Five Year Forward View for Mental Health

Debate between Jeff Smith and Mike Hill

Tuesday 30th October 2018 Westminster Hall

[Jeff Smith]

That is an excellent point; some training packages are available for MPs’ staff. I encourage all colleagues to take advantage of that.

The vast majority of people severely affected by mental illness will receive support within a community mental health team, which is the type of core service that provides help to around 700,000 people in England, often with quite complex needs. Although some specialist services have benefited from additional funding and targets, core services for adults severely affected by mental illness have stood still. Core community services did not receive any funding under the five year forward view, and we found that only £50 million was allocated to other core services nationally.

[Mike Hill (Hartlepool) (Lab)]

In Hartlepool, there is no drop-in centre for people in crisis. Crisis teams are stretched to the limit, and often people wait for two hours or more to access them. Given the current funding review, does my hon. Friend agree that we must urgently resolve such situations?

[Jeff Smith]

Again, that is an excellent point and I strongly agree. The report makes it clear that core services are underfunded and under pressure. There has been great success in getting people better access to psychological therapy, but while IAPT is an excellent service it is not designed for people with severe mental illness. Core services are too overstretched to provide timely talking therapies to people with more complex needs, so those who are most ill often have to wait the longest to get help. Simon Stevens, the head of the NHS, said at the Global Mental Health summit that he believed that we must restrike the balance between new talking therapy services for patients with less severe conditions and the core services for those with long-term and severe mental health needs.

We heard many examples of people with severe mental illness struggling to get therapy. One service user came to us; they had a history of psychosis and were told by their GP that if they wanted to access psychological therapy quickly, they should lie to the IAPT team about having psychosis to avoid being rejected for treatment, because it was too difficult to get the treatment they needed for their condition.

In the worst case scenario, people can be hit with the double whammy of being told they are too ill for IAPT but not ill enough for a core mental health team. People are then left struggling. Another service user, Dani, who has a diagnosis of borderline personality disorder, spoke at our parliamentary launch and contributed to the report. She said that she felt it was strange to be called a service user because her experience was mostly of being told that she was not suitable for services, rather than actually using them.

The inquiry saw the consequences of what happens when people do not get timely support in the community. First, there is a rise in inappropriate out-of-area placements. At the end of June this year, there were 645 inappropriate out-of-area bed placements. Secondly, there is a rise in mental health crises. The report notes that attendances at A&E for a mental health problem have risen 94% since 2010. In our inquiry, we heard from service users who expressed their frustration at turning up at A&E and waiting hours to be seen, before being sent home after a brief chat with a professional. Extra services in A&E, as we were promised yesterday, are positive but a much better solution would be intervening so people do not have to go to A&E. A model already exists where mental health calls to 111 or 999 are redirected to a specialised 24/7 support service staffed by experienced psychological wellbeing coaches, social workers and mental health nurses, who can provide assessments and real-time support. That is successful and it could be rolled out as a national standard approach, which is something the report recommends.

Mental health crises should not be considered an inevitability for people severely affected by mental illness. It is entirely possible to stop people having to go to A&E in a crisis if community services intervene early enough to support them. Support across the country is patchy, unfortunately, as core services struggle to meet the increased demand on budgets. We should not be creating a system that steps in only when people reach breaking point. That is why the report recommends that NHS England should increase resources for core mental health services, such as community mental health teams. Will the Minister set out how the Department of Health and Social Care will help people with severe mental illnesses who are being left without support?

Secondly, I would like to focus on the issue of workforce. Will the Minister set out how we will ensure that we have the staff to meet the needs of everyone with a mental illness? Throughout the inquiry, we heard regularly that the issue of workforce is the biggest barrier to achieving the five year forward view. When workforce and funding for them do not meet demand, the thresholds for accessing treatment rise. That is a problem not just in core services, but in child and adolescent mental health services and across the board.