Mental and Physical Health: Parity of Esteem

Lord McColl of Dulwich Excerpts

Thursday 10th October 2013 Lords Chamber

[Lord McColl of Dulwich (Con)]

I thank the noble Lord, Lord Layard, for initiating this important debate. As a medical student I was rather surprised to hear professionals refer to patients with psychiatric conditions as “nutters” and “away with the fairies”, among similar comments. As the noble Lord, Lord Layard, said, we do not ridicule people with heart failure or cancer; why do we do it with mental illness? This made me rather interested in psychiatry and I did think of entering that profession, or trying to enter it, but that came to an end when I presented a patient to a psychiatrist, who shall be nameless, having spent a lot of time taking a history from the patient and writing it all up carefully. I started presenting it to the psychiatrist and half way through, he started laughing. I said, “What’s the joke?”. He said, “He’s a psychopath”. I said, “I know he’s a psychopath but what exactly is the joke?”. “Well, we can’t do anything for him.” I thought that was totally inappropriate and I learnt later that the psychiatrists call that “incongruity of affect”. Anyway, that put me off psychiatry.

It is not surprising that people with psychiatric problems feel isolated and abused and find it very difficult to talk about their problems, so all credit to Alastair Campbell, Stephen Fry and others who have spoken openly about their own illness. This has encouraged others to do the same. There is, of course, great misunderstanding about so much of mental illness. Take, for instance, Alzheimer’s. Over the years I have been consulted by many people, some of them in this House, about their relatives with Alzheimer’s and how they find it so irritating that they keep asking the same question and so on. The principles are quite simple: you do not ask a patient with Alzheimer’s any questions and you do not argue with them. When they do things that seem very inappropriate, you ask the question, “Does that matter in terms of eternity?”. I remember that once a patient was frying bacon in honey. I was just a very junior registrar in cooking, and I was not sure if this might be some recent recipe. The meal was delicious; it was impossible to clean the frying pan afterwards, but that did not seem to matter. I have also found it important that they have as much independence as possible. That sometimes means taking risks, but it is well worth it.

In the old days, in the 1950s and 1960s, I found it very difficult to get psychiatrists to come to the accident and emergency department. I do not know why that was, but they would never come. One day I was in trouble and I needed help in A&E. I rang the psychiatric department and a lady answered the phone. When I explained that I was in difficulty and asked her to come and help, she said, “I would be delighted to come”. I nearly fell on the floor; I had never had that response before. She was terrific. Her name was Ros Furlong, and she became a very distinguished psychiatrist. I mention that because it seemed to me that when women started coming into psychiatry, it changed things. Mind you, if you go back to 1945 or 1946, before there were many women in medicine, medical schools were a bit of a rough house. On one occasion a lecture was about to start and ex-Wing Commander Twistington-Higgins said to ex-Able Seaman Smith, who was wearing bell-bottomed trousers, “Smith, you’re improperly dressed”, whereupon ex-Able Seaman Smith stood up, picked up the ex-wing commander and knocked him straight out. However, when women came into medicine, the whole thing became rather more civilised.

My wife had Alzheimer’s for the last five years of her life. I pay tribute to the Maudsley Hospital, which was superb in all its help, especially Professor Simon Lovestone, who is a brilliant psychiatrist and a most kindly man. I got to know him quite well, and I told him the story of how I wanted to be a psychiatrist but was put off by the psychiatrists themselves. He said, “My experience is exactly the reverse”. He had wanted to be a surgeon but he met a psychiatrist called Colin Godber, who was a psychogeriatrician—the crème de la crème of the psychiatric world. Colin Godber asked him if he would like to come and visit a patient at home. They went there, the patient prepared a nice cream tea and then played the piano for half an hour, and then they went home. He said to Colin, “He didn’t seem to be much of a patient”. “Oh no, he wasn’t the patient,” said Godber, “It was his wife. I looked after her, and this week is the anniversary of her death. She died two years ago, and on the anniversary I always go and have tea with him”. Simon Lovestone was so amazed by this that he said, “That’s what I want to be; I shall be a psychiatrist”. It worked the other way round for him.

As the noble Lord, Lord Layard, has mentioned, one-third of the population has had a psychiatric illness. I have often wondered why that is so. A group of 50 ladies in their 40s met, and they all had eating disorders. Each of them told their story, and all of them as children had been sexually abused. At a meeting in No.10 Downing Street some years ago, there were 20 of us in a room discussing this very problem. Without thinking, I said, “Of course, at least 10% of children are sexually abused”. They were horrified and just would not believe it. In fact, one of them said, “There are 20 of us here. Do you mean that two are involved?”. I said, “Well, it does go across the board”. We now know that it is much higher than 10%. We know that one in four women is abused in one way or another, which means that millions of men are smashing up millions of women. It also means that millions of other people know about it and do nothing.

Mental health and well-being is a priority for this Government. The overarching goal is to ensure that mental health has equal priority with physical health and that everyone who needs it has timely access to the best available treatment. We have enshrined in law the equal importance of mental health alongside physical health. The Health and Social Care Act 2012 sets out the equal status of mental and physical health. We have made improvements in mental health and treating mental disease is a key priority for NHS England. One of NHS England’s 24 objectives is to put mental health on a par with physical health and close the gap between the two. On 29 June the Royal College of Psychiatrists published Whole-person Care: from Rhetoric to Reality, which is well worth reading. There is so much to be done in this field and we all have a role to play in encouraging the population to do its bit towards helping with this problem.