Mental Health and Wellbeing Plan
(1 year, 8 months ago)
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Derek Twigg (in the Chair)
I will call Kevan Jones to move the motion, and I will then call the Minister to respond. As is the convention for a 30-minute debate, there will not be an opportunity for the Member in charge to wind up.
Mr Kevan Jones (North Durham) (Lab)
I beg to move,
That this House has considered the mental health and wellbeing plan.
It is a pleasure to serve under your chairmanship, Mr Twigg.
It is now 11 years since there was a major debate in Parliament on mental illness, when I and many other hon. Members spoke about their own experiences. That debate changed attitudes in this place towards mental illness and wellbeing, and both the press and members of the public have made great strides in being able to speak about mental health. We also now have members of the royal family speaking about their own mental illness, and it is heartening to see the Prince of Wales taking mental health and wellbeing as one of their charity initiatives. Unfortunately, however, there is still a lot of progress to be made in delivering timely treatment, particularly prevention and early intervention.
In England, the numbers speak for themselves. Around 1.7 million people are in contact with mental health services, and according to NHS England’s monthly statistic dashboard, 26,000 of them are occupying hospital beds or have a hospital bed open to them. We have also seen severe pressures on ambulance services and the police due to people in mental health crisis asking for help. However, according to the National Audit Office, there could be around 8 million people with mental health needs that are not currently being met by mental health services.
I am sure the Minister will tell us shortly that the Government are delivering record levels of investment in mental health services, but according to research by the Royal College of Psychiatrists, almost a quarter of people are waiting more than 12 weeks for any form of treatment. Some 43% of mental health patients say that longer waiting times make their conditions worse, and 78% resort to attending A&E because they cannot access services. I am sorry, but that is unacceptable. It shows that despite the amount of money going into mental health—I would argue that there needs to be more—much more needs to be done on prevention. We need a joined-up approach across Government to reduce the demand on services and to get people more timely treatment and intervention.
That is why I welcomed the Government’s announcement of the development of a cross-departmental 10-year mental health and wellbeing plan last year, and it was also broadly welcomed by everyone in the mental health sphere, including many charities. It was launched with a great fanfare of publicity as a major initiative by the Government, who said at the time of the launch that
“now is the right time to think about bold, long-term actions to build the mentally healthy society that we want to see in 10 years’ time.”
The then Health Secretary, the right hon. Member for Bromsgrove (Sajid Javid), said that
“our new 10-year plan will set an ambitious agenda for where we want the mental health of our nation to be in a decade’s time.”
Over 5,200 individuals, organisations and stakeholders responded to the discussion paper. Charities such as Mind said that a truly cross-Government plan will play a key role in making sure that support for our mental health starts to rebuild, post pandemic, to the same level as our physical health, so it was a bit of a shock when the 10-year plan was quietly scrapped in January this year. Instead, the Government say that mental health will be addressed in their major conditions strategy. As I have already stated, it is clear from the number of people requiring interventions that mental health should be included in any such strategy.
Rachael Maskell (York Central) (Lab/Co-op)
My right hon. Friend is making an excellent speech, and I completely concur with his concern. There is a challenge. We know we are very interconnected beings, and our mental health and physical health are joined up. If we do not provide the focus required around mental health, it can get subsumed into other priorities, with mental health not having its day, its funding or real impact.
Liz Twist (Blaydon) (Lab)
My right hon. Friend mentioned the consultation and the enthusiasm of the respondents. YoungMinds, a great organisation dealing with young people’s mental health, had 14,000 young people commenting as part of that consultation. Is he as concerned as I am that their views will now be lost and that they will be dispirited?
Mr Jones
I congratulate YoungMinds on its great work. It is disappointing that many of those people will feel let down, that their perfectly legitimate concerns around the mental health of young people will not be taken into consideration in a broader strategy. I will come on to that, but I would like to make some progress.
The major conditions strategy covers cardiovascular disease, including stroke, respiratory disease, musculoskeletal disorders, dementia, and cancer. Those are some of the most challenging areas that face the NHS. As my hon. Friend the Member for York Central (Rachael Maskell) just mentioned, much has been said about parity of esteem between mental and physical health. I am a passionate believer; I believe that the integrated whole approach is right and should be our aim. However, a co-ordinated approach does not simply scrap the plan for mental health and wellbeing, if that means, as my hon. Friend the Member for York Central just outlined, that those will not actually be taken up or given the priority that they need.
If anything, trying to create change across a vast swathe of health in one strategy could risk dealing with none of the challenges that are faced in those different areas.
Jim Shannon (Strangford) (DUP)
I commend the right hon. Gentleman for bringing this debate forward. One of my concerns, which I suspect he has along with others, is for those with eating disorders, which is clearly a mental health and physical issue. Across the United Kingdom of Great Britain and Northern Ireland, there are 700,000 young people with eating disorders. That is not a core part of the Government’s plan, but it needs to be. Does he agree that eating disorders have to be key and core to any strategy addressing mental health and physical health?
Daniel Kawczynski (Shrewsbury and Atcham) (Con)
Will the right hon. Gentleman give way?
Mr Jones
Give me two minutes to make some progress. There are two issues that I want to highlight, which will fall through the cracks without dedicated attention. That is tackling disparities, and the mental health of children and young people, just raised by the hon. Member for Strangford (Jim Shannon). In the original plan for the 10-year strategy, the Government spoke about tackling enhanced disparities. They said:
“Addressing disparities will be a key aim across the whole of the mental health plan—from prevention through to early intervention and treatment.”
Daniel Kawczynski
The right hon. Gentleman is talking about young people. We would all concur that additional support for young people with mental health issues is extremely important. Does he agree that emotional intelligence support for young people is related to this? Does he agree that more emotional intelligence should be taught in schools, to help people through with their mental wellbeing?
Mr Jones
Personally, I would not call it emotional intelligence; I would call it emotional robustness and I will come on to say more about that. However, the hon. Gentleman is right about the importance of trying to make sure that young people are as robust as possible in dealing with the situations that face them now in modern life.
The discussion paper for the 10-year plan mentioned no fewer than 18 disparity factors relating to mental health, including financial insecurity, discrimination, the criminal justice system, poor quality of work or employment, living standards—the list goes on. It is important to acknowledge those factors, because the Government themselves said that they needed to be addressed in mental health and wellbeing plan. Colleagues will know that I have often been on the record saying that the way to tackle mental health and wellbeing is to make sure that we hardwire into Government policy consideration of mental health and resilience across Departments. That is why I welcomed the approach in the plan.
However, building consideration of mental health into a major conditions strategy means that only one disparity factor is likely to be taken into consideration, which is physical health. Many other disparity factors, which are often complex, obviously relate to people’s wellbeing, but I fear they will be sidelined in the strategy.
Let us just take one of those other disparity factors, which is financial insecurity. According to the Office for National Statistics last autumn, around one in six adults experienced moderate or severe depressive symptoms. That increased to one in four for those who find it difficult to pay energy bills, or rent or mortgage payments. And according to a YouGov poll for Barnardo’s, almost a third of parents said that children’s mental health has worsened during the cost of living crisis.
We know that the effect of wellbeing on health includes its effect on mental health, which is substantial. This was such a key priority for the Government that they outlined its importance in their levelling-up agenda. The levelling up White Paper said that
“wellbeing has a bearing on all four of the UK Government’s objectives for levelling up”.
The 10-year plan discussion paper specifically said that
“a new plan for mental health is needed to deliver the Government’s levelling up mission to narrow the gap in healthy life expectancy between local areas”.
However, we now have no mental health 10-year plan, so where does that leave those good words that were in the levelling up White Paper?
We also need early intervention and prevention, which are so important. We know for a fact that around 50% of mental health conditions are established by the time that a child reaches the age of 14 and 75% of them are established by the time someone is 24. However, it is estimated that 60% of children and young people who have diagnosable mental health conditions currently do not receive NHS care. I share the very valid concerns raised by mental health charities and others that scrapping the 10-year plan and merging mental health into the major conditions strategy means that the people who will be at most risk will be children and young people, who are less likely to have chronic physical health conditions, but are most likely to benefit from early intervention, for example counselling or psychotherapy.
I have spoken before about the importance of making sure that we get children and young people’s mental health right. Rates of probable mental health disorders in children aged between six and 16 have risen from 11.6% in 2017 to 18% in 2022. That equates to one in six children aged between six and 16 having a probable mental health condition. And as has already been mentioned, 700,000 children have accessed mental health services in the last 12 months.
Rachael Maskell
The Government need to take on board the important point that addressing the scale of mental health challenges in young people will not just be about health and looking at that major conditions strategy and how it interrelates with other health conditions, but about looking at what society offers, such as the education system, the digital community and so much more, which put so much pressure on young people. Does my hon. Friend agree that that is why we need this focus?
Mr Jones
That was the beauty of the 10-year plan; it was going to do that.
Coming back to children’s and young people’s mental health, referrals have increased according to the Children’s Commissioner, but waiting times are growing and fewer children are receiving treatment. We need universal access to counselling for children, which we do not have at the moment. That is why I support providing special mental health support in every school. I stress that schools are not islands, separate from their communities. We also need clear links between the support given there and in the community.
I have already spoken about having a joined-up approach to mental health, but there is another issue: to use a Bill Clinton quote, “It’s the economy, stupid.” If media reports are correct, the Chancellor will stand up later today to deliver what he is calling a back-to-work Budget, but unless we take proper joined-up action on mental health, any ambitions he announces today will not be achieved. Adults with mental health conditions are more likely to be out of work or in lower paid work. The total annual cost to the Government is estimated to be between £24 billion and £27 billion a year, and the overall loss to the economy to be between £70 billion and £100 billion. That is money people could contribute to our economy, so this is not just about people’s wellbeing, but about ensuring the economy benefits from good mental health and wellbeing.
England is the only nation in the UK that does not have a 10-year plan. The Government’s current approach of scrapping the previous 10-year plan risks, as my hon. Friend the Member for York Central said, sidelining mental health and short-changing future funding and policy decisions. It shows the lack of a coherent focus and risks losing the momentum that has been built over the past few years in mental health and wellbeing. Whether it is tackling disparities and the many complex drivers of mental health, or pursuing prevention and early intervention in children’s mental health, long-term planning is desperately needed in this sector. I cannot understand why the Government have put this to one side.
As I said last year to mark the 10th anniversary of speaking about my own mental health in the House of Commons, we need a dedicated public health strategy for dealing with mental health and wellbeing. We need a mental health strategy that is hard-wired into not just the Department of Health and Social Care, but every single Department and into local government. When the Government launched their paper for a dedicated 10-year plan on mental health and wellbeing last year, they said to
“challenge us to be ambitious”.
I am urging the Minister today to be ambitious.
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
It is a pleasure to serve under your chairmanship, Mr Twigg. I thank the right hon. Member for North Durham (Mr Jones) for bringing forward the debate and for all his work in this space. He is absolutely right that mental health affects us all, and for those who have a poor experience with mental health the impacts can be life-changing. He is also right that debates in this place have broken taboos and challenged stigmas around mental health, and have helped with the national conversation about mental health and why it is so important. In one sense, I violently agree with all that he said. The difference is about how we get to that place where we are looking at mental health, rather than just mental illness, and treating people sooner when they need help and support.
I believe that in the last 10 years we have seen a seismic shift in the way that we look at mental health—a shift to parity with physical health, and towards early intervention and community support, rather than waiting for someone to reach a crisis and then intervening. It has been a shift to look at mental health as well as mental illness; the two are very different, but support each other. If we get mental health right, we are much more likely to deal better with mental illness. Parity between mental health and physical health is why the major conditions strategy has mental health in it.
Huge progress is being made. We have committed to funding increases each year, from almost £11 billion in 2015 to £15 billion in the current financial year. Such a level of funding has not been seen in mental health services before, and it is making a difference. The additional £2.3 billion a year to transform mental health services in England has the aim of getting in as early as possible when people need help, and moving to community mental health services as the first port of call for people who need support.
I have seen in practice the difference that the funding and change of emphasis are making. I recently visited Hammersmith and Fulham Mental Health Unit, where community and in-patient mental health teams are working together. If someone is struggling in the community they get input from the in-patient setting, and, when someone is an in-patient, the community team are making sure they are getting the help and support they need for discharge. It is working extremely well.
I have met with police chiefs and talked about the Humberside model, which means that patients are not being taken to A&E or police cells as a first point of refuge, but are instead seen by community support teams. That frees up police time, and is a better experience for patients to quickly receive more appropriate care. That would not have been possible 10 years ago. Of course, there is work to be done, and we get huge numbers of patients who need services and want referrals, but a huge amount of progress has been made.
We recently announced £150 million to support crisis centres in local communities up and down England, so that someone who is not well has easier access to teams and support. Up to 90 mental health ambulances are being rolled out, which means that if someone is going into crisis, it is a mental health support team that responds to them, and not necessarily a paramedic, who would normally be the first responder. That is making a difference, keeping people out of hospital and making sure they are getting the right support as quickly as possible.
Daniel Kawczynski
The Minister will recall a conversation we had some time ago, when I was very keen for her to meet a constituent of mine from Shrewsbury who has a daughter experiencing mental health problems. They are not happy with the level of service we receive in Shropshire. I hope the Minister will commit to meet my constituent.
Maria Caulfield
I am happy to meet my hon. Friend’s constituent.
Record numbers of patients are coming forward, both through referrals and via GPs. The consequence of breaking stigmas and taboos and encouraging people to come forward early is that more people want to use the system, so it is taking longer than we would hope for them to be seen. The situation is the same in Scotland, Wales and Northern Ireland; it is not just something that England faces, which is why we are focused on increasing funding and resources. We are recruiting 27,000 additional mental health staff, and we are on track to deliver much of that in terms of support staff that are already in place.
We are also putting mental health support teams in schools. There are 287 mental health teams in place, covering 4,700 schools and colleges. They are not only helping young people who are struggling, but normalising mental health and making it as important as physical health. We teach young people about their physical health in schools—how to look after it and look for signs and symptoms of concern—but we have not done that in the past with mental health. Mental health support teams will normalise the idea that mental health wellbeing is as important as physical health wellbeing.
It is an achievement that in the major conditions strategy, mental health is on a par with other major conditions in the strategy. We cannot see patients just as people who have mental health needs, or who are suffering with a mental health illness. More than one in four patients who have mental health conditions have two or more long-term conditions, and 30% of people with a long-term physical health issue will also have a mental health problem. We cannot treat problems in isolation—seeing the individual as a cancer patient, a heart disease patient or a mental health patient. People are complex and have multiple issues.
By putting mental health in the major conditions strategy, we are matching what NHS England is doing with its Core20PLUS5 strategy. The right hon. Member for North Durham talked about inequalities. That is exactly what Core20PLUS5 does: it looks at the 20% of the population who are the most deprived and struggling the most with all their health needs, both physical and mental, and drills down into the five conditions that drive those inequalities, of which mental health is one. The major conditions strategy will mirror exactly what NHS England is doing.
Mr Kevan Jones
Will the Minister comment on the 5,200 responses to the discussion paper and the issue that was raised by my hon. Friend the Member for Blaydon (Liz Twist) about groups that fed into the discussion paper? How will that work, and how will charities and people in the sector be able to feed into the new strategy?
Maria Caulfield
I am not one for reinventing the wheel. Consultation work has been done, and we received a significant response. The hon. Member for Blaydon is right to point out groups such as YoungMinds, who will be in Parliament next week—I hope to meet them to follow up discussions. We will publish the previous call for evidence this spring, because we want to use that work to navigate and develop the mental health part of the major conditions strategy. This is not about undoing the work that was done before; it is about including it with physical illness. Over a third of people with severe symptoms of common mental health disorders also report a chronic physical condition, compared with a quarter of those with no or fewer symptoms of a common mental health disorder. Physical and mental health are very much interlinked, and to address one without the other would be to do a disservice to those patients.
Rachael Maskell
I am glad that the Minister has talked about parity of esteem, but only 8.6% of the health budget is spent on mental health. I hope that we will see a real uplift in funding for and investment in people’s mental health. Will the Minister set out the timeline for the publication of the strategy? It feels like the can is being kicked down the road.
Maria Caulfield
For the mental health perspective, which is the area that I work on, we will publish the previous consultation responses this spring—in the forthcoming weeks. That will feed into the development of the mental health aspect of the major conditions strategy, which we want to publish very soon. We also have the suicide prevention strategy, which will be a stand-alone strategy that will dovetail into that as well. There are record levels of funding for mental health. I am sure that more will be required, but it is not just about the amount of money; it is about how we spend it. We want to deliver on mental health ambulances, crisis centres and community support. We want to get in as early as possible.
I hope that I have been able to reassure hon. and right hon. Members that, just because this is not a standalone mental health strategy, that does not mean that we are reducing elements of the work that has gone before. It is so important to include it with those other major conditions, which is exactly what NHS England is doing with its Core20PLUS5 strategy to reduce inequalities. We hope to do the same with our strategy.
Question put and agreed to.