Mental and Physical Health: Parity of Esteem

Lord Stone of Blackheath Excerpts

Thursday 10th October 2013 Lords Chamber

[Lord Stone of Blackheath (Lab)]

My Lords, there is a great deal of expertise here today on this subject. I am no expert, but I have two perspectives based on my particular experiences. The first is as chair of the award -winning health charity DIPEx. We have spent 10 years researching, in depth and on camera through the Health Experiences Research Group at Oxford University, patients’ experiences of illness. We publish them on the internet for free as www.healthtalkonline.org and www.youthhealthtalk.org. We have completed 75 separate modules of different illnesses, each with more than a year’s interviewing.

We have covered a wide range of physical illnesses, including most of the cancers, heart conditions, diabetes and osteoporosis. We have also researched mental conditions such as depression, experiences of psychosis, dementia and life on the autism spectrum, and we are about to launch a recently completed module on the use of antidepressants.

I want to relate here some of the observations from patients’ perspectives. First, patients living with physical, mental and social needs must be seen as actor-agents in their own recovery. The Centre for Mental Health has said that we should ensure that people using mental health services are equal partners in their care and support, with full respect for their needs, wishes and human rights.

Secondly, our senior researcher Susan Kirkpatrick, conducting interviews with the www.healthtalkonline.org patients from the recent antidepressant module to be launched in November, says that while people feel that an antidepressant may be helpful, most say that they benefit most from a combination of medication and therapeutic help. However, the effectiveness of therapeutic treatments seems not to be proven to the satisfaction of those prescribing these medications. The new charity, MQ, has said that to achieve parity of care, we must also have parity of research. MQ is one of the few organisations in the field that does not take sides. It believes that medication and therapies deserve equal research, and says that there is a huge gap between the cost of mental illness and its research funding, as has been mentioned. The UK should capitalise on its role as a leader in research and become one in developing better treatments for mental illness.

Thirdly, as my noble friend has mentioned, for some patients a long waiting time for therapeutic help proves frustrating and even debilitating, and in some mental health cases can be fatal. Here is a disparity. It seems that the system can understand the urgencies in a case of physical illness but with mental illness it feels that the patient can wait. The Centre for Mental Health has observed, as have many people whom we have interviewed, that appropriate waiting times must be established so that people with mental health problems know the maximum waiting time for a treatment, just as people with physical health problems know the longest that they can expect to wait for a treatment.

The NHS constitution has no requirements on waiting times for people with mental health problems, and in particular many psychological therapies are NICE approved and recommended in NICE clinical guidelines. However, due to the NHS constitution, people are not entitled to them in the same way as one is entitled to drugs approved by the NICE technology appraisals. That means that commissioners are not obliged to commission psychological therapies. Even when they do, as has been said, often a maximum number of treatments are prescribed. Can noble Lords imagine, for drugs for a physical illness or chemotherapy, being told, “When you’ve had a maximum of 20 of these injections or radiotherapy sessions, you’re on your own, mate”? Why should that be so for treatment for mental illnesses?

To return to medicines versus therapies, my second viewpoint is from my involvement in mindfulness practice. For centuries we have understood that there are practices we can adopt at an early age for our physical well-being that can be preventive and stop us getting ill, so that even if we contract an illness our physical fitness helps us to recover faster or at least helps us live more comfortably with the condition that we have. We have only recently become aware that the same is true for our mental health. With mindfulness-based practices, one can have a healthier, more enjoyable and productive way of life, and mindfulness can prevent depression and anxiety. It has been proven to NICE that to prevent people slipping back into depression, mindfulness practice can be more effective than drugs or talking methods.

Again, the Centre for Mental Health has said that we need to narrow the gap in the way people’s needs are met in physical and mental health, not only in health and social care but in education, employment and the criminal justice system. A mindfulness strategy for the UK is being designed and developed by my honourable friend Chris Ruane MP and my noble friend Lord Layard and others. It builds upon the work currently being done in this field by universities such as Bangor, Oxford and Exeter. They are working on mindfulness in the education system, for students and teachers in schools and universities, so that it exists in the same way as we have physical training, and are also working in the criminal justice system where, as has been said, we have systemic issues with mental health. Mindfulness practice could be enormously helpful for offenders and police.

Noble Lords may wish to know that in addition to the gymnasium for one’s physical health on the Parliamentary Estate, a mindfulness course operates in this building, including Members of the other place from all parties and a number of Peers. The course is conducted by Professor Mark Williams and Chris Cullen, using their scientifically proven method of training. We have a new series starting here next week, which noble Lords may wish to join. Mindfulness will allow people to understand that mind and body are one and that we should care for each for the development of the other. Thank you.