Mental and Physical Health: Parity of Esteem

Baroness Meacher Excerpts

Thursday 10th October 2013 Lords Chamber

[Baroness Meacher (CB)]

I should like to begin with a very brief response to my noble friend Lady Murphy. The answer to this debate, in my view, is not a redistribution of resources from the secondary mental health services to the primary but, rather, to seek to focus resources on to or into NICE-recommended treatments in both the primary and secondary sectors. An enormous amount can be achieved if we really focus on that objective.

Despite having worked in the secondary mental health services for about a quarter of a century, on and off, I shall concentrate my brief remarks on the lack of parity of esteem in the availability of treatment for children with mental as against physical disorders. I applaud the Government for at least introducing the objective of parity of esteem. I think it is fair to say that we have never had it before.

I have the benefit of access to the draft of a new book on mental health to be published by my noble kinsman Lord Layard and David Clark. You could say that I have access to insider information without which I should not be making this particular speech but doing something completely different.

The need for psychological treatment services for children is overwhelming. Indeed, the evidence suggests that the incidence of emotional and behavioural problems in 15 and 16 year-olds approximately doubled between 1974 and 2004—a 30 year period, of course—and has remained fairly stable since. Today, about 10% of 15 and 16 year-olds suffer with emotional or behavioural problems.

We now have a situation where these problems can be resolved but, tragically, generally they are not. My noble kinsman Lord Layard has talked about the undertreatment of adults, but for children the situation is equally bad. We know that nine out of 10 children with a physical illness will be treated. As my noble kinsman mentioned in relation to adults, only a quarter of children with a psychological problem will be treated. We are talking about children who are just not treated for a problem.

In 2010, Britain’s Royal College of General Practitioners conducted a survey of its members. One question was: “When children are suffering from depression or another disorder requiring specialist psychological therapy, are you able to get them the treatment within two months?”. The results were truly appalling. Only 6% of GPs could get the service they needed for their child patients within the specified time. The timeframe is important, just as it is for physical illness. We have maximum waiting times for specialist treatment for physical conditions, but none for depression and anxiety. Can the noble Earl give the House some reassurance that the Government will extend maximum waiting times to psychological therapies for children, not only for adults?

I applaud the coalition Government’s establishment in 2010 of a new priority for early intervention for children at risk. That followed the release of figures for the number of suicides. However, within two years there were cuts in half of our mental health services, which have surely undermined the Government’s objective. Again, can the noble Earl give the House any assurance about reversing that trend?

Why is our failure to prioritise children’s mental health so important? The answer is simple. Children with mental health problems go on to become adults with mental health problems. Surely it is better to treat children when the problems arise, rather than waiting for them to waste years of their lives in misery and unable to contribute effectively to society. That is obvious from the point of view not only of the individual but of the taxpayer. Our failure in this field is extremely costly. To give just one example, a child with a conduct disorder will cost the taxpayer roughly £150,000 more than if the child did not have the behaviour disorder. We can look at it the other way. If we spend £7,500 on a child with a behaviour problem, the cost is absolutely zero if a mere one in 20 of those children is helped. Of course, the figures are much better than that.

Some might think that the reason that the Government do not invest in those treatments is that they do not work, but we now know that, for children too, there are psychological treatments that have been shown to be effective. The treatments are very similar to those recommended for adults—cognitive behavioural therapy, in particular, and interpersonal therapy—for the common mental disorders. For conduct disorder, however—the single most common mental health problem in childhood —there is now a well established treatment, which is structured parent training. One of the biggest trials in England showed that after seven years the children whose parents had this treatment were 80% less likely to be defined as having oppositional defiant disorder than those not treated. This is a huge success rate. Even for the most difficult children, multi-systemic therapy has produced good results. So there are effective treatments available, if only they are commissioned, for our children. In 2008, however, less than half of children’s services were implementing NICE guidelines—hence my point at the beginning of these short remarks. In another survey, half the therapists said they use CBT for less than one fifth of their patients.

The Minister, as always, knows all these arguments. It will be very encouraging if he can give some assurances to the House today that improvements are being made to the availability of NICE-recommended psychological therapies for children. We are, of course, aware of the IAPT programme for children. I hope the noble Earl can assure the House that this programme will reach all our communities in sufficient depth to ensure that nine out of 10 children with psychological problems can be helped, just as their friends with physical problems are helped in nine out of 10 cases.