Mental Health Patients: Discharge

Lord Markham Excerpts

Tuesday 5th March 2024 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what assessment they have made of the current level of (1) safety, and (2) patient and carer involvement, where mental health patients are discharged from inpatient settings and emergency departments.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

In January, the Government published new statutory guidelines setting out how health and care systems can work effectively together to support a safe discharge process for mental health patients from hospital and ensure patient and carer involvement in discharge planning. This is particularly important given that the National Confidential Inquiry into Suicide and Safety in Mental Health has found that there is an increased risk of suicide within three days of discharge.

[Baroness Merron (Lab)]

My Lords, the Parliamentary and Health Service Ombudsman’s recent report found many failings in care around the discharge of mental health patients, with the most common being a lack of involvement of patients, their families and carers. With the pre-legislative scrutiny of the mental health Bill highlighting the need to address this preventable situation, and the Government still not bringing forward this crucial legislation, what immediate steps will the Government take to involve those who are essential to the care and safety of mental health patients?

[Lord Markham (Con)]

The noble Baroness is correct; the question is of the utmost importance. It is about putting more care into the community—that is why we have put £1 billion of extra spend into community support for mental health. Some 160 local mental health infrastructure schemes are being set up, with 19 in place already, and they are starting to work. The crisis cafés have resulted in an 8% decrease in admissions, while the telephone helpline has resulted in a 12% decrease.

[Baroness Manzoor (Con)]

My Lords, my noble friend will be aware of the link between mental health and homelessness. He will also be aware that 50% and more of those who suffer from mental health illness have been homeless for over a year. What action are the Government taking to work with other government departments to ensure that this issue can be alleviated as soon as possible, and what help and mental health services are these homeless people entitled to?

[Lord Markham (Con)]

My noble friend is correct. In fact, 48% of the reasons for the delayed discharge of mental health patients is because of a lack of suitable housing. That is why we have introduced the specialist housing fund; we are working with Homes England and DHLUC so that supported housing runs alongside more support in the community from the extra mental health services.

[Lord Allan of Hallam (LD)]

My Lords, the Government have said that the additional discharge fund includes support for mental health in-patients leaving hospital. I believe that local areas are required to report fortnightly to the Government on the use of these funds. How much of the additional discharge fund has actually been spent on mental health patients? Does the Minister agree that it is important to have that information in the public domain, given concern that mental health services are treated as second-rate?

[Lord Markham (Con)]

The noble Lord is correct. I agree that it is important that the funds are spent on discharging mental health patients at a community level. I do not have the percentage figures to hand, but I will make sure that I provide them to him.

[Lord Bradley (Lab)]

My Lords, I declare my interests as in the register. Does the Minister think that there are lessons to be learned from the excellent RECONNECT programme by NHS England? It is being rolled out across the country and tries to ensure that vulnerable people, such as those with mental health conditions, are reconnected to local services, and that their release from custodial settings can be successfully undertaken.

[Lord Markham (Con)]

Yes, in a word. We must try to make sure that each integrated care board has a mental health lead in place and that the services are rolled out. Much of the strength of the ICBs is that they can look after the needs of their area in ways that they know best. At the same time, where there is good practice, we must make sure that it is rolled out as well.

[Lord Patel (CB)]

My Lords, suicide is the second highest cause of maternal deaths in England. All such deaths are preventable, because mothers at risk can easily be recognised antenatally, and certainly postnatally. What actions will the Government take to prevent these deaths?

[Lord Markham (Con)]

Like many of us, I am sure, I have had very good personal experience of the midwifery service at community level. I know that there have been some challenges post Covid, but midwives are on the front line in understanding and recognising some issues. I should have mentioned earlier that there will be a round table with the Minister on mental health issues, following the one a few months ago, and this is one of the areas we should bring up with her.

[Baroness Berridge (Con)]

My Lords, as a member of the Joint Committee scrutinising the Bill, it was clear to me that one of the problems was that there is a statutory list of next of kin which does not match the reality of some people’s lives, so there were provisions to introduce a nominated person. It does not matter how good the guidance is. How are we circumventing the statutory requirement for next of kin to be involved?

[Lord Markham (Con)]

Again, like many noble Lords, I understand the disappointment that there has not been the time for the mental health Bill. This is what the round tables are about: exploring with Maria Caulfield, the Mental Health Minister, how we can ensure that we implement as many of these things as possible. We had round 1 and we will set up round 2 shortly. I suggest we take it up then.

[Baroness Pitkeathley (Lab)]

My Lords, one of the problems that carers in these circumstances always report at the point of discharge is that the professionals dealing with the patient are reluctant to share information with the person who is expected to provide care. Although I recognise the sensitivity of these issues and the need for confidentiality, does the Minister agree that if you expect someone to provide care in these circumstances you should at least provide them with the requisite information?

[Lord Markham (Con)]

In a word, yes. We had the rapid review of data in mental health settings. Not surprisingly, in mental health, as in a lot of other settings, ensuring that there is the flow of information so that carers get the right information is paramount.

[Lord Kirkhope of Harrogate (Con)]

My Lords, as a former mental health commissioner, I know that the default position regarding long-term in-patients back in the 1980s and 1990s was to ensure they were given a place in the community. As a result, successive Governments closed down many of our institutions. Can my noble friend comment on the balance between present institutional care and its desirability for many in-patients, and in-patients who are regarded as being in the community but are not necessarily protected sufficiently when they are?

[Lord Markham (Con)]

There is, quite rightly, a balance to be struck. For people with learning difficulties and autism, which noble Lords have debated before, we set a 50% target for that reduction—not 100% because, as has been mentioned, it is not always appropriate as a number of people in those situations need additional support. However, as a general sense of direction I think we all agree that, where we can put support into communities, that is the right thing to do. That is what the £1 billion extra investment is about.

[Baroness Uddin (Non-Afl)]

My Lords, I declare my interest as a former practitioner. I have spoken before about the disproportionate numbers of black and Asian men in the system using mental health services. There is a gross disconnect between the amount of funding available and the services that they receive, particularly regarding carers’ involvement. We must admit that the amount of medication that they are given is not often monitored successfully after discharge. Maybe that is one of the reasons why there is a high suicide rate. How can the Minister ensure that, when patients are discharged to the services of social workers, they are not put in extremely expensive mental health provision or private healthcare housing, which is often not needed? The services are wasting huge amounts of money. Will the Minister look at the disconnect between social services and the healthcare system to ensure that the money is used effectively?

--- Later in debate ---

[Lord Markham (Con)]

Yes, I am happy to look at that. I am on board with what the noble Baroness said, as I am sure all noble Lords are, about wanting to ensure that every pound we spend is well spent. I am aware of the racial disparities that she mentioned, as all noble Lords are. We are looking to address that issue, but in a cost-efficient way.