Health and Social Care Bill

Debate between Lord Sentamu and Lord Rooker

Wednesday 2nd November 2011 Lords Chamber

[The Archbishop of York]

My Lords, I speak as somebody who supports Mind and as somebody with a brother I followed who had acute mental illness and died from it two years ago. I have listened to noble Lords’ speeches, and that of the noble Baroness who moved the amendment, on this amendment and the consequential Amendments 105 and 180. I agree with everything that they have said. It is important to highlight the fact that health and illness include both mental and physical aspects; to me that is not problematic. However, the question I want to ask is, do we still need to speak of them in almost separate categories? The noble Baroness, Lady Murphy, referred to my anxiety; namely, that because we have separated out mental and physical illness, would inserting the words “physical and mental” in relation to illness continue to exacerbate the problem? Is it necessary to put “physical and mental” in this part of the Bill, or will the noble Earl tell us where that matter can be spelt out elsewhere, not necessarily in the Bill?

Noble Lords will probably say of my next point, “We would expect him to say that”. I am one of those who believe that human beings are psychosomatic spiritual entities. The element of the spiritual well-being of people is not on the face of the Bill but I am absolutely convinced that, as it stands, my needs would be taken care of because it talks about,

“the prevention, diagnosis or treatment of illness”.

Illness can be physical or mental but it can also be spiritual. I will not detain noble Lords long but when I first became a vicar of a parish in south London I was invited into a home because somebody said that there was a presence there. I did not understand that phrase but I went into the home where there was a young girl who had not been able to move for nearly three weeks. The GP, a psychiatrist and a psychologist had visited the house. Sometimes the girl shouted a lot in the middle of the night. I went into the house and asked how the girl had got into that difficult state. Somebody said that they had been to a witches’ coven that night where a goat had been sacrificed and the young girl was absolutely petrified that she would be sacrificed next. She could not speak apart from shouting. Doctors, psychiatrists and psychologists had attended the girl. All that I could do was to say a prayer in that little house, anoint the girl with oil and light a candle. I left and received a telephone call later to say that the young girl was no longer terrified and had started to speak. That was not mental or physical illness; there was something in her spirit that needed to be set free.

I am content that the Bill covers all those aspects of the human person simply by using the word “illness” and through establishing a well-being and health board, which suggests to me that that board has a responsibility to ensure that physical, mental and spiritual well-being are taken care of. After all, in our schools these days we emphasise not only the personal, but the physical, mental and spiritual dimensions of a person. Hospital chaplains will tell you that the work they do does not address purely a person’s physical and mental aspects. I do not want to divide up a human person. Therefore, I believe that the Bill covers people’s needs without inserting the words “physical and mental”.

[Lord Rooker]

My Lords, on balance I agree with the most reverend Primate. I speak purely as a lay person but I am very happy to support the noble Baroness, Lady Hollins. I have no medical training. One almost has to declare that as an interest in this debate. However, mental illness can lead to physical illness and massive social exclusion.

I want to share my experience with the House as it is as relevant today as it was at the time to which I refer. Back in 2003, the then Prime Minister and Deputy Prime Minister commissioned the Social Exclusion Unit to carry out work on how we could attack the cycle of deprivation associated with mental illness. The report was published in 2004 with a 27-point action plan. At that time it was a rule of procedure that a couple of Ministers who were not involved in the matter on a departmental basis chaired the steering group that oversaw the work. I was one of the two Ministers. The other was Rosie Winterton, who is now the Labour Chief Whip in the other place. We launched the report at the headquarters of BT. We did that simply because one of the BT occupational medical staff was on one of the relevant overarching boards, but BT’s record as an employer in relation to the mental health of their employees was absolutely first class. Therefore, we were happy to use the BT headquarters for the launch.

Two departments later, as I travelled round Whitehall departments, I wondered what had happened to the 27-point action plan. These things are developed but the Ministers and civil servants involved with them move on. The relevant civil servants were very surprised to hear from a Minister who had had such a tenuous connection with the work he was asking about. The noble Baroness opposite is aware of this as she was involved with the Social Exclusion Unit. The civil servants told me that the action plan was still in place. I have not familiarised myself with what has happened to it over the past couple of years and I would like to be given an update on it. I would like to share with noble Lords some of the points contained in the factsheet that the Social Exclusion Unit published as they relate to some of the myths that have been mentioned. We need to expose those myths and meet them head on.

Four myths are exposed in the Social Exclusion Unit’s factsheet. I will not detain noble Lords for long as this has been a fascinating debate. The first myth is:

“People with mental health problems are dangerous and violent”.

However, the factsheet adds:

“People with mental health problems are more likely to be the victims rather than the perpetrators of violence. Less than 5 per cent of people who kill a stranger have symptoms of mental illness”.

The second myth states:

“Mental health problems are rare”.

We have heard that myth being busted in tonight’s debate. Indeed, the factsheet states:

“Common mental health problems affect up to one in six of the general population at any one time. Almost everyone will know someone who has had mental health problems at some point in their lives”.

The third myth states:

“People with mental health problems are incapable of work”.

However, the factsheet states:

“US research found that up to 58 per cent of adults with severe and enduring mental health problems are able to work with the right support”.

I will give an example of that in a moment.

The fourth myth states:

“People with mental health problems do not want to work”.

However, the factsheet states:

“35 per cent of people with mental health problems who are economically inactive would like to work, compared to 28 per cent of those with other health conditions. Many successful people have had mental health problems”.

In fact, as part of the exercise, I went for a day and a half around London to look at projects manned exclusively by people with mental illnesses. One was at a restaurant, and the only person involved in the restaurant who did not have a mental health problem was the chef, who had come down from a Park Lane hotel to do the training. Everyone else in the kitchen and the front office had a mental health problem. In fact, nine months later, I took my private office staff for their Christmas lunch there. My visit had been in April and I said, “If I am still around at Christmas we will come here for our private office lunch”. Indeed, we did that. When visiting the three projects, I was driven around by one of the patients. I have never felt as safe in a van driven by anyone else. I had no problem whatever. The idea that normal activity cannot take place or that you cannot be included socially is, of course, a myth.

I want to share one of the other aspects that we put out in a factsheet on this issue. The factsheet states:

“Nearly one-fifth of respondents to the Social Exclusion Unit’s consultation argued that mental health services needed to become more socially focused”—

and more holistic. The factsheet continued:

“GPs issue sickness certificates when they assess that a person cannot perform their usual work. Mental health problems are more likely to be listed on the sickness certificates in the most deprived areas of the country”.

That is another fact that we must take on board.

“It is important to ensure appropriate pathways of care between primary and secondary services; up to 28 per cent of referrals from primary care to specialist services are inappropriate”.

I will not read out all the facts, but shall quote the final two. It is stated:

“The range of services is more limited in rural areas, with specialist services often absent”.

That is the reality of many services, but this is the one that we are dealing with. It continues:

“In 2002, 87 per cent of rural households were 4km away from a GP surgery”.

My final example states:

“A person with schizophrenia can expect, on average, to live for ten years less than someone without a mental health problem, mainly because of physical health problems”.

One therefore has to deal with: stigma and discrimination—and we have heard examples of that; the role of healthcare professionals, which we dealt with in the factsheets relating to employment, welfare and benefits; and the role of families and carers, in particular. I shall leave alone the criminal justice system and other issues. Putting the amendments in the Bill is simple—it does not cost anything in terms of money; it should not upset the parliamentary draftsmen; but it sends a massive signal to the whole structure of the National Health Service that Parliament has highlighted and identified this issue, which relates to both Houses. We do not want it to be put in a backwater. We do not want it to be the first thing that is cut. People have to be treated holistically, because we know that if their mental health problems are not treated properly, physical problems start and we then get the queues at accident and emergency—and other pressures on GPs.

I am therefore very happy to support the amendments in the names of noble Lords from all around the Committee. The work of this Government, which I applaud, was mentioned, and I have provided examples of the work of the previous Government where we were trying to deal with the relationship between social exclusion and mental health. It went right across the board—every government department had a role in this. The issue should not be left just to the health department or the National Health Service. It must be dealt with properly by every department—the economic ones as well as the health ones.