright individual, but speaking to her after the debate, I learned that she suffered terribly from post-natal depression.
The second person was the chief officer for a large European defence company. I am sure that some people in the House have met him several times. He is the last person hon. Members might think suffered from mental illness but, as he explained to me, 10 years ago he suffered from a bad bout of depression. The third person, remarkably, is a retired general I know. Others in the House will know him. I will not mention his name, but again he is not someone we might think suffered from mental illness. I pick out those three to demonstrate my point. These are not weak individuals or failures in life, but confident individuals, and had they not told me, I would not have known, and neither would anyone else, apart from their immediate families.
I want to give another example. I was on Chester-le-Street in my constituency one Saturday morning. I was walking down the street and a lady, perhaps in her late 50s, early 60s, came up to me and said, “Mr Jones, can I thank you for what you said on mental illness?” I said, “Thanks very much.” She said, “I’m a recovering alcoholic who had 10 years of depression, but now, with the proper support, I am leading a good, constructive family life.” Normally, if I had walked past her in the street, I would not have thought that this well-dressed, middle-class lady had suffered from mental illness. That reinforced the point that unlike a broken leg, for example, we cannot see mental illness. Every day we pass people in the street or working with people—people we might know very well—who have suffered from mental illness or who has a family member who has suffered from it.
Ian Austin
What my hon. Friend is saying illustrates how important the speeches that he and the hon. Member for Broxbourne (Mr Walker) made were. The key point is that despite the number of sufferers who battle against these problems at some point in their lives, there is still a huge amount of stigma attached to them. That is why debates such as this are so important. On his point about health, it is quite right that the Government and public health organisations do so much on smoking, weight loss and reducing alcohol intake to improve health and well-being, but why does he think so little is said publicly, or by health organisations generally, to raise the problems of mental health?
Mr Jones
That is our great challenge, and not just for the present Government. We did a lot in the last Government to recognise the problem. I pay particular tribute to my right hon. Friend the Member for Leigh (Andy Burnham), who championed IAPT—improving access to psychological therapies—services, for example, but part of the problem is cultural. We do not talk about these issues in this country. I think that is changing—I will come to the stigma in a minute—but for anyone who has suffered from a mental illness or who has a family member who has, there is a sense of shame. There should not be, but there is a sense in which talking about it means that those people are failures, when I would argue the opposite. In many cases it is a sign of strength. With the right support, people can function normally, work perfectly normally and have a perfectly happy and productive family life.
Yasmin Qureshi
I congratulate my hon. Friend on being brave and speaking about his situation—as I congratulate the hon. Member for Broxbourne (Mr Walker) on speaking about his—and on highlighting the issue. There is a stigma attached to it, and we should discuss it more. My hon. Friend said that the lady who approached him said that she was able to recover after she was given support. Does he agree that some mental health treatments are often quite costly? There is a funding issue, so should we not also encourage the Government to ensure proper funding for services across the country for everyone who may have problems?
Mr Jones
We need to explode the myth that the problem is funding. I do not think it is; I think it is where the funding is spent—a point raised earlier. Indeed, funding that is properly spent on early interventions for people with mental health issues will save the NHS money in the long term, not cost it.
Mrs Moon
There is an issue with the interaction of mental health and alcohol. I repeatedly had texts from a dear friend of mine who is a minister in the Church. He had severe depression and was self-medicating with alcohol. His family and the police would repeatedly take him to mental health services, which would turn him away, because they said he had been drinking. He was drinking because he needed their services and could not access them. We have to ensure that mental health services cannot turn away people who have been drinking, but hold them until they are no longer under the influence of alcohol and then ensure that they access the services they need. The link between alcohol and mental health has to be explored and tackled.
Madam Deputy Speaker (Dawn Primarolo)
Before the hon. Member for North Durham (Mr Jones) continues, let me say that interventions are becoming speeches in their own right, when they are supposed to be brief and pertinent to the point that has just been made. If we could return to that, perhaps it would help the flow of the debate.
Mr Jones
It is a statement of fact that people with mental illness will self-medicate, and alcohol is the most easily available drug. I am surprised by what my hon. Friend describes. If services are taking that approach to people, that is wrong. Her point is also linked to the bigger debate about access to alcohol.
Let me return to the issue of stigma, which my hon. Friend the Member for Dudley North (Ian Austin) raised. He quite rightly said that we do not talk about it, but we are making some progress. I thank Mind, Time to Change, Rethink and the Royal College of Psychiatrists for doing a great job of raising the issue and tackling the stigma. We should remember that it is not just the individuals with mental illness who suffer, but family members too. Earlier my hon. Friend the Member for Ashfield (Gloria De Piero) mentioned her own family. A lot of families suffer in silence because they think there is no one to turn to. In many cases, they think they have failed in some way or wonder where they can get help. It is not uncommon—I have come across a lot of these cases—for carers to end up suffering from mental illness themselves because of the daily pressures on them.
The hon. Member for Broxbourne raised the issue of schizophrenia. I pay tribute to the Schizophrenia Commission, which reported towards the end of last year. It looked not only at services for schizophrenia, but at the stigma attached to. Again, the popular image in the media is that someone suffering from schizophrenia is potentially the mad axeman or woman next door who will come and kick the door in, when nothing could be further from the truth. When we describe people’s conditions, there is an onus on us all to describe them properly, because there are people suffering from schizophrenia who, with proper treatment and support, can function quite normally.
I also pay tribute to the hon. Member for Croydon Central (Gavin Barwell), who introduced the Mental Health (Discrimination) (No. 2) Act 2013—a good use of a private Member’s Bill. Like my friend the hon. Member for Broxbourne, I also pay tribute to Lord Stevenson, not only for championing the Bill through the other place, but for the work he does with his new charity. Did that legislation help in itself? Yes, it did, because it sent a clear signal that we were starting to take discrimination more seriously. Will it change things overnight? No, I do not think it will, but the more we talk about the stigma, the better people can address it.
I have been criticised—we see this occasionally in some newspapers—by people who say, “Well, it’s okay for famous film stars or even MPs to say they’ve suffered from mental illness,” as though it is somehow an easy thing to do, but I can tell Members now that it is not. I would like us to reach a position where people generally are talking about mental illness, so that if people are suffering in a workplace, they can open up to their colleagues. I should point out—not just to people in this Chamber, but to those in the wider audience—that most people who are suffering from a mental illness would be very surprised by the reaction if they told people. However, it is a big step, and I know personally that it is a very difficult one to take.
One of the best examples of that was from a Channel 4 programme that I appeared on after I spoke last year—I pay tribute to Channel 4 for its work to raise awareness of the stigma around mental illness. The programme had the great title of “Mad Confessions” and was presented by a very mad individual called Ruby Wax. By chance, it happened to include one of my constituents, Derek Muir, who suffered from depression. The programme started with him talking about his depression—he had been off work for a number of months and lives in Edmondsley in my constituency. At the end of the programme they got all his colleagues together in a room and he told them. It was the first they had known about it, but the reaction was very positive and supportive. That is the point we need to get to. Sometimes it is a big step for people suffering from mental illness or depression to admit what is seen as a frailty—although it is not. The strength is in opening up and asking for help.
One area that we need to do more work in is getting mental health policies in the workplace right. I pay tribute to BT and Dr Paul Litchfield for their policies, which have buy-in not just at the level of personnel managers, but from the board downwards. They are not only talking about getting people to talk to one another and open up about mental illness, but trying to be supportive of people with mental illness. When I was at a seminar with Paul last year, somebody asked him, “Why has BT done this? Is it just to tick the social responsibility box?” He said no. Indeed, the board was quite clear: the policy makes economic sense for BT. The message we need to get across to more and more employers is: “Why write off people who are valuable to your business, just because they happen to suffer from a mental illness?” BT is to be congratulated, and I certainly congratulate the board and Paul on their work in this area.
John Glen
The hon. Gentleman is making a typically brilliant speech on this subject. Will he also focus on what we could change in regard to education in our schools? For many, laying the foundations of understanding at an earlier stage, prior to the workplace, would be very effective in creating better outcomes and helping all those young people who have to witness mental health problems among adults.
Mr Jones
The hon. Gentleman makes a very good point: schools are important in this regard, and it is important to get young people to talk about the issue. I have a fantastic charity in my constituency called If U Care Share, run by Shirley Smith. It was created following the tragic circumstances in which Shirley’s 19-year-old son hanged himself. Her organisation goes into schools, youth groups and football clubs—Shirley is working with the Football Association and others—to get people talking about their emotions. We need to get more of that kind of work going.
The workplace is important. Although he is not in the Chair at the moment, I want to pay tribute to Mr Speaker, as well as to the House of Commons Commission. Following our last debate on this issue, they earmarked some funding for our own mental health in this place. Dr Ira Madan, the head of the unit across the road that MPs and staff can access, has told me that that was valuable in that it allowed her to assist Members with mental illness, and that there had been an uptake of the services since the money was made available. I would recommend that anyone who wants to go and have a chat with her should do so, as she is a very good and open individual. We must give credit to Mr Speaker and the Commission for that funding, because that was not an easy decision to make, especially as he was getting criticism from certain newspapers for giving special treatment to MPs. It is not special treatment; it is a vital service. Unfortunately, it is still not open to many MPs because of the stigma that surrounds mental illness.
Norman Lamb
I pay tribute to the hon. Gentleman for the incredible contribution that he has made to this subject over the past year or so. It was encouraging to hear what he said about Mr Speaker’s actions, and I want to alert him to the fact that I am trying to get every Government Department to sign up to Time to Change, so that they can all make the commitment to be an exemplar. If we are talking about what employers in the private sector should do, it seems to me that we should be taking the lead here.
Mr Jones
I have spoken at a few events with the Minister, and I want to thank him for his interest in, and understanding of, this subject. Getting Government Departments signed up to Time to Change would be a very good move, and he should please ask if he requires any assistance from me.
I want to talk about an issue that affects many of our constituents—namely, the work capability test and the ongoing issue with the company Atos. Is work good for people’s mental health? Yes, it is. Should people be in work if they can work? Yes, they should, with the right support. The problem with the work capability test, however, is that it is still not looking at people with mental illness with any sympathy or understanding.
I believe that individuals with long-term mental illnesses should be taken out of the current work stream, and that there should be a dedicated system for dealing with such people. I am not saying that we should write them all off and leave them at home without making any assessment, but we cannot continue with the present ludicrous system in which they are assessed by the same people who assess claimants with bad backs and other injuries. There are assessors with no expertise at all in mental illness. The assessment process is leading to some people’s conditions being made worse, and, in some cases, to people taking their own lives. One of my constituents has taken an overdose because of the trauma of being asked to attend an interview.
Jeremy Corbyn
My hon. Friend is making an excellent point. Does he think it would be better if, instead of calling people with mental health conditions in for an interview, Atos simply sought medical reports on them and then considered setting up an interview with a suitably qualified examiner? Would that not be better than the production line that Atos operates at the moment?
Mr Jones
My hon. Friend makes a good point. The starting point should be the medical history of those individuals. Someone at the Department for Work and Pensions has said that it is not possible to identify such individuals, but that is complete nonsense. The process my hon. Friend has just suggested should be the starting point.
Professor Harrington’s review of the process put forward the idea of mental function champions. The Government spun that idea out a bit, as though it was the big answer to the problem, and I actually fell for it at the beginning, thinking that those people would be the ones who would carry out the assessments. That was not the case, however; they are there to give advice to the Atos assessors. We still have assessors with no mental health qualifications.
Representatives of the charity Mental Health Matters, a good advocacy charity in the north-east, have just met Atos to ask about the champions, and a number of questions have been raised. Atos would not tell them how the champions were recruited, and there is no indication that they need any formal qualifications. I understand that they are given a two-day Atos in-service training course, but they do not interact with any of the royal colleges or other outside bodies. Remarkably, they are also not accountable to the DWP. I put it to the Minister that he needs to tell the DWP that this must be looked at again. The process is not only causing a lot of heartache and difficulty for many of our constituents; it is actually not a good use of public money. People are failing the tests and going to appeal. At least one of my constituents has been affected in that way. They sometimes go through the process and end up in a residential hospital for a month, which must cost more than the amount of benefit that might have been saved.
We also need tailor-made programmes for people with mental illness. We should consider a separate work stream that could include voluntary work, given that many people with mental illness find the transition back into work through voluntary work easier than being thrown straight back in. We also need a pool of employers who understand and are sympathetic towards people with mental illness. There is an idea that such people can just join the normal job market and that employers will just accept that they might not turn up for work for a day or a week because they are not feeling well, but that is not the case. Those people will not keep their jobs for very long.
Nic Dakin (Scunthorpe) (Lab)
I was at a recent meeting of the Mind support group in Scunthorpe, and I was concerned to hear people saying that they were anxious about taking on voluntary work because of the impact it could have on their benefits and their access to other services. Does my hon. Friend think that that issue needs to be looked at?
Mr Jones
Yes, it does. If there were a separate work stream for those individuals, of which the voluntary sector was a part, we could use the voluntary sector to get people back into the world of work. I agree with my hon. Friend, however, that they should not be penalised for doing so through loss of benefits.
I also want to talk about the old issue of the NHS reorganisation. It provides some great opportunities for doing things differently, and there should be an opportunity for local providers to bring in the third sector. I have one problem with that, however. I am president of the local Mind, which has just received a contract to provide certain services, and the process it has to go through is very difficult. I am not suggesting for a minute that such organisations should not be performance managed, because there are some large contracts involved, but we need an easier system for applying for the contracts. We also need to ensure that when bodies are competing for the contracts, people can access the services.
Another area of concern is the increased waiting lists for IAPT services. I know that the world has changed since 1 April, and people who lobby on behalf of mental health services are going to have to change their lobbying tactics. It is important to ensure that commissioning groups have an understanding of mental illness and of the importance of IAPT services.
If we look at the Royal College’s report, we find that people are going through the system saying they are quite happy when they get a diagnosis, but are then told they might have to wait up to a year for a talking therapy—that is just no good. What we need—again, this will save the NHS and the economy money—is a quick service such as the IAPT service. I know from people in my own constituency and others who have written to me that the wait is totally unacceptable. If we want to make this work, we have to make sure we have a joined-up service and that people who want a diagnosis get the support they need quickly. Otherwise, people will be stuck in this no man’s land between diagnosis and treatment.
Another area on which the new organisation needs to focus is local government. Local government now has an important role in health care through health education and protection. The Royal College of Psychiatrists is working with councils on a project to have champions at the local level. It is important for local councils to have councillors or chief officers who can champion the need for mental health services locally.
I welcome the debate. It is important to talk about these subjects, and the more we do, the better. To adopt an old BT phrase, “We need to talk”. If we talk about it—whether it be in schools, the workplace or here—we will erase the stigma of mental illness. That has to be the goal: mental illness being treated just like any other long-term condition. People should not be afraid of admitting to it and should not feel that they cannot be helped. We also need to recognise that in many cases—including, I have to say, my own—it can be strength rather than a weakness.
Caroline Nokes (Romsey and Southampton North) (Con)
I add to those of other Members my congratulations to the right hon. Member for Sutton and Cheam (Paul Burstow) on securing this debate, and indeed to the Backbench Business Committee on having agreed the time for it.
I fear I shall stray into what some Members might regard as rather a niche area of mental illness. Some will recall that I led a Westminster Hall debate several months ago on the topic of eating disorders, raising the connection between eating disorders of whatever type and other mental illnesses.
One of the sadnesses I encountered in the run-up to that debate was the trivialisation of eating disorders even by some fellow Members, who made the point that they were not serious conditions but just the afflictions of silly teenage girls who needed to get a grip on their eating patterns. Far from it: in fact, eating disorders are one of the most prevalent mental illnesses. There are thought to be some 1.6 million sufferers in the UK. Anorexia nervosa is the most lethal mental illness: 20% of sufferers eventually die from it and a further 20% never recover.
It is important to recognise that the symptoms of a wide variety of mental illnesses such as low self-esteem, physical abuse and alienation from peers are common traits in a wide range of mental health problems, and are often particularly manifested in eating disorders. As I have said previously, the route map to an eating disorder is not identical for everybody, but similar traits and commons themes can be found. The same route map and traits can be found in schizophrenia and serious personality disorders such as bipolar disorder, for example.
I want to pick up and draw on as a point of contrast the issue of borderline personality disorder. I want to make the point, hopefully as succinctly as I can, that eating disorders are not the poor relation of more serious personality disorders and mental health problems; they are a serious condition of the psyche that should command far greater public awareness and, indeed, greater public spending.
To demonstrate the significant threat posed by eating disorders, one need only make a comparison with a more well-known and recognised mental health problem such as borderline personality disorder. BPD has a higher incidence of occurrence than schizophrenia or bipolar disorder and is thought to be present in about 2% of the general population. It has a phenomenally high rate of suicide and self-harm: 10% of BPD sufferers eventually commit suicide. Those mortality rates are augmented by disorder-related deaths from drug or drink abuse. One of the most well-known cases of undiagnosed BPD was that of the singer Amy Winehouse, who eventually died from alcohol poisoning.
However, anorexia nervosa—like BPD, it is thought to affect roughly 2% of the population—has a 20% mortality rate, which is nearly twice that for BPD. Yet awareness of this shocking statistic is not high; people simply do not know about it. That could be because, unlike BPD, those deaths do not predominantly come from suicide—although that is not uncommon—but happen many years later after the physical effects of anorexia have taken their toll. Many of the deaths occur from multiple organ failure or heart attacks, in addition to the straightforward and more well-known effects of the sufferer having too low a body weight for them to survive.
Mr George Howarth (Knowsley) (Lab)
I congratulate the hon. Lady on the persistence with which she has raised this issue and the trenchant way she argues her case. She will be aware that one of my concerns is type 1 diabetics who, by manipulating their insulin intake, can achieve rapid weight loss, which is in itself a form of eating disorder. Does she agree that the major problem confronting these people is falling between two stools? On the one hand they get physical treatment for the physical consequences of their rapid weight loss—organ damage and so forth—while on the other they have difficulty getting access to proper psychological or psychiatric services. Does she agree that the two need to be more integrated?
Caroline Nokes
I thank the right hon. Gentleman for that timely intervention. That is one of the key problems. Far too often in eating disorders, the treatment is focused on body-mass index and ensuring that the sufferers are physically well, but without necessarily addressing the underlying cause through therapies and treatments that deal with what triggered the condition. The right hon. Gentleman’s example of diabetics who manipulate their insulin intake is a particularly stark one. Anyone who has done work with diabetics knows that incorrect levels of insulin can lead to horrendous physical complications. Across the whole spectrum of eating disorders, there is far too much focus on physical and too little on mental well-being.
The Parliamentary Under-Secretary of State for Health (Anna Soubry)
I would not normally intervene, but will my hon. Friend join me in paying tribute to the right hon. Member for Knowsley (Mr Howarth) for the great work he has done to raise with me and my Department this often unheard of, certainly unrecognised and very serious problem of type 1 diabetics with eating disorders? In considering how to tackle it, it is indeed important that we look at the mental conditions and problems my hon. Friend has identified.
Caroline Nokes
I certainly join the Minister in paying that tribute. I am delighted to hear her make the point that we must start addressing the underlying mental health conditions, when in too many cases the physical treatments are the sole emphasis.
I want to touch briefly on the significant impact eating disorders can have on future career opportunities and in the workplace. As I said earlier, eating disorders are often trivialised and generalised as being conditions affecting teenage girls. That is far from the truth, as the highest rate of increase is among male sufferers. In addition, many eating disorder sufferers are managing their conditions over many years or even decades. I am the first to emphasise that sufferers can be of any age and of either gender, although I acknowledge that the age at which an eating disorder is most likely to manifest itself is 17, and that it is most likely to do so in girls. It often occurs in academically high-achieving individuals who put themselves under immense pressure to be absolutely perfect in every way they can. That frequently manifests itself in a control of food intake. Those determined to put themselves under significant academic pressure also put themselves under massive physical pressure and wish to conform to a body ideal that is actually far from healthy.
I want to pay tribute to the work of April House in Southampton—a specialist unit that focuses on eating disorders in the city. I paid a very enlightening visit to the centre just over 12 months ago and met a number of sufferers, several of whom came from my constituency. Although April House serves the wider Southampton area, three of them were Romsey residents. They have kept in touch with me since my visit, and have emphasised that they have not only benefited from the work done at April House, but have undertaken other therapies.
I am very aware of the work of an organisation in Southampton called tastelife, which was set up by the families of people suffering from eating disorders. The aim was to move the focus away from the physical, and, through self-help groups, to encourage sufferers to talk about their issues, work through them with other people and concentrate on not just physical but mental wellness.
I pay tribute to the hon. Member for North Durham (Mr Jones), who drew attention to the stigma experienced not only by those who suffer from mental health problems, but by their families. Before the Westminster Hall debate, I was contacted by many parents, husbands and, indeed, wives of people with eating disorders, who told me that not just their relatives but they themselves suffered that stigma. A number of them believed that they must be in some way to blame for the fact that their relative, perhaps their child, suffered from an eating disorder. Many were suffering from massive levels of guilt and introspection because they felt they must have somehow caused it.
I have tried to emphasise during discussions of this topic that it is not possible to identify a single trigger, and that a parent cannot do anything to prevent the descent of a child into a form of mental illness, but what that parent can do is help. I was pleased to hear various Members stress the importance of having a parent or other relative as an advocate. In the case of eating disorders, it is almost inevitably the parent who will know the young sufferer best. I think it very important that we be prepared to talk openly about the subject and to move away from the stigma.
Many of those who attended the Westminster Hall debate will remember my hon. Friend the Member for Braintree (Mr Newmark) talking about a pea. He described how he had suffered at school from anorexia nervosa, and had decided to address his condition by seeking to tackle it one step at a time. The first step involved a single green pea on a plate, which he pushed around endlessly, trying to summon up the ability to eat it. His was a moving and interesting account, which gave those of us who had by then been debating the issue for some hours something on which we could really focus: that vision of a plain white plate with a single green pea on it.
Unfortunately the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), is no longer in the Chamber. I am sure the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), will do an admirable job in responding to the debate, but the point I am about to raise is one that I raised with the Minister of State after it was raised with me by an organisation called Anorexia and Bulimia Care.
Once a young person suffering from an eating disorder has turned 16, they can choose to accept or refuse treatment and their parents no longer have a say. In order for them to be force-fed, they must be sectioned. That brings me back to what I said earlier about teenagers who are in the middle of academic exams and approaching A-levels. Being sectioned could have a significant impact on their future career choices.
I am not necessarily suggesting that we should insist that the parents must be in charge until a child reaches the age of 18. The Children’s Minister explained to me carefully and clearly about previous rulings in this place and in the courts which have granted people Gillick competence at an earlier age. I am not saying we should insist that that right be taken away from eating disorder sufferers. I think it important for us to work with health care professionals, and with mental health experts in particular, to find a solution to what I regard as a very knotty problem.
Among the sufferers to whom I have spoken during various meetings at April House and elsewhere, one sticks especially keenly in my mind. She was a lady my own age, and, although she was not one of my constituents, she came from Hampshire. She had suffered from anorexia for decades, and was incredibly frail. When I mentioned April House she shuddered visibly, because she regarded it as a place where she had been effectively force-fed. She had not come through the treatment successfully; here she was, 20 years on, still suffering from anorexia nervosa.
I always find myself—with good reason, I believe—on the side of the sufferer or the patient, and I am therefore not suggesting to the Minister that when it comes to the debate about whether parents should have the right to insist on force-feeding young people until they reach the age of 18, we should enter the fray. I recognise it is a very difficult area. However, I want to leave that thought with the Minister. I have raised the issue with her colleague the Minister of State, and no doubt I will raise it again over the coming months and years.
Jeremy Corbyn (Islington North) (Lab)
Like all the other Members who have spoken, I welcome the debate. It is important for us to have it, and I hope that it will become an annual event. It is a way of reducing the stigma that is attached to mental illness, increasing understanding of it, and also, quite correctly, holding the Government to account on how their policies develop.
There is still an enormous amount of discrimination against people who have suffered from some kind of mental illness or breakdown, or have spent time in a long-stay institution. Like all discrimination, it is incredibly wasteful of resources, because it means that those people cannot contribute to society in the way that we want, and as a result we all lose out.
I want to raise two points. The first relates to local experiences, and the second to national policies. My borough has an image as being relatively wealthy and high-achieving, and there are certainly some wealthy and high-achieving people in it. Islington council, however, undertook an interesting exercise: it set up a fairness commission to examine the quality of the delivery of public services to everyone in the borough, with the aim of ensuring that the purpose of the council’s policies, including health policies, was to reduce inequality.
According to a briefing that the council gave me before the debate, it is estimated that in my borough
“30,000 adults experience depression or anxiety disorders in any one week…. Mental ill health among 5 to 17 year olds is estimated to be 36% higher…than the national average”.
The briefing states that more than one in eight children are
“experiencing mental health problems at any one time.”
It also states:
“The suicide rate is… 8 per 100,000…second highest in London”,
and broadly
“similar to the national average”.
Physical ill health is often related to mental health problems. According to the briefing,
“Poor mental health was found in 43% of all Islington patients who died of cardiovascular disease before the age of 75. As people live longer, there are an increasing number of people with dementia, although Islington has a relatively smaller number of older people”—
only 9% of the population. Islington has a 70%—higher than average—rate of diagnosis of dementia. Increasingly, as others have pointed out, people who care for adults with mental health problems are much older people who find it extremely difficult to cope. Those carers need more support, so that they are better able to look after people who are becoming more and more dependent.
Both my local council, in its study, and the Mental Health Trust draw attention to the enormous over-representation of people from black and minority ethnic communities in the context of diagnosis and, in particular, the context of long-stay institutions. We should ask whether there is, in fact, a higher level of prevalence, or whether there is a perception that it is somehow OK to put black and minority ethnic people into long-stay institutions, whereas it would not be OK in the case of other people.
Indeed, I urge Members to visit long-stay institutions and talk to people resident in them. I get the impression some of them have had very difficult lives and very little support, and that they have led very isolated existences. I also get the impression that many of them have very few friends and very little representation, and whereas those who come from a fairly stable family background with a series of understanding relatives are able to get representation and often win their cases where there has been a section order, others do not get the same quality of representation and consequently do not win any tribunal cases.
In an earlier speech, I made an intervention about the role of the voluntary sector in dealing with mental health conditions. As I have pointed out, my borough has considerable problems in dealing with mental health, but we have a number of very good local organisations that often deal with mental health issues in an innovative and supportive way, and are often very successful. Nafsiyat, an intercultural therapy centre based in Finsbury Park which was founded by the late Jafar Kareem, was groundbreaking in its ideas of looking at the cultural background and ensuring culturally appropriate treatment of people with mental illness, for example by making sure there are people who speak the necessary languages and understand something of the specific cultural background. The Maya Centre, which particularly relates to women, does much of the same work, as does ICAP or Immigrant Counselling and Psychotherapy, a counselling and psychotherapy centre originally founded by people in the Irish community that now deals with a much wider community.
We also have a considerable refugee population. A very good group called Room to Heal deals with people who have achieved asylum status in this country. They have often been through the most dreadful experiences of torture, which are frequently dealt with in a community way. People meet regularly and do things together, such as gardening and taking trips. Many of them improve a great deal and get through the terrible traumas they have suffered. I find it very interesting talking to people from different countries all around the world who have all experienced torture in one form or another and who have benefited from these activities. We also have the Refugee Therapy Centre and the Women’s Therapy Centre, which also provide therapy on a culturally sensitive basis. Finally, we have the Holloway Neighbourhood Group stress project.
These are all valuable groups, and they all depend on contracts obtained either from the local health authority or neighbouring health authorities. All of them spend a great deal of time filling in forms in order to gain what are often relatively small sums of money for relatively short-term contracts. Health authorities must value these organisations and look to use them. We should give out the message that we recognise that the voluntary sector has a very important complementary role to play in supporting statutory services in the treatment of mental illness. I do not see them as competitors or rivals; I see them as complementary.
Mr Kevan Jones
I agree with what my hon. Friend says about the smaller contracts these organisations get and the bureaucracy they have to deal with. Does he agree that some of them could bid for larger contracts to provide services as well, but the bureaucracy and financial hurdles involved in bids for such contracts make it very difficult for them to do so?
Jeremy Corbyn
I agree. The bureaucracy involved and the skewing of the contract culture frequently means voluntary organisations that have a tradition of the voluntary provision of services—often in an effective and innovative way, as I have described—are debarred by the contracting process. Instead, very large private sector medical companies come in to privatise those services and run them in a profit-related way, rather than the voluntary sector, which is motivated not by profit, but by the care of the individuals. I urge Ministers to look very carefully at how services are contracted out to the private sector, which is motivated by profit, as opposed to voluntary sector organisations, which often have a very good record in looking after people who need help and support.
We must also recognise that if we are to deal with mental illness problems in any community, there must be a level of understanding that goes wider than just what GPs, hospital doctors and the statutory services do. There is the question of signposting. I pay tribute to local organisations—voluntary groups, churches, mosques —that understand the situation and help signpost people into getting help and support, because many people in our society with some degree of mental illness get no support whatever. This debate may well help us to understand that that is needed.
We must also recognise that there is a cost involved. The cost to health budgets of dealing with mental health is very high. Unfortunately, the policy of community care for the mentally ill has often resulted in lack of care, and in deep isolation and serious problems for the individuals concerned.
I recall a debate in the House in 1986. The Select Committee on Health was looking in an interesting and critical way at the closing down of large asylums and long-stay institutions, such as Friern Barnet and Napsbury, that existed all around London, and, indeed, all around the country. The Committee warned that community care should not be seen as a cheap option, saying it should instead be seen as an opportunity, but as one requiring comprehensive support, support workers and care.
I am sure all MPs have talked at their surgeries with neighbours of those with mental health problems who have come to complain about noise and inappropriate behaviour. Many of them say to me they are sympathetic to the plight of the individual, and recognise there is a lack of support. We should not see community care as the cheap option. It is an option that can be followed, but a great deal of support is also required to carry it through.
Mr Kevan Jones
Does my hon. Friend also agree that under the new NHS structure, local councils will have to do a lot more in terms of understanding the needs of people with mental health conditions?
Jeremy Corbyn
Absolutely, which is why I referred in my opening remarks to the strategy adopted by my local authority. It has taken the issue very seriously, and has developed a strategy that involves signposting, understanding, support for care in the community and a close relationship with the mental health trust locally. I suspect many local authorities are not particularly well geared up for that role, and they need to address that quickly.
We must recognise that children and young people suffer a great deal of diagnosable mental health conditions. The Mental Health Foundation estimates that one in 10 children suffer from them. One in six young adults aged between 16 and 24 are also suffering from them at any one time. It is very hard for young adults and teenagers to admit they have mental health problems. It is very difficult for them to go to a GP and say they have a mental health problem. Peer group rivalry and peer group abuse—abuse in schools and colleges—is nasty, dangerous, damaging and very hurtful, and can ultimately lead to suicide. The old saying “Sticks and stones can break my bones, but names cannot hurt me” is wrong. Names do hurt. Name calling does hurt. It can lead to young people becoming isolated, and in extreme situations it can lead to suicide.
Mike Crockart
The all-party group on social mobility has looked at that issue, and we found that one of the major things holding children back from realising their full potential was not necessarily access to the right type of education—further education or higher education—or to funding for such education. Instead, it is their having the social and emotional resilience to be able to bounce back from such problems and take their careers forward.
Jeremy Corbyn
The hon. Gentleman is absolutely right in what he says. Bouncing back from these things and then getting on in education or any career is very important. I hope that debates such as this one and the remarks made by hon. Members who have been through mental health problems and depression begin to help give a greater understanding in the much wider community.
I wish to make only a couple more points, because I know that other colleagues wish to contribute to this debate. I intervened earlier about the number of suicides that take place in prisons and the number of people in our prisons who are suffering mental illness. Although such people may be there on the basis of a crime, they need mental health support rather than incarceration in a prison. Today’s edition of The Guardian contains a helpful reproduction of a map of suicides in British prisons. Although the number of suicides has reduced, 833 prisoners committed suicide in the decade up to 2011. When a prisoner commits suicide it is traumatic for the prison and for the prison officers concerned, and devastating for the rest of the prison population. We need to look much more seriously at how our prisons operate, the training that is given to prison officers and the mental health issues that need to be assessed much more carefully by the courts and by the prison services. We also need to examine whether it is really necessary or appropriate to put someone who has a mental health condition into a prison, at any level of security, knowing that there is a real danger of their committing suicide. They are not going to become less better because of this approach; they are probably going to get considerably worse.
My hon. Friend the Member for North Durham (Mr Jones) made an important point about people’s availability for work interviews undertaken by Atos on behalf of the Department for Work and Pensions. I am sure that every hon. Member has had people come to their constituency surgery who have been through the misery of an Atos interview when they are suffering from a mental health condition. Whether on a good day or a bad day, nearly all of them get assessed as being capable of work. They therefore start losing benefits and then go through an appeal. Usually, these people eventually win the appeal, but the trauma caused during that process has led to suicides, to deep depression and to deep fear among them.
When I intervened on my hon. Friend, I suggested that instead of automatically calling those with mental health conditions in for an interview, just as every other person with a disability is called in, medical records should be looked at first and a much more sympathetic and appropriate way forward should be taken. Where someone is able to work and an employer is able to take them on, as there is a job, that is clearly good—we want and welcome that—but we should not force them into it. We should not force people to try to hide mental health conditions. Instead, we should be supportive and sympathetic towards them. I hope that the message we can send from the debate is that that is the direction in which we want to go.
This is a valuable and timely debate on an issue that can affect any of us at any time. We all know people who are affected by mental health conditions and as a society we should stop the name calling, stop the abuse and start understanding this as a condition that we can all suffer from and that we can also, generally speaking, always get over.
Dr Sarah Wollaston (Totnes) (Con)
It is a pleasure to follow the hon. Member for Islington North (Jeremy Corbyn), who made some powerful points. Perhaps I might add to what he said about the appalling difference in respect of the use of compulsory detention under the Mental Health Act 1983 for those from black and ethnic minorities. We heard in evidence that the fear of this among some communities is acting as a deterrent to seeking early help. We must address that, making sure that people do have that access and that that fear is removed from communities in order to improve health for everybody.
I wish to begin by stating for the record that I am married to a consultant NHS psychiatrist who is also chair of the Westminster liaison committee for the Royal College of Psychiatrists, which provides impartial advice to all political parties on psychiatry. He is also now a clinical director of NHS England’s mental health and dementia network in the south-west.
The corresponding debate last year focused importantly on the issue of stigma in mental health, and I congratulate the ongoing work of Time to Change in reducing stigma. The other issue that was raised, which many Members have focused on today, was parity of esteem. It is wonderful that that important principle is established within the Health and Social Care Act 2012, but we now need to ensure that that translates into action and practice on the ground. As we have heard, 23% of the overall disease burden lies in mental health, but we all recognise from stories that we hear in our constituency surgeries, and from clear evidence, that that does not translate into either funding or our constituents’ experiences of services. How are we going to see that translated into action? We need to look at the evidence of what works and to focus on the outcomes.
We know that 30% to 65% of hospital in-patients have a mental health condition and that mental health and physical health are inextricably linked. Not only is someone more likely to suffer from a mental illness if they have a chronic long-term condition, but someone who has a mental illness will find that there is an impact on their physical health. We have heard again about the scandal that the life expectancy of people with a serious mental illness will be shortened by between 20 and 25 years.
Anna Soubry
My hon. Friend is picking up on the point made by the hon. Member for Islington North (Jeremy Corbyn) about there being a real link between public health issues such as smoking and alcohol, and mental health issues. Does my hon. Friend agree that we can do great work in this area at a local level, especially under the new arrangements whereby public health is devolved back down to local authorities, where it used to be and always should have been?
Dr Wollaston
I am grateful to the Minister for that intervention. There has been a consistent tendency to ignore physical health problems in those who have severe mental health illness. She is right to say that putting in primary prevention work locally is important, but the Government could perhaps do more on primary prevention, through having a relentless focus. I am grateful to her for the personal support she has given to addressing issues such as alcohol pricing and the availability of ultra-cheap alcohol. Such issues are very important, and the Government need to deal with them to support the work that is being done. Minimum pricing is, of course, not a magic bullet, but unless we address the issue of ultra-cheap alcohol all the other measures that public health directors wish to take within local communities risk being undermined.
Anna Soubry
Does my hon. Friend agree that we can do great work on the minimum pricing of alcohol at local level? I urge her to examine the work being done in Newcastle and, in particular, in Ipswich, where all the agencies are coming together. We have seen supermarkets and many off licences agreeing not to sell cheap beer and lager. Does she agree that such an approach has the potential to be a better way—I think it is one—of dealing with this issue than minimum unit pricing?
Dr Wollaston
Although I absolutely agree that those projects in Newcastle and Ipswich are impressive, there will, unfortunately, always be ways in which they can be undermined. In my area we can find an example of maximum alcohol pricing, whereby white cider is being sold at a maximum price of 23p a unit, and that is destroying areas. There will always be a way for people to get around a minimum pricing level and, although we can see real benefits from these projects, particularly for street drinkers in isolated pockets, I feel overall that minimum pricing would be a good way of addressing this issue on a wider level. But I will not focus on that today.
I want to draw attention to the evidence on providing integrated services. Mental health and physical health services should be much better integrated. Is the Minister aware of the recent report by the Centre for Mental Health and the London School of Economics, which evaluated the use in Birmingham city hospital of the RAID service—the rapid assessment interface and discharge psychiatric liaison service? Is the Minister aware of the role that liaison psychiatry plays? Such services are greatly appreciated by patients and provide an excellent way for them to receive services; moreover, they are incredibly cost-effective. By providing rapid access to a professional service, not only for in-patients but for people who attend accident and emergency services and those who are seen by the poisons unit, it reduces re-admission rates, provides better care and far better outcomes, and saves money. The pressure on A and E services has been much in the news in recent weeks. Liaison psychiatry reduces re-attendance at minor injury units and A and E departments, so such services are vital. It would be really helpful to know whether the Minister is aware of the evidence base and will be promoting liaison psychiatry services.
I want to talk about social exclusion and the role of mental health services in social exclusion. If a person is homeless, they are far more likely to suffer from mental health problems. Equally, if a person has mental health problems, they are very much more likely to end up homeless and on the streets. In my area of Totnes, we tragically have suffered some deaths among our homeless population. We know from those who provide help to the homeless in south Devon the level of dual diagnosis—the number of people who have both mental illness and, for example, addiction problems. I would very much like to hear from the Minister in her summing up what work will be done to improve access to dual diagnosis. I pay tribute to Mark Hatch and the work that he has been doing, alongside very many dedicated volunteers, with the Revival Life Ministries and with Shekinah, providing an outstanding service to our local community.
I want to raise a point about access to GP services for the socially excluded and homeless. In coming months, there will be much focus on how we reduce health tourism. If, in reducing health tourism, we require people to bring a passport to their GP in order to be registered, very many people who are socially excluded will not be registered because they simply do not have access to identification. I ask the Minister, in addressing an important problem of great concern, to be particularly careful to avoid making it even harder for the socially excluded to obtain help with their problems. That would be a real avoidable tragedy.
Prior to the debate, a constituent wrote to me most movingly about the Cinderella service around autism, and lack of access to mental health services for those who suffer from autism, which has a knock-on effect on their carers. Listening to accounts from parents, who have been struggling for so long to obtain the help that their children need, and their description of what happens as their children move into adult services, it becomes clear that that is an area where services genuinely need to be improved. I look forward to hearing from the Minister what more can be done.
Finally, I return to the Health Committee’s review of the Mental Health Act. Would the Minister look at the evidence on the variation in the use of community treatment orders around the country, and tackle that variation? It cannot be right that in some parts of the country they are not used at all, while in others they are heavily used. The evidence base on their effectiveness is very poor. Should the Government lead on that, or should the royal colleges take a lead, so that we have a system that is transparent and used equally around the country?
Mr Steve Reed (Croydon North) (Lab)
It is a pleasure to follow many moving and thought-provoking contributions. I want to raise the case of Olaseni Lewis, known to his family as Seni, who died after his family left him in the care of the mental health service. Seni was a 23-year-old young black man living in Croydon North, the constituency that I now represent. He had a degree in IT and plans for further postgraduate study.
Seni had no history of mental or physical illness when, on 31 August 2010, he started to behave in an uncharacteristically odd and agitated manner. His parents did what they thought was the right thing by taking him to hospital. He was admitted as a voluntary patient for a few days’ assessment and care. His family left him, when visiting hours ended at 8 pm, with reassurances that they would be contacted if anything happened.
Seni became agitated in his family’s absence, and even more so after he was told that he could not leave the hospital even though he understood he was there voluntarily. It appears he was sectioned in order to detain him against his will, and was then restrained and held face down on the floor by several members of staff and by police officers who had been called after he kicked a door, although there is no evidence that he was violent towards anyone.
Seni was held face down in a seclusion unit by up to 11 police officers for a total of 40 minutes in a way that appears to contravene international conventions on human rights and torture. During the course of that restraint, Seni slipped into a coma and was eventually put on a life support machine, which is how his family found him when they were eventually called four hours after they had left him. He was pronounced dead four days later.
The Independent Police Complaints Commission is responsible for investigating the events leading to Seni’s death. Its investigation began in September 2010. Instead of conducting its investigation under criminal proceedings and interviewing the police officers under caution, it chose instead to accept written accounts which were never challenged. It now accepts that that was a serious mistake.
In August 2011 the IPCC referred the matter and its report to the Crown Prosecution Service to decide whether to prosecute, with a recommendation against. In the meantime, the IPCC had received new information that led it to believe that a criminal prosecution should in fact be pursued. That new information, received in July 2012, was the pathologist’s report, which raised fresh concerns about the extent of restraint used against Seni Lewis. Frustratingly, the CPS refused to accept that new evidence because it was not included in the IPCC’s original report—even though it was the IPCC that wished to amend its own submission. The IPCC claims it has repeatedly raised that point with the CPS, but to no avail. The CPS refused to prosecute.
The IPCC, eager to put right its own admitted mistakes, tried to persuade the Metropolitan police to reopen its investigation in order to trigger a fresh investigation by the IPCC. Following legal advice, the IPPC believed that that would allow it to interview the police officers under caution and include the pathologist’s findings in a new report to the CPS. The Met, unfortunately, had contradictory legal advice telling it that the IPCC could not overturn its own original report and refused to open a fresh investigation. The IPCC is now accusing the Metropolitan police of blocking the investigation that the IPPC wants to reopen.
So we reach a highly unsatisfactory impasse. The police will not reopen the investigation, the CPS will not accept the fresh and potentially compelling evidence, and the IPCC is not allowed to overturn its own decision not to investigate under criminal proceedings even though it believes that the original decision was wrong. In the meantime, a bereaved family have been waiting, with astonishing patience and great dignity, for over two years and eight months for an answer to how and why their beloved son now lies dead after they placed him in the care of a hospital when he showed early signs of mental ill health.
The questions that this case raises are profound and frightening. The organisation Black Mental Health UK is concerned that black people are 44% more likely to be subject to detention under the Mental Health Act than their white counterparts, even though there is no higher prevalence of mental illness among the black community. Once in the system, black people are more likely to be labelled psychotic than their white counterparts for exhibiting exactly the same behaviour. They are also more likely to be given a diagnosis of schizophrenia and to be considered an immediate threat than non-black people. This group is 29% more likely to be subject to restraint and 49% more likely to be placed in seclusion. Black Mental Health UK believes this may be the result of prejudicial assumptions made about young black men in general, and in particular those labelled as suffering from mental ill health.
If black people are being treated differently from other people in a way that threatens their well-being, the community needs reassurance that the mental health service is not institutionally racist. We need a public inquest to establish exactly what happened to Seni Lewis in the four hours after he was first taken by his parents to A and E in Croydon. To date the Lewis family have been failed by the mental health service and the entire criminal justice system. Instead of the open inquiry this case deserves, we are treated to the unseemly spectacle of the IPCC, the CPS and the Metropolitan police fighting with each other and unable or unwilling to work together in the public interest to allow an effective investigation to take place.
I have raised the case of the Lewis family with Ministers over recent months but I am dissatisfied with their responses. When I asked when an investigation would be progressed, I was told this was an operational matter, but this case points to a wider systemic failing that requires Ministers to act and address it. When I asked the Home Secretary what advice was given to the police over how to operate in a mental health setting, I was told none. When I asked what discussions had taken place between the Home Secretary and the Health Secretary about the use of the police in mental health settings, I was told none. When I asked the Health Minister how many patients were restrained in a mental health setting and what their ethnicity was, I was told that the Department of Health does not collect these data. I do not wish to impugn the intentions of Ministers, but I have concluded that they are failing to give this matter the priority it deserves.
Norman Lamb
I apologise that I came in halfway through the hon. Gentleman’s contribution, but he is making extremely serious points. I would be happy to talk further to him about the case after the debate.
Jeremy Corbyn
I compliment my friend on an excellent speech. Does he agree that the problem of representation of people both in initial assessments and when they are placed in long-stay mental health institutions often means that many poorer young black men never get any representation whatever and end up being completely institutionalised as a result, leading to those ludicrously higher statistics for black and ethnic minority people, who are no more prone to mental health problems than anyone else in society?
Mr Reed
I thank my hon. Friend for that contribution. There are a range of concerns about the treatment of black people in the mental health system that need to be tackled to reassure that community.
I believe other Members in the House will agree that this cannot be allowed to go on. I urge Ministers to use their offices to persuade the IPCC, the CPS and the Metropolitan police to work together to obtain a quashing order against the IPCC’s original decision so that a criminal investigation into the Seni Lewis case can go ahead, followed by a full public inquest. Instead of apparently washing their hands of the concerns that this matter raises, Ministers should acknowledge the need for a national strategy on policing within mental health settings.
The organisation Inquest points out that it is an unacceptable anomaly that there is no independent body charged with investigating deaths in the mental health service, as there is for deaths in police custody. As a result of that anomaly, reviews are conducted internally, they may not involve the family affected, and there is no collation or joining up of learning across the service nationally. After this case and other cases like it, the community deserves the reassurance of an independent inquiry into the treatment of black people in the mental health service.
Two years and eight months after their son’s death, the Lewis family still do not know how or why he died. The public hearings scheduled for July 2012 and then March 2013 were both delayed without explanation. Seni Lewis deserves justice. The Lewis family deserve justice and they must not be kept waiting any longer.
Andrew Jones (Harrogate and Knaresborough) (Con)
It is a pleasure to follow the hon. Member for Croydon North (Mr Reed) and other Members from across the House who have given powerful speeches today. I congratulate the Backbench Business Committee on granting this debate and colleagues across the House on requesting it, particularly my right hon. Friend the Member for Sutton and Cheam (Paul Burstow).
This is an important debate because mental health is one of the last taboos in this country. There is still stigma, and that stigma has a devastating impact. The impact is on those who suffer, who can feel isolated and alone, who can face discrimination, who may be reluctant to seek help or the treatment they need and who worry that even suggesting there may be an issue will lead to pressure on families and challenges to careers. So tackling this taboo, removing this stigma, is important, and a way to do that is by encouraging openness, showing that is not just okay to talk about mental health, but right and important to do so. That is why debates such as these are so important.
The last debate we had here on the issue was one of the best I have heard since I started here. Members spoke powerfully and personally, and showed great leadership, particularly the hon. Member for North Durham (Mr Jones) and my hon. Friend the Member for Broxbourne (Mr Walker). Talking about the issue here, in our national debating chamber, helps to change attitudes. It helps those who suffers by demonstrating recognition of their challenges, and it places mental health firmly on the health policy agenda and also on our national agenda.
I have long been concerned that mental health care is a bit of a Cinderella service within our NHS, and that is why I have chosen to speak up about it more than any other health issue locally. Service users are often very vulnerable members of our community and are less able to speak up for themselves. Some of the most challenging, complex and moving pieces of casework I have had to tackle have all involved mental health issues.
Today I shall speak about two areas—dementia care and safe havens. Yesterday I attended the Alzheimer’s Society event in Portcullis House to launch dementia awareness week. Tomorrow I am opening a new care home for dementia patients in Starbeck in my constituency. We all know that dementia is an enormous problem. Every Member will deal with it in their constituency and every family will have to face it at some stage. There are an estimated 800,000 people in the United Kingdom who suffer from Alzheimer’s. In North Yorkshire we have the highest proportion of people aged 85 and over in the north, and we know that one in three people in that age category suffer from some form of cognitive impairment. That is more than 3,000 people in the Harrogate district, but we have a diagnosis rate of only 40% to 45%, so many people suffer without receiving the support they need. The average lifespan in my area for people after a dementia diagnosis is 15 years, so living with and managing the condition is critical.
Ian Swales (Redcar) (LD)
I would like to raise a small point about living with the condition on behalf of my constituent, Caroline Simpson, who has dementia but is physically capable of walking a certain distance. Her family have been unable to get a disabled person’s parking badge. This is an example of the problems that occur in living with dementia.
Andrew Jones
My hon. Friend makes an important point. The challenges are not fully understood and the support that people need is not recognised. That example is just one of many forms of discrimination that can take place.
In North Yorkshire there have recently been some changes in the way the problem is tackled. The Harrogate Dementia Collaborative has been formed, which brings together different bodies. I have met the collaborative and it has told me of the progress it has made. Bringing good care together really makes a difference. It means bringing together the different providers: the local mental health trust, the foundation trust, social services and the voluntary sector.
A few ingredients have contributed to the progress that has been made: working together to provide that integration, which I have already mentioned, and cross-service working is not always easy within our public services; specialist memory nurses, who were not in place two years ago; a clearer pathway to correct and timely treatment, leading to great progress on waiting times; and a determination to provide care in the home or as locally as possible. I applaud the focus being placed on dementia nationally by the Prime Minister and by Health Ministers, both in this Government and the previous one.
When I meet mental health groups in my constituency, one of the issues they raise with me is the provision of a safe haven, a secure place where people can feel safe, and “safe” is the word that is used time and again. It is a place where they can find understanding of the challenges they face, where there is no stigma and where a supportive environment exists. Such places must be provided by local NHS mental health services, but they can also be supported by the work of the voluntary services. I would like to pay tribute to Harrogate Mind and its team, led by its chair, Mr Peter Thompson. I have visited its base, the Acorn centre on Station parade in Harrogate, and found it to be a friendly and relaxed environment with a fantastic range of activities. Users have told me that they view it as an essential safe place for them. However, the provision of such places is also a public duty, something that must be recognised in the NHS and the police services, as the police are often on the front line in dealing with those who face mental health issues.
Lastly, I have been pleased to see the Government recognise the importance of mental health through publication of their “No health without mental health” strategy. I want to see mental health given the status it deserves.
Yasmin Qureshi (Bolton South East) (Lab)
I congratulate the right hon. Member for Sutton and Cheam (Paul Burstow) on securing the debate and thank the Backbench Business Committee for granting it. I also pay tribute to all hon. Members who have spoken today and in the previous debate. They have covered many aspects of mental health, many types of mental health illnesses and many groups of people affected by them.
When many normal members of the public think about people who suffer from mental health problems, they often think about those who go around killing or assaulting people or self-harming, but they are a small minority. The majority of people with mental health problems, as my hon. Friend the Member for North Durham (Mr Jones) said earlier, look very normal; it could be any one of us, or people who look similar to us. Mental health issues do not often result in people self-harming, but there can be problems with depression or with how to relate to families and friends or to the community at large.
Of course, sometimes those health issues are difficult to identify and assess, and as a result it is sometimes hard to prescribe the right treatment. However, I believe that if enough time and effort is taken to try to identify the problem and support the person fully, it is probably easier to find out what is going on and what the right treatment is.
Members have already touched on how people can be reluctant to talk about their mental health issues because there is still an element of stigma and shame. Although it is great that people are talking about it, we know that it is still not being talked about enough and that there is still stigma. Mental health issues can also affect employment and housing and can lead to rejection by family and friends.
Different communities and groups of people have been mentioned. My hon. Friend the Member for Bridgend (Mrs Moon) quite properly touched on mental health issues in the armed forces, and other hon. Members touched on mental health issues in black and minority ethnic communities. I will mention that as well because, in addition to a number of barriers, such as jobs, stigma and rejection by family and friends, they also face the barrier of accessing appropriate care and treatment that is also culturally sensitive.
Although it is accepted that there is nothing genetically that makes people from black and minority ethnic groups more vulnerable to mental health issues, often those issues are not diagnosed properly. Psychiatry in the United Kingdom, understandably, is based on the western understanding of mental illness and often medical models are used to treat it, but in fact mental health means different things to different people from different cultures and different communities, and they can be affected by many different issues, such as spiritual, religious and background issues. Those might relate, for example, to the countries they have come from. Therefore, a purely medical approach is not necessarily the right one for many people. A more holistic approach that looks at a person’s overall health should be considered.
Contrary to what was said earlier, there are of course problems with resources. We know that mental health issues can be very expensive to deal with, because often it is hard to identify what is happening and the treatment might take months or years and require one-to-one assessment. It is much easier when somebody has a damaged arm or a faulty kidney; such conditions can be expensive to treat, but at least they can be identified and treated. Once the treatment is done, the person recovers. But mental health is unique in that respect, because that does not happen.
We know that drug and alcohol addiction is often linked with mental health issues. In fact, units that deal with addiction are very expensive, so there are funding problems. I know that from my own practical knowledge and experience, having been a criminal law practitioner for 20 years before becoming a Member of Parliament. When clients were charged with various criminal offences, they often had psychiatric problems or problems with drug or alcohol addiction. When they were being sentenced, the pre-sentence report would often require us to look into drug or alcohol rehabilitation units. The first question we used to ask was whether the local authority or social services responsible for the person had the necessary funding. Weeks used to go by while everybody searched around to find the funding so that the person could go into the unit. That is why I raised funding for mental health issues earlier and questioned whether it is sufficient and appropriately applied to the whole country. In parts of the country, there are very good practices and systems, but in many others that is not the case. It is a question of ensuring that the same treatment, facilities and services are available across the whole country.
More treatment centres should be available in the criminal justice system. There should also be more psychologists and psychiatrists. The problem we had in criminal cases was that the person in question often needed to be assessed by a medical expert or psychologist, and it used to take weeks and weeks before that could be done, which then used to take time away from treatment. Six months can elapse between somebody being charged and getting treatment. That is if they even get the treatment, because sometimes the funding authority will not fund it, so they end up in the prison system, which does not help them. That is partly why a large number of people, in comparison with the rest of the population, commit suicide in prison.
Everybody here, including Ministers, I am sure, wants to deal with mental health on a humanitarian level, but there is also an economic and financial case for ensuring that the system is working properly. If we are able to help a person to recover from their mental health problems, it will be better for our country and for society generally. For example, if an adult who cares for children suffers mental health problems and is not treated properly, those children will often be taken away and put into care homes or with foster families. That is an incredibly expensive process. If we are able to support and help the parent, the thousands of pounds that it would cost to deal with the problem will be saved. Everyone talks about the humanitarian case, and we all agree with that, but it makes economic sense as well.
I pay tribute to hon. Members who have mentioned their mental health experiences; it is great that that has happened. I hope there is a debate about this issue in the rest of the country and it is appreciated that many people can experience mental health problems of differing natures. If we recognise that, then medical and social services professionals, and others, can intervene to help. I congratulate the hon. Member for Broxbourne (Mr Walker) and my hon. Friend the Member for North Durham on talking about their experiences. It takes a lot of courage for a public person to mention these issues, and I thank them for what they have said.
John Pugh (Southport) (LD)
I apologise to the House for not having been here at the start of the debate. I was in the Finance Bill Committee, and unfortunately I cannot be in two places at the same time. I also apologise for missing the introductory speech by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow). I pay tribute to everything he has done to put mental health on Parliament’s agenda.
It is unquestionably the case that Parliament has got its act into gear on this. I refer to Parliament rather than the Government or the Opposition because this is genuinely an all-party matter. Last night I went to a very encouraging event, which other hon. Members attended, run by the Alzheimer’s Society. The Minister was there, as was the shadow Secretary of State, a Conservative Minister, and my right hon. Friend the Member for Sutton and Cheam, and they spoke with their customary eloquence. In fact, to be fair, there were not very many Members there. I think that other people were detained with matters that had something to do with Europe. However, all of us who were there would have to acknowledge that no matter how eloquently the Minister or the shadow Minister spoke, the most impressive speech was by a very feisty medical lady who had Alzheimer’s and discussed the importance of talking about her condition and people talking to her about it.
That emphasises the fact that there is a blurred division between people who have mental problems, allegedly, and those who appear not to have them. There genuinely is not a clear distinction, other than at the extremes. If we were asked who here has perfect mental health, we would not necessarily all volunteer with alacrity, any more than we would if someone asked who has perfect physical health. It is rather like the Bible saying that the person who is without sin has to step forward. We would not say that because we acknowledge that we all have our own peculiarities and weaknesses and are not as mentally robust as we would always wish to be.
I was made aware of that the other day when I went to an event organised by Liverpool Personal Service Society, which is a well-established charity. The event was a memory day for elderly people in which it invited me to participate. The old ladies and old men were passing round objects that came from their youth, and music was being played in the background that also came from their youth. The environment was made to look almost like a 1950s drawing room. I was very struck by what it did for them. It was like the events organised by football clubs such as Everton and my own local football club in Southport, which bring old men together to talk about teams long since vanished and the glories of the past.
I picked up on two important features of that occasion. First, it was undoubtedly beneficial to the people concerned, who have dementia. Secondly, it is not in any way onerous for anybody else to participate in it. It is incredible fun. It is really enjoyable to hear these people talking about things that are now obsolete, like cigarette cases, nylons of the kind that people had in the war, or EPs—things that we no longer have and that our children do not even understand. That brings it home to us that memory is very relative. There is no magic cut-off point between a memory lapse that may afflict us at any time—
John Pugh
We are presumably talking about unintentional memory lapses—senior moments that may afflict any of us.
There is no absolute cut-off point between mildly obsessive behaviour and obsessive compulsive disorder, between mood swings and genuine bipolar conditions, or even between irrational fears of which everybody is sometimes a victim and some of the conditions we would call paranoia. There is a continuum; it is, to some extent, a matter of degree. It is even possible, apparently, to have hallucinations without having schizophrenia. Delusions are not unique to asylums; there are many victims in this place. There is nothing especially rational about clever, civilised people gathering here every Wednesday at 12 o’clock just to shout at one another.
There are two aspects to addressing the stigma of mental health. One of those is to persuade people that this can happen to anyone, including MPs. That is very important. The other job is to persuade the public that mental health is not an either/or, black/white distinction. I recognise that there are conditions such as serious neurological malfunctions, deterioration of the brain, and so on. Affective disorders can be evident in people classified as being well and also in people classified as being unwell with mental health issues. What determines the classification is not only the severity of the condition—the extent to which the person is down one continuum or another—but the capacity of society to deal with the condition and the ability of the person to cope within society with the condition. The cultural comparison made by the hon. Member for Bolton South East (Yasmin Qureshi) is useful in this context. The mental health of a society and the mental health of individuals are intertwined, and one is the index of the other. I wonder whether, when we talk in this place about producing a prosperous society or economic growth, or doing something about social mobility or social inequality, we ask ourselves sufficiently whether we are doing enough to make society a happy place for us all to live in.
Let me add one other point with which I think you, Madam Deputy Speaker, will be au fait. Community treatment orders were a bone of contention throughout the passage of the Mental Capacity Act 2005, when I served on the Bill Committee. We have to review that issue, and the Minister needs to make a response. I think that we made the right decision, but that depends on whether the Act is understood and implemented properly. There is a genuine case, particularly given some of the variations, for trying to see whether we have got it right.
Mr Charles Walker
On that point, it is very important to ensure that advocacy requirements are being met.
Jane Ellison (Battersea) (Con)
Thank you, Madam Deputy Speaker, for allowing me to speak in this debate. I had not planned to do so, but I realised earlier today that I wanted to address an aspect of female genital mutilation, which I have discussed often in the House. When I listened to the opening speeches, I realised that I have never talked about an issue that many of the campaigners I work with discuss a lot, namely the mental health aspects of both acute and, in particular, chronic FGM.
I just want to put the issue on the record for the Minister to think about; I do not expect any instant answers. As many Members have said, it is hard enough to talk about mental health, but raising the issue of the mental health problems of the victims of a secret, taboo and illegal practice that we have never successfully prosecuted adds several layers of difficulty to an already difficult situation. We know enough, however, for the matter to be put on the record so that somebody at the Department of Health can at least think about it. We should be worried about it.
Female genital mutilation is practised in many countries around the world, but it is predominantly an African practice. In this country, it is practised predominantly by communities from east and sub-Saharan Africa. Most professionals in the field think that the largest diaspora groups in which FGM remains prevalent are probably from Kenya and Somalia; it is certainly heavily practised in those countries.
In the absence of a more up-to-date study, people work on the numbers given in a 2007 study by FORWARD—the Foundation for Women’s Health, Research and Development—which was itself based on the 2001 census. The study established that there are at least 66,000 women with FGM living in England and Wales and that about 21,000 more girls are at risk of becoming victims. Of course, given the substantial migratory trends of people from practising countries to the UK in recent years, the real figure is likely to be higher.
In 2004, the British Medical Association recorded that it believed that there were 9,032 births to women who had had FGM. It should be noted that not all hospitals are required or able to record FGM at birth, and I know that one of the Minister’s ministerial colleagues is looking at trying to get that right. Recent freedom of information requests by the press also show that hundreds of similar women are giving birth every year in hospitals in Leeds, London and elsewhere. We know that this is a problem and that the practice is not being abandoned at anywhere near our desired rate.
During visits to schools in my constituency in recent months, I have asked questions about the issue—other Members may also have done so—but I have not received any satisfactory answers. Most recently, a headmistress who knew about the practice, which is unusual, had been told by a school community worker, “Don’t go there. Let’s not talk about that topic.” This is a problem; do not let anyone believe that it is a myth and that we do not have a problem in the UK.
A study cited by the World Health Organisation in the mid-2000s examined the effects of FGM on the mental health of women. The researchers concluded that FGM is
“likely to cause various emotional disturbances, forging the way to psychiatric disorders,”
especially post-traumatic stress disorder, possible memory dysfunction and other problems associated with trauma.
This issue was brought home to me by a Radio 5 programme I took part in recently after a two-part story on “Casualty”—they were two very powerful episodes—featured the acute health aspects of FGM. The story centred on an older sister who was trying to stop her younger sister being taken abroad to be mutilated, and on the impact of birth on the mother of the family, who had been infibulated.
One of the other guests on the Radio 5 discussion the following morning was a marvellous GP called Dr Abe from Slough, who told me that she sees two or three women a week who have chronic illnesses, some of which are mental-health related, associated with FGM. She asked me—the BMA stresses this and I will cite its guidance in a moment—to imagine the trauma experienced by a small girl who is being held down by people who are usually relatives or people she knows while a brutal procedure is carried out on her without anaesthetic. It is not difficult to imagine that such children will be troubled.
In case anyone thinks that such things do not really happen, let me point out that Dr Abe said that she regularly deals with children and young women whose bodies are contorted with pain and whose limbs are bruised, broken, battered and dislocated as a result of being held down by relatives. Few people who have that done to them by those who purport to be their loved ones will then go on to live with them as a family. I think we can all imagine the special and difficult mental health problem associated with that, and we are only beginning to understand it.
The BMA’s 2011 guidance acknowledged that little is documented about the psycho-sexual and psychological effects of FGM, but it does say:
“Long term consequences might also include behavioural disturbances as a result of the childhood trauma and possible loss of trust and confidence in carers who have permitted, or been involved in, a painful and distressing procedure”
and that
“women may have feelings of incompleteness, anxiety and depression, and suffer chronic irritability, frigidity, marital conflicts, or even psychosis.”
Many of the professionals and campaigners I work with stress the growing problem of anger, particularly among young women who suffered FGM before coming to this country. They are in a conflicted state, because the mentality of those who put them through FGM could not be more different from the mentality that they see around them in Britain. It is considered entirely normal in a sexualised society for magazines to invite young women to express their sexuality and have a fulfilled sex life. If someone has had a procedure carried out on them, the entire aim of which is to stop them wanting to have sex and to be a sexual person, and to restrict them and preserve their virginity—and everything else associated with the centuries-old tradition of FGM—that leads to conflict.
Both Efua Dorkenoo, who wrote the WHO guidelines, and campaigners such as Nimco Ali of Daughters of Eve talk about a growing pool of angry young women who are caught between those two very different worlds. It is also difficult for them to talk about it, because the subject is already taboo. Some Members may have read a recent article in The Sunday Times, which reported that Nimco Ali, who has been very bold in speaking out, has been threatened by people telling her that she should stop speaking out.
Mark Hendrick (Preston) (Lab/Co-op)
Is the hon. Lady saying that FGM is taking place in this country, or are parents taking their children abroad to have it done before coming back?
Jane Ellison
That does not relate strictly to the debate topic, but I will answer. We do not strictly know, but a growing body of evidence suggests that FGM does happen here. The girls I meet through some of the groups I work with will say off the record that it is happening here, but it is more difficult to get people to say so on the record and to point the police in the right direction. For example, women are re-presenting having being re-infibulated in hospital, which is also illegal. I think there is enough evidence now to suggest that FGM is happening here, but I think that the predominant view, and that of the police and the Crown Prosecution Service, is that girls being taken overseas is still the biggest problem. Since 2004, when a private Member’s Bill closed a loophole in the Prohibition of Female Circumcision Act 1985, such girls have also been covered by British law. The extraterritorial aspect of the law means that it is against the law to take a British resident or citizen abroad to perform FGM on them. Either way, that is covered. I think it is happening here, but we do not know.
Jane Ellison
No; to the eternal shame of this country, in 25 years of this being an illegal act, there have been no prosecutions.
In recent times—I will return to the mental health aspects in a moment, Mr Deputy Speaker—we have had encouragement because Keir Starmer, the Director of Public Prosecutions, has been really good on this issue. He has a new action plan for the Crown Prosecution Service. It has reopened several old cases and is going through them with the police to see whether a prosecution is possible. It is also looking more imaginatively at prosecuting the aiders and the abetters, such as the people who set up the travel and those who supply the strong pain killers. If we wait for a seven-year-old girl to walk into a police station and report her parents, we will have a long wait. That is one reason why there have been no prosecutions. However, I am more optimistic now than ever that the police and the CPS are taking the matter seriously.
To return to the mental health aspects, a recent survey by the National Society for the Prevention of Cruelty to Children showed that 83% of teachers either do not know about FGM or have had no training on it. From memory, 16% of teachers thought that condemning FGM was culturally insensitive. That is extremely disturbing, given that it is an illegal act.
Mr Charles Walker
It is child abuse. There is no ambiguity. It is child abuse and it must be stopped.
Jane Ellison
I could not agree more.
My worry is about the 83% of teachers who just do not know about FGM or have not had the training. There are good guidelines, but they are not statutory. Not enough is filtering down. In my constituency, I have encountered people who say, “Don’t go there. It’s too difficult.” There is a role for Members of Parliament in pushing this matter at a constituency level. If teachers have no idea what FGM is or what the behavioural and psychological consequences might be, they will fail to understand why a young girl who has come back from being mutilated abroad is exhibiting naughty, disturbed or bad behaviour. It is therefore important to get more knowledge out there about the physical and psychological aspects of FGM so that we can understand and help children who present with signs of being disturbed.
In UK culture, women have an expectation that their sex life will be enjoyable and that they can have a normal expression of female sexuality. That is very much at odds with the mentality that leads to somebody being mutilated. Many of the women who are suffering the physical and mental complications of FGM do not speak English and live in socially isolated communities in which they are not encouraged to speak about it because it is entirely taboo. That is added to the taboo of speaking about mental health.
The lack of knowledge about FGM among teachers and medical professionals will increasingly be a problem as diaspora communities become scattered to places in the country where professionals do not see it as much. It is easier for a specialist in central London to know what they are looking for. Even if we stopped all FGM happening to young girls tomorrow—would that we could—we would still have to deal with the large number of women who are suffering the long-term consequences of it.
There is documentary evidence that some parents have second thoughts about having done this to their children. Some parents express regret. The Home Office had a good initiative last year, which we adopted from the Dutch, in which it provided girls and parents with a health passport to carry abroad with them to remind members of their extended family that the practice is illegal in the UK and that they must not do it, but must respect the rights of the child.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. It is for the Chair to decide what is in order and what the debate is about. I need no help from the Back Benches, although it was very kind of the hon. Lady to intervene.
Jane Ellison
I have clearly outstayed my welcome, so I will conclude. I realise that time is short.
The point that I want to make is that there is a significant mental health aspect to FGM, but that it is not well documented. Not many of our front-line professionals have it at the front of their minds when trying to explain other problems. I just want to put that on the record so that the Minister and the Department of Health can reflect on it and so that it starts to become a normal thing for mental health professionals to talk about and think about, particularly when they see people from communities that practise FGM and who might have suffered it.
Many of the young girls and women who talk about FGM speak of a silent scream for help. All I wanted to do today was to give that scream a voice in the House of Commons.
Mike Freer (Finchley and Golders Green) (Con)
One of the first mental health cases that I came across was that of a wife and mother who had been subjected to repeated rape by an invading force. She was a refugee in this country. It was a tragic case. Although the physical manifestations of the ordeal had healed, the mental manifestations continued a decade on. She could not function either as a woman or as a mother and wife. That case drove home to me that many of the mental health issues that we face in this country are ignored simply because we cannot see them. That is reflected in the funding priorities in the NHS.
Two issues have come to my attention recently through my casework: the speed of treatment and the consistency of care. One of my constituents had to wait for many weeks to be referred to a psychiatrist. She was able to cope with that, but every time she went to see the psychiatrist for an appointment, she saw a new psychiatrist and had to repeat her case history. Although the notes may have been there, the new psychiatrist either had not bothered to read them or wanted the patient to repeat the details. That was disruptive to the treatment.
My second constituent was a young teenager who grew up being treated for an eating disorder in a residential unit. I see that my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) has returned to her place; I heard her powerful comments. When my constituent turned 18 or 19, she was no longer suitable for the facility that she was in. She had to fight for a new facility, with the help of her parents. When she eventually got into a new facility, it was not in the same place or with the same clinicians. That disruption of care and change in setting set her and her family back a huge amount.
No matter what I did, I could not make the mental health trust realise that sometimes the rules are there to be broken, or at least bent, if the mental health of the patient would benefit from continuity. Continuing my constituent’s care when she was 19 or 20 might not fit the rules, but it fitted the patient. I gently ask the Minister whether there might be some service-level agreements on allowing flexibility in provision.
The NHS website on improving access to psychological therapies does not mention service standards, consistency of clinical care or speed of referrals. The website of the Barnet, Enfield and Haringey Mental NHS Trust mentions a named care co-ordinator, who I assume is an administrator, but there is no mention of clinical standards or continuity and speed of care.
I realise that this is a complex issue and that there are no easy solutions, but I gently ask the Minister whether the Department of Health will consider publishing guidance on speed and continuity of care because it would benefit my constituents greatly.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
I apologise to the House for not being present for the debate’s opening speeches, which was due to circumstances beyond my control. I certainly meant no lack of respect for this debate; I think these Backbench Business Committee debates have been one of the more important and successful innovations of this Parliament, and mental health is a particularly important subject.
I congratulate the right hon. Member for Sutton and Cheam (Paul Burstow) on leading the debate in a detailed and informative fashion, and my hon. Friend the Member for Bridgend (Mrs Moon), who raised a number of important points, including alcohol abuse and its impact on mental health—those two issues are inextricably linked. I follow the hon. Member for Totnes (Dr Wollaston) in saying that if we are concerned about addressing alcohol abuse, one issue—although not the only issue—must be to do something about the flood of cheap alcohol that is overwhelming some of our communities, and put in place a minimum price for alcohol. I am glad to say that that is the Labour party’s policy.
I congratulate the hon. Member for Broxbourne (Mr Walker) on his speech. I remember a similar debate last year in which he made a moving speech about his experience, which resonated country-wide. Since then, he has shown great leadership in the mental health all-party group. He made a number of important points, including the fact that although the NHS can be good at managing symptoms, it is not necessarily so good at addressing their underlying causes. I will return to that issue when I mention Atos later in my remarks.
I am sorry to have missed the remarks of my hon. Friend the Member for North Durham (Mr Jones). He is always well worth listening to, and he too received country-wide respect for his contribution to last year’s debate on mental health when he spoke about his personal circumstances for the first time on the Floor of the House. He made a number of important points, including that mental illness and depression are equal opportunity conditions. They do not discriminate; they affect all social classes and backgrounds.
The hon. Member for Romsey and Southampton North (Caroline Nokes) spoke about a number of issues, including borderline personality disorders and the way that eating disorders affect women and girls. She made the important point that, although we sometimes associate mental disorders with socially marginalised communities and persons, eating disorders can affect the most high-achieving, educationally focused girls. That issue should not be trivialised because it is harming the life chances, health and well-being of many young women up and down the country.
My good Friend the hon. Member for Islington North (Jeremy Corbyn) made an important speech about mentally ill people in prison. When getting caught up with the “prison works” narrative, it is worth remembering how many people in prison are either illiterate or simply mentally ill, and if we want to contain the number of people in the prison estate, we must address the mentally ill. My hon. Friend also mentioned black and minority ethnic communities and mental health, and I will return to that point later.
The hon. Member for Totnes made an important speech and mentioned social exclusion and BME mental health. My hon. Friend the Member for Croydon North (Mr Reed) made an important speech about Olaseni Lewis and the issue of black and minority ethnic persons detained under the Mental Health Act 1983. I am glad that the Minister has agreed to meet my hon. Friend and engage with him and the family on that issue. The hon. Member for Harrogate and Knaresborough (Andrew Jones) also made an important speech.
My hon. Friend the Member for Bolton South East (Yasmin Qureshi) made a speech about—among other things—the importance of a holistic treatment for mental health issues and taking account of people’s different cultural backgrounds, which I thought was important. There was, as always, an interesting and provocative speech from the hon. Member for Southport (John Pugh), and I was interested to listen to the hon. Member for Battersea (Jane Ellison) who spoke about mental health and female genital mutilation—if it had been my choice, her speech could have gone on longer. I thought she raised important issues, and the House should respect the lead that she has shown in addressing the issue, which is difficult for people outside the affected communities to address. If in future some young girls are not subjected to that child abuse because of her work, she will deserve the congratulations of this House. The hon. Member for Finchley and Golders Green (Mike Freer) also made an important contribution.
We have heard figures for the incidence and prevalence of mental health problems, and because it is a Cinderella service and a Cinderella issue it is always worth reminding people that one in six people in Britain is affected by mental illness at any one time. In other words, almost every family will have experience of mental health. It is not something that happens to other people, but something that happens in our own families. One in four of us will suffer from mental illness at some point, and by 2030 depression will be the leading cause of disease around the world, costing the NHS a further £10 billion a year. The criminal justice system will also pick up the bill because 70% of those in our prisons have a mental illness. Mental health problems cost British business almost £26 billion a year.
The subject has been addressed by my right hon. Friend the Member for Doncaster North (Edward Miliband) who made an important speech to the Royal College of Psychiatrists in October last year. The key points he made are worth reporting and concern the importance of breaking down stigma—something that the House dwelt on at length in last year’s debate—and the importance of parity of esteem for mental health within the NHS. My mother was a mental health nurse in Huddersfield, and her hospital was a former Victorian workhouse on the fringes of Huddersfield. Having an old workhouse outside the city for mental health issues, and mainstream health services in the centre, illustrates the lack of parity of esteem for mental health in relation to the services we offer, and also to practitioners at every level within mental health services.
Finally, my right hon. Friend the Member for Doncaster North mentioned the importance of mental health in our society, and argued that good mental health does not start in hospitals but in workplaces, schools and communities. He took the opportunity last October to announce the formation of a taskforce on mental health in society, which will look in particular at employers and the role they play.
Jeremy Corbyn
Perhaps my hon. Friend can help me. I hope that the taskforce will also look at issues surrounding the voluntary sector and its excellent work within the mental health service, as well as the dangerous tendency of franchising out mental health services to the private sector by some mental health trusts that do it for profit rather than care.
Ms Abbott
My hon. Friend’s points are well made.
Let me consider the future for mental health and set out for the House how important the role of local authorities can be in addressing the social determinants of mental ill health. Public health has become the responsibility of local authorities. They have a ring-fenced public health budget, and despite all their pressures and difficulties—which I do not seek to minimise—there is an opportunity for local authorities to do important and interesting work, bringing together education and housing with health care to address mental health problems and intervene in them early.
I was shocked to hear of a social housing project near King’s Cross that, presumably to make its tenants more manageable, did not want to give tenancies either to people who had a history of rent arrears or to people who had a history of mental health problems. Such things need to be highlighted and addressed. Sitting responsibility for public health with local authorities could address mental health, particularly in respect of early intervention and preventive work with children in schools.
I gave a speech this morning on the crisis in masculinity. We need to focus on the mental health challenges that face men. Whether it is because they are unwilling to come forward or because of stress in society, we know that, during a recession or economic downturn, suicide rates among men increase. Suicide is currently the biggest cause of death among under 35s. In planning services nationally and locally, we need to pay particular attention to that issue among others.
The hon. Member for Totnes made an important point. She said that, in our desire to reduce health tourism—a desire supported by the Opposition—there is a notion that people will need their passport when they turn up to see their GP. That runs the risk of making it harder for the socially excluded to access health care—many simply do not have a passport or such documentation.
I will not speak at this point about the merits or otherwise of the welfare reforms, but there is a lot of anecdotal evidence that they are having an effect on the mental health of some who are caught up in the system. There is a lot of anecdotal evidence that Atos, as it is currently configured and as it currently operates, does not meet the needs or seem to understand the problems of people with mental health challenges.
Mark Hendrick
I am sure that my hon. Friend, like many other hon. Members, has come across many constituents attending surgeries who are developing serious mental health problems purely and simply because of the pressures caused by the reforms to the benefits system. I am finding that people who are mentally ill and do not know it are getting worse—they are under pressure from the benefit changes that have been made and those that will take place in future.
Mr Charles Walker
I apologise to the hon. Lady because I am about to leave the Chamber—I am chairing a debate in Westminster Hall in a moment. I agree entirely that Atos should not be a blunt instrument used to beat those who have mental illness. We need a system that empowers people with mental illness to re-enter the labour market, and not one that terrifies them.
I endorse the hon. Lady’s views on young men. Young men need to feel part of something and they need to feel wanted by their community. They need to have a job and a role. If they do not have those things, they join gangs. Her point about young men was beautifully and perfectly made.
Ms Abbott
I entirely agree with hon. Gentleman. Changes in society and economic changes such as the collapse of manufacturing and of de-industrialisation have left many young men unclear about their role, which puts tremendous pressure on their health and well-being.
Before concluding, I want to say a few words on black and minority ethnic persons and mental health. It has been known for at least 25 years that BME persons are disproportionately present in the mental health system. We are more likely to be diagnosed as schizophrenic, less likely to be offered talking therapy, and more likely to be offered drugs and electro-convulsive treatment—the hon. Member for Totnes touched on that important point. There is therefore a great deal of fear and anxiety about approaching the mental health system on the part of some of our BME communities. Very often, mothers will be trapped at home with sons who have serious mental challenges. I have dealt with cases in which they are assaulted in their own homes, but are so frightened of the system that they will stay trapped rather than take their sons for treatment. That is a real problem. We must monitor what is happening and use the voluntary sector. We need to ensure that minority groups do not hold back from presenting with mental health problems. The later people present, the more severe the problems.
Mental health is the biggest financial burden on the health service. It will affect the families of all hon. Members in the Chamber in our lifetimes. There is much to be concerned about in mental health trends. For instance, there is a rise in mental health issues among young people. Fully half of lesbian, gay, bisexual and transgender youngsters are self-harming.
As I have said, there is a relationship between an economic downturn and a rise in suicides of men under the age of 35. None the less, there is the possibility of progress. I believe that there is now less stigma about mental health than there was a generation ago, and the debate we had last year on the Floor of the House played its part in helping to lessen it. I think there is more understanding about some of the contributory issues than there was a generation ago, and I believe that public health going to local authorities opens up the possibility of innovation in mental health, working together with the voluntary sector.
I am grateful to the right hon. Member for Sutton and Cheam for securing the debate. I hope that it is part of a process of parity of esteem that will improve the outcomes for so many of our men, women, family members and communities.
The Minister of State, Department of Health (Norman Lamb)
I thank the shadow Minister for her contribution. I feel that this subject brings out the best in this place—we have had a well-informed, civilised and rational debate. There has been no political point scoring, just thoughtful concentration on an important subject, and I am grateful to all hon. Members.
Before I come on to the contribution of my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), I will say that I completely agree with the hon. Member for Hackney North and Stoke Newington (Ms Abbott) that the arrival of public health in local authorities presents us with an opportunity. The establishment of Public Health England brings its expertise to bear on its relationships with local practitioners in public health, working alongside other services. The potential for public mental health, which has been largely disregarded or ignored in too many places in the past, is real. At the conference for the directors of children and adult services in Eastbourne last October, I attended a presentation by an academic from the London School of Economics on the economic case for interventions in public mental health. There is a powerful return on investment, which means that people are benefiting from it. We have a great opportunity, and I am grateful for the hon. Lady’s comments.
The hon. Lady made important comments about black and minority ethnic communities and the mental health system, and I will come back to that. I appreciated the comments made by the hon. Member for Croydon North (Mr Reed), and I will refer to them later.
The hon. Lady raised the issue of suicide and young people. There are too many cases in too many hospitals where people who have self-harmed turn up and do not get a psycho-social assessment. We know that having that assessment, with the therapy that can follow, massively reduces the risk of suicide, yet only about 50% of A and E departments ensure that that happens. That has to change, because lives are literally at stake. We have to take this issue very seriously.
I am tremendously grateful to the Backbench Business Committee for giving us another chance to talk about mental health. I again pay tribute to my right hon. Friend the Member for Sutton and Cheam for leading the debate and for the great work he did in office to lay the foundations for the progress we are now tangibly making. The previous Government invested heavily in mental health, as well as the rest of the health service, and it is right to acknowledge that progress was made in that period. The focus on parity of esteem, and making it a reality, is potentially exciting. I was struck by an interview with Angela McNab, the chief executive of the Kent and Medway mental health trust, which is one of the larger mental health trusts. She said that the Government were
“prioritising mental health like never before, making sure that it fits on a par with physical health”—
and that this had come as a welcome step change to mental health professionals. That is an encouraging view from the front line.
My right hon. Friend raised several important points, including about recovery colleges. I am very interested in the whole recovery model and the role of recovery colleges. He also talked about the importance of the inspiring Time to Change campaign, which is part- funded by the Government. I mentioned earlier that I am encouraging all Departments to sign up to that campaign, so that we can lead from the front. We cannot expect private sector and other public sector employers to act properly if the Government do not lead, so it is important to demonstrate parity of esteem in the way that the Government treat employees.
My right hon. Friend also referred to the adult psychiatric morbidity survey. I can confirm that discussions are taking place between the Department and the Health and Social Care Information Centre and that it should take place in 2014. He also referred to the intelligence network. NHS England and Public Health England are developing plans and using the cancer intelligence network as a model, not necessarily to replicate, but to learn from. I am grateful to him for raising those issues.
The impassioned words that we have heard today show that within these walls lies the ambition, across all parties, to make the necessary changes, and I thank all hon. Members who have spoken about their experiences, views and, yes, even their criticisms. This sort of open debate can help to challenge stigma, scrutinise services and scrutinise commissioning decisions, which are critical in terms of how much money is allocated to mental health as against physical health and to ensuring that mental health remains a core priority not just for the Government, the House and the NHS and care system, but for the whole of society.
We have heard many good contributions. I shall write to hon. Members to respond to the substantive challenges and questions they have raised, but let me touch now on several quick points made today. The hon. Member for Bridgend (Mrs Moon) mentioned the importance of recognising the link between alcohol abuse and mental health. She talked about people who have left the armed forces with problems of post-traumatic stress disorder, which has become prevalent with the conflicts in Iraq, Afghanistan and so forth. Simon Wessely and his colleagues are doing some fantastic work on that.
The hon. Lady also mentioned the role of the police, particularly the Metropolitan police, and made the valid point that they are not trained well enough or systematically enough. Lord Adebowale, whom I met this week to talk about his report, makes the point that the police will always have to deal with mental health. It is not a question of it being wrong that they are dealing with it; the critical point is that there should be close working between the police and mental health services so that there is an immediate referral, not an inappropriate placing of someone in a police cell. Just imagine suffering from a mental health crisis and ending up in a police cell. It is the worst possible thing that could happen. Even children sometimes end up in police stations. It is totally inappropriate and avoidable—that is the important point.
The hon. Members for Broxbourne (Mr Walker) and for North Durham (Mr Jones), who have done so much to challenge stigma, have performed a valuable service in speaking out about their own experiences of mental illness. They have demonstrated, very visibly, that someone can be successful and make an enormous contribution to society, yet also have mental health problems. That is an incredibly important point. The hon. Member for Broxbourne talked about the role of employers and mentioned some really good employers, such as BT. This is about enlightened self-interest, not just about being kind to people. It is in companies’ and employers’ interests, including the Government’s, to treat mental health issues seriously. The cost to employers when those suffering from mental health problems lose their jobs—the loss of all the training and experience or just the sickness absence—is enormous, but it can be significantly reduced with a smarter approach. The hon. Member for North Durham talked about a number of individuals who have had mental health issues, but also been very successful. He talked a lot about the importance of tackling stigma.
The hon. Member for Croydon North (Mr Reed) made an important contribution about the treatment of black people by mental health services—the shadow Minister talked about that as well. There is something wrong that has to be challenged. The hon. Gentleman raised the case of Seni Lewis, which I am happy to talk to him about—I have surgeries on Monday night and we can discuss this. I have agreed to attend the Black Mental Health conference on police and mental health in June, because I felt it was important that I should engage in this whole issue and take it as seriously as it deserves to be.
The hon. Member for Totnes (Dr Wollaston)—I apologise for missing her contribution and a number of others—raised a number of issues. I will ensure that she receives proper responses to them. She talked about liaison psychiatry. While we are talking about emergency services, one thing that has become more and more apparent to me is the complete disparity between what happens to people with mental health problems and what happens to those with physical health problems. I was utterly shocked—but sadly not surprised—by a letter that a Member of Parliament in the south-west wrote on behalf of a constituent. The constituent had rung the crisis number for mental health services in his area and had not got a reply. No one was answering the crisis helpline. On another occasion they rang and were asked to ring back in half an hour. In the meantime that person could have committed suicide.
Then we come to what happens in A and E and the fact that in too many hospitals there is no mental health specialism available. Last Saturday I met a constituent who had found her son at home with ligature marks round his neck. She took him to A and E, where there was a half-hour conversation with a junior doctor before he was discharged home. The next day she found him hanging in her home. She is determined to pursue the complete failure of the system when something so dreadful can happen.
Whether we are talking about what happens when someone is picked up in the middle of a mental health crisis by the police and taken to a police station inappropriately, what happens when someone tries to get in touch with crisis services or what happens at A and E, we have to have an effective emergency mental health response system in place. This is a matter of real urgency, so I have asked all the relevant organisations—the Home Office, the Association of Chief Police Officers, the Department of Health, the Royal College of Psychiatrists and so on—to come together and draw up an agreed plan to tackle the most stark differences between the treatment received by people with physical health needs and that received by those with mental health needs.
Paul Burstow
That is a welcome announcement from the Minister about achieving parity of esteem in emergency and crisis care. However, in the wake of the Francis inquiry, which rightly drew our attention to serious patient safety and dignity issues in our physical health care system, I suspect that we will need to ensure that we are not distracted or led into not addressing the same issues—which clearly exist—in our mental health systems.
Norman Lamb
My right hon. Friend makes a very good point and I completely agree.
The hon. Member for Romsey and Southampton North (Caroline Nokes) spoke again about eating disorders—I took part in a debate that she secured in Westminster Hall. She talked about the role of parents, the nightmare of a child—I will call them a child—over the age of 16 deciding to refuse treatment and the horror that parents sometimes go through when they are not listened to sufficiently by clinicians dealing with their loved one’s condition. She also mentioned type 1 diabetes sufferers, and I would be interested to hear more about that.
My hon. Friend the Member for Harrogate and Knaresborough (Andrew Jones) is no longer here. Oh, yes he is! He has moved to a different place, just to confuse me. He talked about the low diagnosis rate for Alzheimer’s and dementia in his area. He also stressed the importance of the recognition of mental health by the Government, which I think he welcomed.
The hon. Member for Bolton South East (Yasmin Qureshi) talked about the importance of accessing appropriate and culturally sensitive care and treatment. That is incredibly important, as is getting the approach right for each individual and giving them the power to determine their priorities. She made those points well. She also stressed that the picture round the country was very variable. That is more the case in mental health than in physical health. Some areas have great services, some of which I have witnessed, but in others they are simply not good enough.
Ms Abbott
On the question of culturally appropriate care, does the Minister agree that it can extend to quite mundane matters? There are mental health wards in this country with large numbers of BME people in them. Those people sometimes do not have the right hair care or the right music, or they might not have their culinary needs addressed. Those things can be really disturbing for someone who is already in a mentally fragile condition.
Norman Lamb
Yes, I completely agree. This is about treating people as individuals, and with dignity and respect. Those things are important to people and they should be treated as such.
Jeremy Corbyn
My hon. Friend the Member for North Durham (Mr Jones) and I raised the question of the work capability interviews being undertaken by the Department for Work and Pensions with people with mental health conditions. I do not think that the Minister was in the Chamber at the time, but we suggested that it would be better for the DWP to have access to those people’s medical reports rather than conducting rather bald interviews. Would the Minister be prepared to undertake discussions with the DWP about the treatment during those interviews of people who suffer from mental health conditions?
Norman Lamb
I am grateful to the hon. Gentleman for his intervention. I was going to mention his contribution, even though I was not present to hear it, for which I apologise. As a Member of Parliament, concerns have been raised with me about the suitability of those tests for people with mental health problems, and I was going to suggest that I should talk to the appropriate Minister at the DWP. I am of course happy to do that. Someone else made the point that this is not a question of not addressing the need to help people get back into work. Work is particularly important in relation to people suffering from mental ill health, and the idea that we should simply leave them undisturbed and out of work for the rest of their lives is totally wrong. The way in which we handle this is incredibly important, however, and if we have more to learn in that regard, we should be prepared to learn the lessons.
Mr Kevan Jones
I made the point in my speech that work was good for people with mental illness. The problem is that the present system is inefficient and costly, and that it is creating absolute agony for many people. I know that the Minister has a great understanding of, and a deep passion for, the subject of mental health, and I urge him to put pressure on the DWP to change the system. We are not asking that people should be excluded completely from work capability tests; we are just asking for the system to be changed.
Norman Lamb
I am grateful to the hon. Gentleman for reminding me that he, too, had made that point. I knew that someone else had talked about it, but I could not remember who it was. I take his point; I have heard it.
My hon. Friend the Member for Southport (John Pugh) made a thoughtful speech in which he talked about reminiscences. Oh! He has gone! Even though it pains me, as a Norwich City supporter, to talk about Everton, it appears that Everton and even Southport have done some very good work in these areas. My hon. Friend talked about a continuum of mental health. That was a good point, well made. He also mentioned community treatment orders and the need to look at how they are working. I will certainly reflect on that.
My hon. Friend the Member for Battersea (Jane Ellison) made a powerful contribution about the mental health aspects of female genital mutilation, a most horrific experience suffered by so many young girls. I really pay tribute to her for the work that she has done on that issue. The fact that there are 66,000 females in this country who have suffered this assault was an extremely striking point.
The hon. Member for Finchley and Golders Green (Mike Freer) talked about waiting times for access to treatment. He asked if he could gently challenge the Minister—I appreciated that approach. On the mandate for the NHS Commissioning Board, NHS England has been very clear that we expect it to assess the scale of the problem of access, including for IAPT. Other Members have raised the question of whether we are meeting the IAPT programme’s four-week target. We want the NHS Commissioning Board to assess the scale of the problem with a view to setting access standards.
One of the big problems relating to what I regard as the institutional bias against mental health is that on one side of the equation we have the 18-week maximum waiting time for physical health, which is a very powerful political driver of where the money goes, yet we have nothing equivalent for mental health on the other side. That, to me, is a lack of parity of esteem. For people with mental health problems, early access is particularly important to ensure that their condition can be halted, if possible, and the deterioration stopped. The hon. Member for Finchley and Golders Green made a good point there, and he also rightly talked about the importance of consistency and continuity of care.
I want to mention four of the most important things that this Government are doing to create the environment and incentives for improving mental health across the system as a whole. The first is the Health and Social Care Act 2012, which creates a “parity of esteem” so that mental and physical health share the same importance, as we have discussed this afternoon. Changing the law is just the start, but it sends a clear signal—that mental health is important, and that the health and care system can and must play a leading role in changing attitudes across society as a whole.
Secondly, there is the mandate the Secretary of State has issued to NHS England. It shows the importance we have ascribed to mental health and makes it clear where improvements are needed. The mandate makes clear our overarching goal—that mental health must have equal priority with physical health across all aspects of NHS work. In particular, we have highlighted the need to close the gap in outcomes between people with mental illness and the population as a whole, as well as the absolute imperative to ensure that people can access the services they need when they need them. Neither of these facets of good mental health treatment is entirely up to scratch at the moment. I think we all recognise that.
Mr Andrew Smith (Oxford East) (Lab)
The Minister is generous in giving way, and he is making some very important points. Would he include within this the importance of access to family therapy both to repair broken relationships and to aid recovery—an issue that Oxford Mind raised with me?
Norman Lamb
Yes, absolutely; I understand the importance of that. Incidentally, I visited children and adolescent services in Oxford and I was very impressed by the work under way there. I am getting a message that I am under some pressure from Mr Deputy Speaker to make some progress—
Mr Deputy Speaker (Mr Lindsay Hoyle)
I may be able to help the Minister there. It is not a question of pressure from me; it is a question of the Backbench Business Committee suggesting that Front-Bench contributions should be up to 15 minutes. If he looked at the clock, he would recognise that he has spoken for more than 20 minutes. He should not suggest that the Chair is interfering; it is the Backbench Business Committee.
Norman Lamb
I am sorry for putting the blame in the wrong place; I take full responsibility; I have tried to be responsive to Members as I have proceeded.
We are working with NHS England to decide how best to measure progress in these areas. Because, as we all know, words are not enough, we have to be certain that the objectives we have set out on paper actually translate into better, more accessible care for those who need it.
Thirdly, I mention the three outcome frameworks: for the NHS, adult social care, and public health. These frameworks will enable us to hold the health and care system to account for achieving what matters most—good outcomes for the people who use services and for the population as a whole. In the NHS outcomes framework, there are four measures that relate specifically to mental health and many others that include mental health just as much as physical health. The other outcomes frameworks contain other measures designed to ensure that we improve well-being and tackle the wider determinants of mental health, and that we provide the best possible care and support to those people with mental health problems who need it.
Finally, I want to mention our continuing commitment to the IAPT programme. Since the programme began, it has treated more than 1 million people with depression and anxiety, and as a result nearly 75,000 people have moved from benefits into work. Nevertheless, we need to do more. We are currently involved in a joint programme with the Department for Work and Pensions, which involves commissioning work to find a way of providing much speedier access to psychological therapies for people with mental health problems who are out of work. It seems crazy that we are spending money on benefits when giving those people access to therapy might help them to recover and return to work.
George Freeman
I am sorry that I was not able to be present earlier. I pay tribute to the Government for the work they are doing, and to the Backbench Business Committee for raising this issue. Does the Minister agree that, on the role of mental health in mainstream health, there is important evidence concerning outcomes and compliance with mainstream medicine? Important work carried out in America by the United States Veterans Association and the American dementia and mental health societies has shown the importance of positive psychology in helping people to recover and play an active role in society.
Norman Lamb
The hon. Gentleman has made some extremely good points.
The Government are implementing a diversion service to ensure that, as far as possible, people are diverted from the criminal justice system and from prison if that is not where they should be. If they are suffering from mental health problems, they should ideally be given treatment rather than being locked up inappropriately in prison.
Personal health budgets are a really good innovation, started by the last Government and continued by this one. Giving people—particularly those with mental health problems—power to determine their own priorities, and giving them some control over the resources available for their treatment, is an incredibly important development, for which I shall continue to proselytise at every opportunity.
In order to avoid any further trouble from the Backbench Business Committee—rather than from your good self, Mr Deputy Speaker—I shall draw my remarks to a close.
Today’s debate allows us to explore what more we can do to improve services for people with mental health problems, but as I said earlier it also allows us to encourage others to follow suit. We all have the same ultimate ambition—to provide excellent services and support for all who need it, when they need it—but if we are to achieve that ambition, all groups need to do their bit. We will not be able to do this alone. However, we can lay the groundwork to ensure that local leaders and local people can develop the excellent mental health care and treatment that can turn our common ambitions into reality.
I thank all Members who have spoken today. I also thank the Backbench Business Committee for allowing me to speak beyond my “guideline” time, and to explain what the Government are trying to do to improve access to, and the quality of, mental health treatment. Again, I congratulate my right hon. Friend the Member for Sutton and Cheam on securing the debate.
I am pleased to be able to count on my parliamentary colleagues to maintain the momentum of discussion of mental health in public forums, and I pay tribute to all who have spoken for their incredibly valuable contributions. I look forward to our third convention.
Paul Burstow
I thank the Backbench Business Committee again for enabling us to have the debate. I also thank those on both Front Benches, my hon. Friend the Member for Broxbourne (Mr Walker) and the hon. Member for Bridgend (Mrs Moon), and every other Member who has either intervened in the debate or contributed directly.
Today’s debate on mental health, like last year’s, has created and elevated a sense of hope. It has made it clear that there is a real commitment across parties in the House to do better and to do more: to enable people to gain access to the right care, at the right time, in the right place. That means starting early. It means starting in our schools. It means ensuring that when there is a crisis, we have an emergency service that is as good as our physical emergency services. I welcome what the Minister has said about that today.
A number of Members have suggested that this should become an annual debate. Clearly Parliament needs to hold the Government and the NHS Commissioning Board to account on these issues, and it would be good if we could find time every year to see just how much progress has been made.
It has been very interesting for those of us who follow Twitter to see just how many people have been tweeting about the debate. It has already extended well beyond the confines of this place, and that is to the good. I am pleased that so many Members have taken part, and I am very grateful to them. I hope we will eventually reach a place where there is no health without good mental health.
Question put and agreed to.
Resolved,
That this House has considered the matter of mental health.