Mental and Physical Health: Parity of Esteem

Lord Alderdice Excerpts

Thursday 10th October 2013 Lords Chamber

[Lord Alderdice (LD)]

My Lords, I also congratulate the noble Lord, Lord Layard, on achieving this substantial debate and indeed, as he himself mentioned, on the timing of the debate. He has been pressing the case for some time, and in doing so he has my support and that of many in this House. I identify myself very much with the speeches of my noble friend Lady Tyler of Enfield and the noble Baroness, Lady Murphy. I wish to touch upon many of the things that they mentioned and I strongly support others, although I will not refer to them.

As was said by the noble Lord, Lord Layard, in many ways this debate comes from the crucial decision by your Lordships’ House to press the case for parity of esteem between physical and mental illness to be included in the Bill which passed through this House. I well remember that reassurances were given, both in negotiations outside the House and on the Floor of the House, that this was not necessary. I pay tribute to my noble friend Lord Howe, who has made it very clear on a number of occasions since the Bill became an Act that it does make a difference, that it is a legal requirement, that health commissioners now have to address this question, and that others who need care can turn to it in various ways as a matter of law in this country. We must now press the case as strongly as we can. I welcome this debate because it is part of the process of pressing the case.

The noble Lord, Lord McColl of Dulwich, reminisced about his experience as a medical student, and inevitably encouraged me to think in the same way. I remember quite a different experience. As a young medical student I went to work for a psychiatrist, Dr Artie Kerr, for a number of weeks. I was enormously impressed by the way in which he could understand what was going on behind the scenes with the patient. He was able to pick up—and to help me to understand in a way that I simply had not seen at all—how sometimes the person who came along smiling was actually deeply depressed inside, and how in fact much could be done even with those people who had been ill for a long time, not least in caring for them when you could not cure them.

What an extraordinary business it is that we think that if you cannot cure someone with a mental illness you should not bother to look after them. If this was a patient with diabetes, which we cannot cure, would we say, “Ah well, we should forget about it”? Take a child with cystic fibrosis. We know that they are likely to die early, but should we say that we should not bother putting any money into caring for them? Yet if someone has a mental illness, and they are not going to get better in a short time or perhaps not at all, then caring does not seem to matter. It is all about cure. Let us not be seduced by those kinds of arguments. They take humanity out of our service, and they take humanity out of ourselves. It was that understanding from Dr Kerr which made me feel that that is the kind of work which I want to pick up on.

As a junior psychiatrist I used to spend a lot of time going round NGOs and charitable bodies, giving lectures and doing radio and television work at home in Northern Ireland, trying to get across this whole question. I remember very well doing a programme with a very senior surgeon, Professor Rodgers. He had been a surgeon all his life, and was a very eminent man. He listened to me for a little while, and then he said, “You know, I have treated many people with terminal illnesses, very painful illnesses, who were having a very hard time. Very, very few of them ever decided to end their life; some did, but very few. But I know that a large percentage of people with mental illness find life so intolerable that they want to bring it to an end. In many ways, the suffering of mental illness is so much greater than the suffering of even some of the dreadful cancers I have had to treat”. I have never forgotten that. It was a very human response, and a very real one.

One of the striking causes of mortality in mental illness is of course when people take their own life, in suicide or in self-harm that goes further. We are talking about something that really does mean a life-threatening disturbance. That is why I was commissioned, with a number of colleagues, by the royal college to produce a report on suicide and self-harm, and what we can do for patients. That report was produced in June 2010, and it was not just a matter of a few of us sitting down and thinking about it. We did a survey of a large number of members of the Royal College of Psychiatrists, and we concluded that,

“there is enough evidence to demonstrate that we are far from achieving the level of care that service users need or the standards set out in policies and guidelines. Poor assessments, relying too much on risk issues, staff unskilled in dealing with patients who harm themselves, inappropriate discharge arrangements, lack of follow-up of patients, lack of care pathways, insufficient access to psychological treatments and poor access to services for particular groups amount to inadequate standards of care that impact on the lives of service users and their families. There is a serious problem relating to the deployment and availability of senior staff, with adequate psychotherapy and psychiatry training. It is likely that because of these services and staffing defects, the majority of self-harm remains invisible until a crisis occurs, adding to human misery and to the stress on hospital services.”

The noble Baroness, Lady Murphy, pointed out that since that time in 2010 the incidence of suicide has actually increased rather than decreased. I therefore ask my noble friend the Minister if he would agree to meet with me and a small number of colleagues from the Royal College of Psychiatrists to look at how far the findings of that report have been taken up and implemented by Her Majesty’s Government since then and how far they have not, and to explore how some more progress might be made on the findings of that report.

While something dramatic such as self-harm or suicide is clearly a crisis, there are all sorts of ways in which mental disturbances differ from each other. This is not a homogenous group of people with a homogenous group of disorders, which is one of the reasons why we run into problems. On the physical side we are very aware of the difference between symptoms and a disorder. If I run up the stairs to the Principal Floor I will probably be breathless; I am not terribly fit, you see. That is a reaction to physical exertion, but it is not a sign of illness. It is a sign of unfitness, but not a sign of illness. However, if I am sitting on the Bench here and I become breathless, that is wholly another matter.

There are many ways in which we experience psychological symptoms. It always seems curious to me that we accept that we will all have physical illnesses, mild and more severe, during our lives, yet we pretend to ourselves that we will not have mental and emotional disturbances—every single one of us, not just the ones who have to be referred for treatment. However, many of the emotional reactions that we have are not a sign of illness or disturbance. If someone is down and depressed and is not sleeping very well three weeks after the death of their spouse, that is not a sign of illness; it is a sign of an appropriate reaction to a bereavement. If, three years later, they are in the same state, that is another matter. However, we have to differentiate those people who can get better with a little help from their family and friends and whose condition does not need to be medicalised, as well as those who suffer from relatively moderate disorders, from those who have very severe disorders, as the noble Baroness, Lady Murphy, pointed out. It is clear that if we do not do that, we will be so swamped that it will be impossible to deal with the problems. What will happen is that those with the more severe illnesses will end up being set to the side because they have illnesses from which it is difficult to get better. That is a very serious problem for us.

I should like to believe that we have begun to think not only about treating the illnesses but about how to prevent them. We are clear that government policy should say that we should not smoke, drink too much or eat too much and that obesity needs to be addressed. However, what about bullying behaviour in government departments? It sometimes almost seemed to be a policy approach that the way to increase productivity was to drive people into the ground, and I have absolutely no doubt about the adverse mental health impacts of that. Surely preventive health plays a part in the way that we approach things in government and set as an example to people outside government.

Worst of all is the feeling that somehow things are getting worse—that we are taking less of an interest in certain areas. I shall give your Lordships one example and, from that, pose a question to my noble friend. In the early 1960s, a chair of mental health was created at Queen’s University in Belfast. For the next 30 or more years, psychiatry and mental health was developed as a crucial component of the training of young doctors in Belfast. There is now no professor of psychiatry or mental health in Belfast. Massive amounts of money go into cancer research but there is not even a professor of mental health. Will my noble friend approach the GMC and ask it to insist that no medical faculty trains young doctors without having a professor of psychiatry in its medical faculty? It seems a very simple thing to ask.