Mental and Physical Health: Parity of Esteem

Baroness Warwick of Undercliffe Excerpts

Thursday 10th October 2013 Lords Chamber

[Baroness Warwick of Undercliffe (Lab)]

My Lords, I thank my noble friend Lord Layard for providing this opportunity on World Mental Health Day to focus our attention on how we treat mental health in our National Health Service.

The prevalence of mental illness in the UK was starkly set out in the Government’s mental health strategy, No Health Without Mental Health. I have no expertise in this area, but the figures are desperately worrying. Others have mentioned them, so I will just single out three: almost half of all adults will experience at least one episode of depression during their lifetime, and depression affects one in five older people; about 10% of children have a mental health problem at any one time; the UK has one of the highest rates for self-harming in Europe—400 per 100,000 population. Perhaps I should add that only one in 10 prisoners has no mental disorder.

These numbers have far-reaching impact. As we have been reminded, people with severe mental illnesses die on average 20 years earlier than the general population. People with mental health problems often have fewer qualifications, find it harder to find and stay in work, are more likely to be homeless and have poor physical health. We know that higher levels of insecurity and stress due to the recession, the poor job market and major upheavals in the welfare system have all had an impact on the mental health of the nation in recent years. It is no wonder that mental health services—what my right honourable friend the leader of the Opposition recently called the “afterthought” of the NHS—are straining at the seams.

As others have noted, mental illness is responsible for the largest proportion of the disease burden in the UK at 22.8%, larger than cardiovascular disease at 16.2% and cancer at 15.9%. Yet only 11% of the NHS budget was spent on NHS services to treat mental health problems for all ages during 2010-11. While figures show that investment in mental health services for adults of working age has increased by 1.2% in cash terms, this in fact amounts to a real-terms decrease.

My noble friends Lord Layard and Lord Stone drew attention to the poverty of investment in research into mental health issues, on which I hope that the Minister will comment in his reply.

A report last month from the Mental Health Foundation, Starting Today, showed how demand is rising just as investment in mental health services is falling. It reminds us that these services face even greater pressures in the future: a growing and aging population, increasing levels of simultaneous mental and physical health problems and, of course, funding constraints that have no end in sight. One of its key findings was the need for mental health to be treated as a core public health issue, with a public health workforce that sees mental health as one of its core responsibilities so that,

“it will be as normal for everyone to look after their mental health as it is to look after their physical health”.

This finding is at the heart of today’s debate. I support the Mental Health Foundation in its call on the coalition Government to prioritise investment in our nation’s mental health services. There is an overwhelming need for the aims of parity of esteem to be speeded up and given even higher priority.

The MHF report generated some useful media coverage. However, I am afraid that many more people will have read the stories just days later about the appalling “mental patient” and “psycho ward” Halloween costumes briefly released by two supermarkets, Tesco and Asda, offering customers the chance to dress up as a terrifying, straitjacketed crazy person covered in blood and brandishing a meat cleaver, or in an orange boiler suit, complete with jaw restraint and optional machete. The retailers withdrew the products and apologised with donations to the charity, Mind.

However, then came this week’s front-page headline in a tabloid newspaper, the Sun, giving a shock figure about the numbers “killed by mental patients” over the past decade. The headline plays on precisely the kind of prejudice that people with mental health problems have come to fear most, implying that they are violent, unstable monsters. Of course, the reality is that people with mental illnesses are three times more likely to be victims of crime than the general population, they are five times more likely to be victims of assault and severely mentally ill women are 10 times more likely to be assaulted.

Appallingly, victims say that their reports to the police are often dismissed or disbelieved. So it was good to see, earlier this summer, that there is to be an extension of the pilot scheme for mental health nurses to accompany police officers on emergency calls, to try to improve the way that people with mental health problems are treated during emergencies. This might go some way to avoiding incidents such as those referred to by the noble Lord, Lord Adebowale, and one that a friend of mine recently reported to me. A colleague of hers had a husband who was finding it difficult to manage his bipolar medication. He had gone missing during a particularly distressing bipolar episode and the wife’s sister, a GP, had alerted the local police about his condition. Nevertheless, when he was found, banging on the locked door of a church, he was handcuffed, mistreated and kept in a police cell overnight on the assumption that he was drunk and would be sober in the morning.

We must tackle the stigma attached to mental illness. That stigma feeds prejudice and can lead to discrimination, particularly at work. For me, this comes close to home. A senior member of my staff told me only years later that she had left out her own brief history of clinical depression on the HR department’s health declaration form, for fear of being considered not capable of doing the job. That fear of discrimination remains. As someone told me recently, “If you phone work saying you’re staying in bed for a few days with flu, employers will be understanding. You’re not likely to get the same response if you say you’re staying in bed because you’re depressed, or feeling suicidal”.

Stigma and discrimination ruin lives and prevent people with mental health problems using their full potential and playing an active part in society. Mind and Rethink Mental Illness are campaigning to change this, but, sadly, it is still true that we view mental illness differently from physical illness and that has a direct, negative impact on people with mental illness and on the understanding and services that they receive.

The Mental Health Network says that parity of esteem for mental health will happen only if services and organisations work together. The Royal College of Psychiatrists’ trenchant Whole-Person Care report earlier this year sets out what it believes a parity approach should look like. Crucially, it emphasises that there should be investment in the prevention of mental health problems and in the promotion of mental well-being, in proportion to need. Yet only five strategic health authority regions were able to report increased investment in mental health in 2011-12. Underinvestment in the mental health care system, when those in most need often miss out on essential care, is a disgrace. While we have heard much about the Government’s commitment to ensuring parity between services for physical and mental illness, it is abundantly clear that we need to do much more to bring this parity about. There used to be a taboo about speaking about cancer —“the big C”—as which, thankfully, has now disappeared. The same must happen with mental illness.

To end, I will echo the concerns of my noble friend Lord Layard about the new commissioning systems. Will the Minister, in his reply, tell us how the new GP commissioning process, as a front-line service, will respond to the need for parity? How will CCGs be helped to improve their mental health commissioning capability and the quality of the mental health services that they are commissioning? What assurance can he give us that the new NHS commissioning systems will truly deliver for mental health?