Mental Health

Lord Patel Excerpts

Thursday 15th January 2015 Lords Chamber

[Lord Patel (CB)]

My Lords, it is a great pleasure on behalf of the whole House to congratulate the noble Lord, Lord Suri, on his maiden speech. As he mentioned, he is the second Sikh to enter the House of Lords. He has also represented 450,000 Sikhs through his honorary secretaryship of the Sikh forum. No doubt, he brings his experience and wisdom from that time of representing Sikhs who contribute so widely to this society. He evaluated the many contributions he has made to the wider society in faith and commerce. He has also been a magistrate for over a decade, so he has many talents. Today he has demonstrated his commitment to mental health and his experiences in supporting prisoners. We welcome him to the House and look forward to hearing from him on many occasions.

I am going to concentrate mainly on what parity of esteem means. I declare two interests. I am an honorary fellow of the Royal College of Psychiatrists, not because I have contributed much to mental health but for reasons I do not understand. The second is why I am interested in parity of esteem. Some noble Lords will remember that, during the debate on the Health and Social Care Bill 2012, I spoke on an amendment to give mental health parity of esteem. I was the third name on the amendment. The first name was that of the noble and learned Lord, Lord Mackay of Clashfern, and the second was that of the noble Baroness, Lady Hollins, one of the most respected psychiatrists in the land. Neither of them could attend that day and it was by chance that I called a vote which was won by four votes. Parity of esteem is now in the statute because of those four votes and the fact that the other place did not overturn it, presumably because of the wisdom of the coalition Government—I emphasise coalition.

Much has been said in the past two years about parity of esteem. It has almost become a slogan. Whenever anybody speaks about mental health, whether they work in the mental health field or in health services generally, they talk about parity of esteem. It means different things to different people, but it probably means nothing at all to the public, the patients and their families. Turning the slogan into the practicality of what it should be will make the families and patients feel what parity of esteem for mental health is.

The duty to ensure parity of esteem was enshrined in the Health and Social Care Act 2012, by securing improvement,

“in the physical and mental health of the people of England, and … the prevention, diagnosis and treatment of physical and mental illness”.

This duty provided a legal backing for the commitment to parity of esteem within the Government’s 2011 mental health strategy, No Health Without Mental Health. However, parity of esteem in mental health refers to a broad range of issues which reflect the role of mental health across all the different areas of our lives. “Parity” therefore refers not only to equivalent levels of funding for mental health but to a whole range of areas which affect our mental health—in and out of mental health services. Furthermore, parity of esteem needs to address “parity within parity”. By that, I mean the inequalities within mental health in terms both of the differential prevalence of mental ill health within marginalised groups and of achieving fair and equal access to services.

Parity of esteem and its applications may come in different forms. When we look at parity between physical and mental health, we see a persistent mortality gap between people with a diagnosis of bipolar disorder or schizophrenia and the general population, as has already been mentioned. Measuring the parity gap may focus on the excess mortality that patients with mental ill health suffer. They die 15 to 20 years earlier than those who do not have mental ill health. The parity measurement gap may also refer to the burden of disease. One-quarter of the NHS disease burden and disability is due to mental health.

The parity gap can also be measured by the treatment gap; that is, the number of people who may have a condition, but do not get the treatment for it. It is as low for common mental disorders as 24%, compared to 85% for a broken hip. The parity gap in treatment is therefore considerable.

In cases such as schizophrenia, the gap in the general population is widening among certain groups. Problems such as diagnostic overshadowing mean that the physical health needs of people with mental health problems are not sufficiently investigated. Only recently have waiting time targets been introduced for psychological therapies, already mentioned, in contrast to long-standing physical health waiting times. In mental health, we currently see one in 10 people waiting up to a year to receive treatment, particularly for psychological therapies. It is still hard to get the full range of NICE-recommended psychological therapies—only 15% of people are offered the full choice of approved therapies.

Mental health must also have an equal footing with physical health in public health strategies. There is clear evidence and a convincing economic case for investing in public mental health. Parity in funding has already been mentioned. Mental health has been historically underfunded compared to physical health. At present mental health accounts for only 13% of NHS spend on health, despite accounting for 23% of the burden of disease. Mental ill health is also the single largest cause of disability in the UK. Investment in mental health research is key to advancing parity of treatment for mental health.

Despite mental health problems affecting one in four of us, funding for mental health stands at less than 6% of all health research funding. A commitment to parity in funding must be consistent across government and health services. In 2014 Monitor announced a funding decision to cut mental health services by 20% more than NHS hospital trusts. I know that Ministers did not approve of that, or like it, but none the less, the funding was cut. Reports found that 77% of clinical commissioning groups have frozen or cut their children and adolescent mental health services budget between 2013-14 and 2014-15, alongside 60% of local authorities in England having cut or frozen their budgets since 2012.

Mental health services must see real-terms funding increases to be equipped to meet increasing demand and unmet needs for both adults and children. Parity within mental health is essential to ensure that anyone who experiences a mental health problem has fair and equal access to treatment, especially among marginalised groups. This includes adapting services to make sure that they are inclusive of all. There are no hard-to-reach people—there are only hard-to-reach services.

One way to address this is through the coproduction of services. Outcomes for people with complex needs and from minority-ethnic communities are unacceptably poor. This also means that mental health services should be appropriate for people across the life course, from children to later life. Young people need to be given the skills to address life’s challenges with the confidence to manage their well-being, and older people need services that are accessible and appropriate. Health inequality increases the likelihood of experiencing mental ill health, and addressing inequalities can promote the population’s mental health.

Parity and stigma is another issue, which some noble Lords have already mentioned. Nine out of 10 people with a mental health problem experience stigma and discrimination. It is essential that the work of the Time to Change programme continues to improve public and professional attitudes to mental health. It is essential to eradicate the stigma surrounding mental health in professional health settings, as stigma affects the esteem in which professionals are held.

I have two questions for the Minister. First, what steps are the Government taking to reduce the imbalance in the provision of publicly funded research into mental health? Secondly, what are the Government’s plans to ensure that mental health services are appropriate for people across the life course?