Mental and Physical Health: Parity of Esteem
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The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I join other noble Lords in thanking the noble Lord, Lord Layard, for his tireless efforts in ensuring that evidence-based psychological therapy is available for everyone who needs it, and for convening this debate and providing me with an opportunity to assert once again this Government’s commitment to parity of esteem for mental and physical health.
The Royal College of Psychiatrists, in its recent report, Whole Person Care, describes parity as,
“valuing mental health equally with physical health”.
Equality is certainly the principle which underpins parity. As the noble Baroness, Lady O’Neill, said, equality is not just how we think about mental and physical healthcare but how they are valued. Parity of esteem is not just an abstract concept. It is the subject of an active and ongoing programme between the Department of Health and its system partners, dedicated to closing the gap with physical health services and to translating rhetoric into reality. We made our commitment explicit in the Health and Social Care Act 2012, as my noble friend Lord McColl reminded us, where we enshrined in law the equal importance of mental health alongside physical health. My noble friend Lord Alderdice was right to say that this explicit statement in statute does matter.
The noble Baroness, Lady Warwick, asked how we will improve the skills of GPs and the ability of CCGs to commission mental health services. We have made putting mental health on a par with physical health one of NHS England’s key priorities, as well as ensuring that everyone who needs it has timely access to the best available treatment. The mandate to NHS England is strong on mental health. It makes it clear that everyone who needs it should have that timely access to evidence-based services, and I can tell noble Lords that we are determined that mental health should play a similarly pivotal role in the forthcoming refresh of the mandate for 2014-15. Of course this needs investment, a point which again was made by the noble Baroness, Lady Warwick. We must remember the role of government here: as she knows, the Government set the outcomes that they expect the NHS to achieve in the NHS outcomes framework. There are a number of outcomes specifically for people with mental health problems and others about the quality of services, and patients’ experience of them, which apply equally to mental health services.
One crucial measure is that of excess mortality. It is up to commissioners to prioritise their resources to meet these outcomes for the population, based on assessments of health need, while taking into account the mandates requirement to make demonstrable progress in achieving parity of esteem for mental health services. We will hold the NHS to account for the quality of services and outcomes for mental health patients through the outcomes framework but it is worth noting that in 2011-12, the total invested in mental health services for working-age adults was £6.629 billion, or £193.30 per head of weighted working-age population.
The noble Lord, Lord Layard, my noble friend Lady Tyler and the noble Lord, Lord Hunt of Kings Heath, raised waiting times for mental health and the noble Baroness, Lady Meacher, was particularly concerned about waiting times for children. We are clear that mental health treatment should be available for those who need it and we have asked NHS England, through the current mandate to the NHS, to look into waiting times for mental health treatments. We will be expecting progress on this and my honourable friend Norman Lamb will be taking a close interest in the progress that is made.
The noble Baroness, Lady Murphy, reminded us that too many people with mental health problems die prematurely. We know that people living with significant or persistent mental illness have significantly reduced health and quality of life. They live on average 16 to 25 years less than the general population. That is why reducing premature death in people with serious mental illness is defined as an improvement area in the NHS outcomes framework and why the NHS operating framework specifically focuses on the physical healthcare of people affected by mental illness for the coming year.
The noble Lord, Lord Adebowale, reminded us of the disproportionate burden of mental illness experienced by people from BME communities. We know that black and African-Caribbean men are more likely to be detained under the Mental Health Act. The reasons for this are complex. I can present him with no simple answers; we recognise that more work needs to be done to establish the causes of higher rates of mental illness in some communities and how communities access early intervention services. We are in discussion with a number of BME leaders and influencers on this. I recognise the concerns about incidents in recent years where someone with a mental health condition has either died or been seriously injured after police contact. I welcome the report of the independent review led by the noble Lord, Lord Adebowale, and I echo his view that it is important to get to the truth of matters with clarity of focus and to remove any excuses for not taking the chance to improve practice.
I listened with care to the noble Baroness, Lady Murphy, who called for more psychiatrists. We are supporting local organisations in taking effective action to improve mental health. Our mental health strategy and implementation framework and our suicide prevention strategy focus on specific actions which specific local organisations can take to improve mental health across the life course in their areas. We are investing more than £400 million to give thousands of people, in all areas of the country, access to NICE-approved psychological therapies. The mandate to NHS England makes it clear, as I have said, that everyone who needs it should have timely access to evidence-based services. This will involve extending and ensuring more open access to the Improving Access to Psychological Therapies programmes, in particular for children and young people and for those out of work. My honourable friend the Minister of State for Care Services will be meeting system partners monthly to ensure that IAPT is being delivered.
My noble friends Lady Tyler and Lord Carlile and the noble Baroness, Lady Meacher, spoke about the importance of parity for children and adolescents. Children’s mental health is a priority for the Government. We are investing £54 million over four years in the Children and Young People’s Improving Access to Psychological Therapies programme, giving children and young people improved and timely access to the best mental health care. It will of course be up to NHS England, working with local commissioners, to decide how to spend this money in the most effective way.
Parity is also core business for the reformed health and care system. Key bodies within the system are addressing this. NHS England is working with national clinical directors and others to develop a programme of work with the dual objectives of delivering parity of esteem across the health and care system and supporting NHS England, as an employer, to promote parity of esteem. The priorities here include: support for people with mental health problems following early diagnosis, particularly through appropriate use of primary care and supporting the roll-out of health checks; ensuring people have access to the right treatment at the right time; and measuring and publicising outcome data for all major services by 2015. In other words, they are making every contact with patients count. There will be a statement very soon from NHS England on this. I obviously cannot pre-empt that here but it will set out the detail of this programme of work.
In that context, I pick up a point made by the noble Lord, Lord Stone, about NICE. NICE clinical guidelines are, I put it to him, in no way inferior products to technology appraisals; they often perform a valuable role in putting NICE’s technology appraisal recommendations into the context of the overall care pathway for patients.
My noble friend Lord Carlile rightly emphasised the importance of attending to the mental health of the elderly, but here again it is right for me to point out that the mental health strategy No Health Without Mental Health is an all-age strategy: that is the approach that it adopts and it means that its focus is equally on all members of the population from the young to the old—all are equally important.
My noble friend Lady Tyler spoke about those with complex needs, particularly those who indulge in alcohol and drug misuse. Improving co-ordination between mental health, drugs and alcohol services is vital for improving outcomes for the most vulnerable and excluded. Practitioners may also be involved in the design, planning and delivery of high quality services and are well placed to help GPs and local partners in commissioning high quality services.
My noble friend Lord Carlile spoke of the need for therapists in the community and I listened with care to what he said. Secondary mental health services have been reorganised to improve care in the community and in hospital and timely care and treatment is increasingly offered in the most suitable and least restrictive environment. Even though there are more people being treated in secondary mental health services, the proportion who needed to be admitted to in-patient psychiatric care fell by 2.9% in 2010-11. Acute beds have got to be there for those who need them, but providers have a responsibility to listen to patients and offer care in the community as well as in hospital.
Public Health England is embedding mental health across its work, including developing a national programme for public health mental health. This will support No Health Without Mental Health, prioritising the promotion of mental well-being, the prevention of mental health problems, the prevention of suicide and the promotion of well-being for people living with and recovering from mental illness. I refer to an issue raised by the noble Lord, Lord Hunt, about a focus on reducing smoking. Public Health England’s work plan in relation to mental health and well-being will include a specific part on smoking cessation.
The noble Baroness, Lady Murphy, and my noble friend Lord Alderdice spoke about suicides. Suicide rates in England are low compared to those in other European countries but we are not complacent about these figures, which is why we launched the new suicide prevention strategy in September of last year. The strategy can help sustain and reduce further the relatively low rates. As well as targeting high-risk groups, improving the mental health of the whole population can, of course, prevent suicide and the mental health strategy has that all-population approach, as I mentioned earlier.
Supporting parity is also a key objective of Health Education England. The Government’s mandate to Health Education England recognises the importance of professional culture to achieving parity. It tasks them with ensuring that the mental health workforce has the skills and values to improve services and to promote a culture of recovery and aspiration for their patients. It also notes the importance of mental health awareness in the wider health workforce. My noble friend Lady Tyler argued that maternity services need to look for early signs of mental ill health; I do, of course, agree with that. Mental health is a matter for all health professionals including midwives and health visitors. The Government’s mandate to Health Education England includes the commitment to ensure that all healthcare staff are equipped to treat mental and physical conditions with equal priority.
The noble Lord, Lord Layard, referred to the need for research. As a prerequisite for parity of esteem, ensuring that we have the right data, the right measures, is absolutely essential. One of the most important roles the centre can play is gathering and distributing information about mental health in order to inform evidence-based commissioning and service delivery and that is why NHS England and Public Health England are jointly working to establish a national mental health intelligence network which will be a key driver of continuous improvement in mental health intelligence and information. The noble Lord, Lord Hunt, asked whether the Government are discontinuing the adult psychiatric morbidity survey. The department and the Health & Social Care Information Centre are currently discussing plans for the next survey which should take place in 2014.
My noble friend Lord Carlile spoke about stigma. True parity also requires a shift in attitudes, not just in service providers but across society as a whole. That is why we are investing up to £16 million in the Time to Change programme, supplemented by a further £4 million from Comic Relief. This ground-breaking programme works to empower people to talk about mental health problems and to tackle the discrimination that they face. We aim to make Time to Change reach 29 million people and increase the confidence of 100,000 people with mental health problems to challenge stigma and discrimination.
I say to the noble Lord, Lord Bragg, that the mental health needs of people in the workplace have not been overlooked. Helping people with mental illness find and sustain work is a priority across the health and care system. A measure of employment for people with mental health problems features in all three outcomes frameworks. We are also challenging the stigma and discrimination experienced by people with mental health problems, as I mentioned, in the Time to Change programme and I regard that programme as very much aimed at employers and those whom they employ.
The noble Lord, Lord Layard, suggested that there should be a Cabinet Minister for mental health. While there is not a Cabinet Minister whose sole responsibility is mental health, this does form an important part of the portfolio of the Minister for Care and Support, my colleague Norman Lamb, and I know that this is also one of his personal priorities. We are actively encouraging every government department to pledge its support for the Time to Change campaign and ensure that mental health issues are taken into consideration in policy-making and planning across government.
I hope that the noble Lord, Lord Layard, will think I am right to celebrate some of the achievements to date, but the scale of the challenge ahead should not be underestimated. It will require significant changes to the way mental health services are delivered locally, based on a clear understanding of local needs and with the accent firmly on delivering better outcomes for users. There are exceptional services that others can learn from, but as we move forward a focal point must be more effective collaboration between public services, to enable early identification of mental health problems and to provide more co-ordinated care.
In that context, I pick up a point raised by the noble Lord, Lord Stone, about the police and their interactions with those with mental health issues. I referred to this briefly earlier. We know that we have to have an effective emergency mental health response system in place and we have asked all the relevant organisations, including the Home Office and the Association of Chief Police Officers, to draw up an agreed plan to tackle this problem. Street triage teams, currently being piloted around the country, partner mental health clinicians with police officers to attend emergency responses involving those with suspected mental health problems.
Of course, more needs to be done for acute and crisis care, a point made by the noble Lord, Lord Adebowale. Improving acute mental health services is a key priority for the Government, as identified in the first mandate to NHS England and underpinned by the outcomes framework. As I have said, we are clear that where someone needs an acute bed, it has to be there for them and there has been significant capital investment in the mental health in-patient environment in the past decade.
All of this matters, because achieving parity is a challenge which extends far beyond health and social care. It requires a genuinely cross-government approach, involving all aspects of public service delivery as well as many partners across the voluntary sector. Momentum is gathering and over the months to come I am confident that we will progress further and faster towards our end goal.