Mental Health

Baroness Jolly Excerpts

Thursday 15th January 2015 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I thank my noble friend Lady Tyler for tabling the Motion for this excellent debate. It has really been a series of mini-debates. We have had experts of all sorts bringing their experience to bear on subjects such as parity of esteem, maternal health, dual diagnosis, children and young people, prisons and public health, to name but a few.

Mental illness can emerge at any age and can have highly significant impacts across much of the life course for the individual, their family and the community. The noble Lords, Lord Goodlad, Lord Farmer and Lord Bradley, among others, have outlined some statistics—and I have some more. We know that at least one in four people will experience a mental health problem at some point in their life. Mental health problems are the single largest cause of disability in the UK, contributing up to 22.8% of the total burden, compared to 15.9% for cancers and 16.2% for cardiovascular diseases. It is estimated that the wider economic costs of mental illness in England are, according to anyone’s figures—and we have heard several this afternoon—enormous.

The noble Lords, Lord Patel and Lord Goodlad, raised the issue of parity of esteem. This has been a game-changing issue. The Government’s commitment to prioritising mental health is encapsulated in the principle of parity of esteem—equal priority for mental and physical health—which was set out in our 2011 mental health strategy, No Health Without Mental Health. This commitment to parity was made explicit in the Health and Social Care Act 2012. Many noble Lords here will remember that vote well and many will be grateful for it.

The 2014-15 mandate to the NHS sets an explicit target for NHS England to make measurable progress to ensure that,

“everyone who needs it has timely access to evidence-based services”.

My noble friend Lady Janke referred to the challenges posed by those who only attend emergency and crisis services. In October 2014, NHS England set out its vision on the future of the NHS in its Five Year Forward View. This recognises that,

“the NHS must drive towards an equal response to mental and physical health, and towards the two being treated together”.

As part of that commitment, for the first time ever, waiting time standards will be introduced in mental health services in 2015-16. My noble friend Lady Tyler referred to these. They will include: 75% of people referred to the Improving Access to Psychological Therapies programme will be treated within six weeks of referral, and 95% will be treated within 18 weeks of referral; and at least 50% of patients experiencing a first episode of psychosis will be treated with a NICE-approved care package within two weeks of referral.

On the subject of child and adolescent mental health services, my noble friend Lord Addington spoke movingly about the fact that, if people are different, mental health problems can follow them. He spoke about dyslexia, dyspraxia and autism. 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. Early intervention is known to reduce not only the incidence, duration and severity of lifelong mental health problems, but also the cost of mental health problems to the economy. We will invest £30 million a year over the next five years to improve services for young people with mental health problems. We are also investing £54 million over the period 2011 to 2015-16 in the Children and Young People’s IAPT programme, to transform child and adolescent mental health services. In August we set up the Children and Young People’s Mental Health and Wellbeing Taskforce, to focus on innovative solutions to improve outcomes for children and young people’s mental health. It will report to Ministers in spring this year.

My noble friend Lord Storey brought his experience as a head teacher to the debate. I can tell him that I have recently spoken to the Care Minister, Norman Lamb, on the issues that he mentioned, about how things will work and the work that will be going on with the Department of Health to try to nail some of those problems.

Mental health crisis care is crucial. People in mental health crisis need speedy access to safe and compassionate care in the right environment. My noble friend Lady Janke gave us an example of a multidisciplinary, multiagency approach in Bristol—the Golden Key approach. We know that an effective response can often prevent an in-patient admission, which is disruptive to an individual’s life and their well-being, as well as costly to the taxpayer. It can also help to avoid totally unacceptable admissions a long way away from people’s homes. The first national crisis care concordat was published in February 2014 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. The concordat—the noble Baroness, Lady Chisholm of Owlpen, spoke about the Cambridge one—is a national commitment for agencies to work together to support people in crisis to find the support that they need.

The 2014-15 mandate to NHS England specifies that NHS England must make rapid progress, working with clinical commissioning groups and other commissioners, to help to deliver on the shared goal to have,

“crisis services that, for an individual, are at all times as accessible, responsive and high quality as other health emergency services”.

That picks up on the question asked by the noble Lord, Lord Patel. I can report that, as of 22 December 2014, every local community now has its own local crisis care declaration in place. Local action plans, most of which are expected in the first quarter of 2015, will make sure that improved crisis care is embedded in services for years to come. I have too many responses to contain in this speech, so I will use this opportunity in answer to the noble Lord’s question on how these will be followed up and monitored to say that that will go out in a letter that I shall send to all Peers.

On offender health, my noble friend Lord Suri brought up the important issue of mental health in prisons. I congratulate him on his maiden speech and look forward greatly to his work in your Lordships’ House. I can assure the noble Lord, Lord Ramsbotham, that the NHS provides treatment and care according to clinical need, so offenders, irrespective of gender, should receive the same range and quality of treatment and services as anyone else. Offenders within the criminal justice system—whether in the community or outside—with mental health needs should have their treatment delivered in the most appropriate setting, whether in prison or in the community. We should listen to his wise words on the issue of young offenders’ mental health. We have committed £25 million to introduce a new standard service specification of liaison and diversion services in England to identify and assess the health issues and vulnerabilities of all offenders when they first enter the criminal justice system. Prison healthcare has improved significantly since the NHS first became responsible for commissioning it in 2006 and it continues to improve. But we should not be complacent. The noble Lord, Lord Ramsbotham, also mentioned health and well-being boards. These were set up locally to meet local needs, so the frequency of their meetings will be determined locally, not nationally.

On mental health information, the lack of mental health data is an issue that goes to the heart of equal priority for services. We do not have the same level of information on mental health services as we do for physical health. Information that has proved so critical in driving improvement and service change in the rest of the NHS is either absent or incomplete for mental health. We are driving forward plans to address gaps in mental health information on prevalence, waiting times and access, outcomes, spend, uses of out-of-area placements and restraint. To further the parity agenda, data from across the health and care system has, for the first time, been brought together on the NHS Choices website. Key in this is the inclusion of a specific mental health section. This level of data will help to facilitate evidence-based decision-making, drive up quality and standards and ensure genuine accountability for the services provided. It will, in time, create the most transparent mental healthcare system in the world.

The noble Lord, Lord Goodlad, raised the issue of schizophrenia and questioned why little progress had been made on schizophrenia research. More than £400 million is being invested over the spending review period to make choices of psychological therapies available for those who need it. We are investing in improving provision, including for those with severe mental health conditions.

Data are also vital to research, helping us to provide the evidence that we need to transform services. Investment in mental health research by the National Institute for Health Research—the NIHR—has nearly doubled in the past four years, from £40 million in 2009-10 to £72 million in 2013-14, and we will continue to support the work of the NIHR and the network of specialist clinical research facilities in the NHS.

From September 2014, more than 800,000 people with the most complex physical and mental healthcare needs are benefiting from the Proactive Care Programme. This is being delivered through an enhanced service to the GP contract. Many of these people will have complex physical and mental health needs and this initiative will ensure that they get personalised, joined-up care and support, tailored to their needs.

NHS England is working with commissioners to make mental health a bigger priority, with better integration of physical and mental healthcare in primary care and, indeed, in all settings. Improving the diagnosis of mental illness is one of four national goals for 2014-15. Providers will be rewarded for better assessing and treating the mental and physical needs of their service users.

The issue of training for GPs was raised. The Royal College of General Practitioners has a programme around training. However, there are two issues: one is the training of new GPs before they go out and practise; the other is the ongoing training of GPs in all the new developments. The noble Lord, Lord Bradley, raised the issue of the mental health workforce. Health Education England has increased training places for mental health nurses by 3.2% for 2015-16.

As for mental health unemployment, getting people back to work is a priority for the Government. Jointly with the Department for Work and Pensions, we commissioned external policy advice from RAND Europe on how we can achieve better outcomes for people with common mental health problems. Based on the recommendations put forward this year, we are taking forward a number of feasibility pilots to explore the most promising and evidence-based approaches.

My noble friend Lord Addington addressed the issue of ensuring awareness among healthcare professionals of potentially vulnerable groups. As the mandate to NHS England makes clear,

“everyone who needs it should have timely access to evidence-based services”,

including people with autism and learning disability. In line with the Equality Act, we expect all service providers to make reasonable adjustments so that disabled people are not placed at a disadvantage compared with non-disabled people.

My noble friend Lady Tyler raised the issue of Time To Change, the country’s largest anti-stigma and anti-discrimination mental health campaign—indeed, several other noble Lords mentioned it—which the department currently funds by up to £4 million a year. Between December 2012 and December 2013, we have seen a 20% decrease in the number of life areas in which people experience discrimination. On discrimination for black and minority ethnic patients, this Government are committed to tackling inequalities in access to mental health services. The commitment to reduce inequalities is in our action plan, Closing the Gap. The 2014-15 mandate to NHS England makes it clear that everyone should have access to the mental health services that they need.

On the issue of mental health and perinatal health for mothers, the mandate to NHS England includes an objective for NHS England to work with partner organisations to reduce the incidence and the impact of post-natal depression through earlier diagnosis and better intervention and support.

On the budget, mental health funding is not ring-fenced. However, we expect commissioners to demonstrate parity of esteem when agreeing financial statements. Aggregate CCG expenditure is not yet available for 2013-14, but NHS England advises that total mental health spending in 2013-14 was £11.3 billion with an estimated £11.6 billion planned for the following year—an increase of £302 million.

There are many other issues that I will write to noble Lords about. I am proud of the Government’s record on mental health, of the role of my honourable friends Paul Burstow and Norman Lamb in the other place and of the commitment and leadership of the DPM. But as the noble Baroness, Lady Tyler, has highlighted, there is still more to be done. I would not want to suggest any complacency on the part of the Government on this vital issue. I feel confident that, whatever May brings us, Members of your Lordships’ House will keep the feet of the new Government well and truly to the fire on issues of mental health. I particularly thank the noble Lord, Lord Farmer, and the noble Baroness, Lady Tyler, for giving us some ideas for the new Government to start with.