Mental Health and Well-being of Londoners
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The Parliamentary Under-Secretary of State for Health (Jane Ellison)
We have, unsurprisingly, had a very thoughtful debate, and this has been a welcome opportunity to discuss such an important topic. I hope that the hon. Member for Liverpool, Wavertree (Luciana Berger) will forgive me if I focus my response on Back-Bench contributions, given that this is a Backbench Business Committee debate. She regularly debates these issues with the Minister of State who leads on care issues.
I congratulate the hon. Member for Hackney North and Stoke Newington (Ms Abbott) on securing this debate on an issue that is important to her and her constituents, and to me as a London MP and my constituents. It is good to see a broad cross-section of London colleagues in the Chamber.
The fact has been well established that at least one in four people will experience a mental health problem at some point in their life. As others have said, that means an estimated 2 million Londoners, and we know that London has the highest rates of mental ill health in the country. Some Members spoke about the reasons for that—those things that we know are responsible—and others suggested alternative reasons. I would slightly guard against the over-use of the word “crisis” and exaggerating to make a political point. To prepare for this debate, as the House would expect, I met some of the leading mental health clinicians in London and put some searching questions to them. I did not gain a sense of crisis, although we all gain the sense that this area has not been given sufficient attention in the past and needs to be given far more attention in the future. We all agree on that, and I hope to outline some of the areas that the Government are paying attention to and working on.
The Government’s commitment to prioritising mental health is encapsulated in the principle of “parity of esteem”, which others have mentioned. This means equal priority for mental, as for physical, health. This commitment was set out in our mental health strategy, “No health without mental health”, in February 2011, and was made explicit in the Health and Social Care Act 2012. Planned NHS spending on mental health is expected to grow by over £300 million in 2014-15, and in our five-year plan for mental health, “Achieving Better Access to Mental Health Services by 2020”, we identified £40 million of additional spending for this year, and freed up a further £80 million for 2015-16. This will for the first time ever enable the setting of access and waiting time standards in mental health services, to which the hon. Member for Islington North (Jeremy Corbyn) alluded.
Looking at the constituency of the hon. Member for Hackney North and Stoke Newington, I am sure she would welcome the fact that the City and Hackney clinical commissioning group has increased spending on mental health services by almost 4% this year, and is investing almost £2 million in a range of new service alliances intended to reduce service variation, reduce inequalities, and improve access and recovery outcomes.
I was glad to hear my hon. Friend the Member for Hendon (Dr Offord) refer to the Mayor’s London Health Commission and the work done by the Mayor’s office. The hon. Lady also referred to the work of the Greater London authority. The commission, led by the Mayor, has identified the mental health and well-being of Londoners as a key priority for the Mayor’s office. Indeed, the Mayor has said:
“Mental ill health is an issue that affects millions of Londoners, yet we are too often frightened to discuss it, worried about what people might think, or unaware of who to turn to.”
That very much captures what was said by my right hon. Friend the Member for Uxbridge and South Ruislip (Sir John Randall).
In a report on London mental health which was published in January last year, the Mayor made clear that mental health is an issue for everyone who lives and works in the capital. The report attempted to quantify, as far as possible, the impact of mental ill health on Londoners in order to gauge the scale of the problem. I shall not repeat the statistics, but they show that there is a considerable impact not only on individuals and their families, but on the economy of our city and everything that flows from it, and on the costs of care. However, despite those substantial costs, diagnosis and treatment rates for mental disorders have remained poorer than those for most physical health conditions. NHS England has worked with partner organisations to establish a strategic clinical network for London chaired by Matthew Patrick. The network’s members include MIND, Rethink and the National Survivor User Network.
Let me now deal with the important issue of race equality in mental health care, to which the hon. Lady devoted much of her speech. The issue is obviously of great concern to her, but it is of concern to all of us, because we all acknowledge London’s incredible diversity, although the degree of diversity in our constituencies varies. Our commitment to tackling inequalities in access to mental health services is set out in our mental health action plan “Closing the Gap”, which was also published in January last year. That plan recognises that people from black and minority ethnic communities are less likely to access psychological therapies. We are working with the sector to find out exactly why that is, and what can be done to change it. NHS England is also working with BME community leaders to encourage more people to use psychological therapies, and to establish the reason for those barriers. In 2012-13, as part of the Time to Change programme, the Department of Health funded a mental health anti-stigma and anti-discrimination project. It ring-fenced 25% of a fund amounting to up to £4 million for work with African and Caribbean communities, which involved building partnerships with trusted BME organisations in BME communities. I think that, to some extent, addresses the point made by the hon. Member for Islington North, who is no longer in the Chamber.
NHS England has worked with Black Mental Health UK, and has established a leadership programme for GP mental health leads for London. A BME taskforce is undertaking a root-and-branch review of mental health services in London, to ensure that they are equitable and free of ethnic bias. I am not sure whether the hon. Lady is in touch with the taskforce, but I am sure that she would want to be. I shall ensure that she is given details of who is leading it, and I should be happy to put other Members in touch with it if they want to know more.
I must put on record that the hon. Member for Islington North is now present. He may not be in the place where he was before, but he is here.
The mental health trust in east London is strengthening families, with a focus on support for BME groups, by helping the families of patients with serious mental health issues, using an approach that treats the condition as being similar to any other long-term chronic illness and providing positive support and advice. That, I think, addresses a question raised by a number of Members: why, in many instances, are such different approaches taken to physical and mental illness?
Members rightly expressed concerns about child and adolescent mental health services. It is estimated that 50% of mental illness in adult life begins before the age of 15 and that 75% of mental illness in adults starts before the age of 18, so—as others have pointed out—early intervention is key. Over the next five years, we will invest £30 million a year in improving services for young people with mental health problems, with a particular emphasis on eating disorders, which were also mentioned. We are investing £54 million between 2011 and 2015-16 in the children and young people’s IAPT—improving access to psychological therapies—programme to transform child and adolescent mental health services. I am glad that my hon. Friend the Member for Hendon mentioned that. Let me also draw attention to his distinguished record in respect of looked-after children; I was very aware of his work when we were both on Barnet council.
Public Health England also plays a role in addressing the mental health needs of Londoners and is engaging with schools, teachers and pupils to promote and build resilience among young people through the London grid for learning. As a partnership, City and Hackney, about which I was briefed in anticipation of the debate, has one of the highest spends in London and England on CAMHS—close to £5 million.
I want to pick up a point that the hon. Member for Hackney North and Stoke Newington mentioned with regard to BME children being recorded in prevalence data. I want to give her some assurance on that. The commissioning of a new prevalence survey on children and young people and mental health is a priority for the Department. Our chief medical officer has identified the need for prevalence data on the mental health of BME children and young people. Therefore, we anticipate that the new survey will look at the prevalence of issues in those groups and we hope to announce the procurement process in the near future.
More than £400 million is being invested over the spending review period to make a choice of psychological therapies available in all parts of England for those who need them. We all acknowledge that we are not there yet, but it is important that as part of the “Five Year Forward View”, NHS England has committed that, by April 2016, 75% of people referred to the IAPT programme will be treated within six weeks of referral and 95% will be treated within 18 weeks of referral; and that more than 50% of people experiencing a first episode of psychosis will be treated with a National Institute for Health and Care Excellence-approved care package within two weeks of referral. Those are important and ambitious targets to secure improvement in this area.
Data on mental health bed occupancy has not been routinely collected across the NHS London region, but NHS London has initiated a process to do that to allow year-on-year comparisons to be made. The first year of the initiative was 2014. The results of that suggested that across the different types of mental health in-patient facilities occupancy rates ranged from 78% to 100% during the period the audit was undertaken, which was September to November 2014.
London’s CCGs are committed to delivering the IAPT access and recovery targets for 2014-15. Additionally, the hon. Lady’s CCG, City and Hackney, is using a range of alliances—I was interested to hear about this—across CAMHS, psychological therapies, dementia, primary care and crisis services to improve the integration of service partners, with a clear focus on involving voluntary sector and social enterprise groups. I am sure that that is mirrored in other parts of London.
The hon. Lady raised the challenges facing LGBT people. The National Institute for Mental Health in England carried out a review that showed that LGB people are at greater risk of suicidal behaviour and self-harm, as others have said, and that the risk of suicide is four times more likely in gay and bisexual men, while the risk of depression and anxiety is one and half times higher in LGB people. I was interested to hear what she said—it mirrors my experience—highlighting the concerns of young gay people from BME communities. I have experienced that too as a constituency MP. Interestingly, some of those people said that the worst prejudice they experienced was from within their community. In that regard, London’s diversity also poses us a challenge sometimes. We as constituency MPs, and in other roles we have in our communities, must try as much as possible to stand up to and challenge that when we acknowledge London’s diversity.
West London mental health trust has a specialised gender dysphoria service, the largest in the country, which is accessed following GP referral to general mental health services with a question as to whether the patient has gender dysphoria. The total annual value of that service is £9.9 million. The London Lesbian and Gay Switchboard provides national information and a listening service over the phone and by e-mail and instant messaging. The helpline operates from 10 am to 11 pm, seven days a week, 52 weeks a year. It is based in London but takes calls from the whole of the UK. I thank all local LGBT support groups. They do such a great job. I look forward to spending this evening with the Wandsworth LGBT forum at one of its film nights. We will watch a new film that addresses issues of particular concern. That organisation provides a great service in my community. I am sure other people have the same experience.
As we have heard, mental health crisis care is crucial. The first national crisis care concordat was published in February last year to improve service responses to people in mental health crisis, and in particular to keep people in mental distress, who have committed no crime, out of police cells. NHS England has signed up to the mental health crisis concordat and is in active partnership in London with the police, the ambulance service, the mental health trusts, CCGs, local government and the voluntary sector, as we would expect. Huge progress has been made in London in reducing the number of people taken to police cells for assessment after they have been detained under section 136 of the Mental Health Act. I am pleased to tell the House that this number has reduced from several hundred a year to less than 20. That is a very welcome process.
Interesting contributions were made by Members on both sides of the House about the conversations we have had with our local police agencies. I, too, had an interesting experience when I went out with two very impressive young officers as part of my rapid response unit locally. They showed great understanding of the challenges they met. It was nice that that was acknowledged in all parts of the House, while also recognising the very considerable concern that the hon. Member for Islington North raised about deaths in custody.
Jeremy Corbyn
I am sorry that I was out for a couple of minutes during the Minister’s concluding remarks. The point about deaths in custody is essentially about the powers of investigation—the powers of inquiry. In my experience, too often it is left to the randomness of whether there is a family and community support network or not. If there is not one, absolutely nothing happens; if there is one, something might happen. I am sure the Minister is aware of this, and I would be grateful if she would have a good look at the INQUEST report on this subject. Perhaps her Department might like to study it and come up with some proposals in relation to its very sensible suggestions.
Jane Ellison
I will of course bring that report to the attention of the right Minister in our Department, and the hon. Gentleman is correct to highlight it.
I want to give a note of assurance on street triage, which was mentioned by my hon. Friend the Member for Hendon. The DOH has funded nine street triage pilots, with police and mental health professionals working together to support people in crisis. In the areas where the pilots are operating, the number of people being detained under section 136 has dropped by an average of 20%. There are some encouraging results.
On the points made only by the hon. Member for Islington North, we are obviously concerned about the reports of high levels of physical restraint. Restraint should only ever be used as a last resort, and we think that the transfer of police custody health to the NHS and commissioning to a standard specification, together with liaison and diversion services being available in every police station, will help to improve that situation and the care and advice available to people in police custody.
I am proud of the Government’s record on mental health, but we have always acknowledged that there is more to be done, and I would not want to suggest any complacency on the part of Government on this vital issue. I will certainly draw to the attention of my DOH colleague the Minister of State who has responsibility for care, all the issues raised by Members on both sides of the House in this very thoughtful debate. I end by thanking all the people in our constituencies—whether within the NHS, the voluntary sector or all the community groups that Members have acknowledged—who provide care to those experiencing mental ill health. We are grateful to them all for what they do to keep Londoners well.