Mental Health: Ensuring Equal Access to Mental and Physical Healthcare

Lord Tunnicliffe Excerpts

Thursday 26th May 2016 Lords Chamber

[Lord Tunnicliffe (Lab)]

My Lords, I thank the noble Baroness, Lady Brinton, for bringing this debate to the House, and I congratulate her on such a comprehensive introduction. I will not bore the House by repeating much of the same stuff, because she presented it in such an effective way. I also thank the noble Lord, Lord Oates, for his personal statements about mental illness. We now come into contact with mental illness more readily than we did before, because we are beginning to see the extent to which it is present in society, but we still have a problem in talking about mental illness. It is possibly the last great taboo. Along with these reports, we must give some thought to how we can change that.

The one thing that I have learned in my own life is that the word “normal” actually means average. In fact, there is enormous diversity in human beings, in how they feel, and how they cope with pressure and the depression that sometimes comes from pressure. I have worked in extremely highly pressured situations and I have certainly had days when I have felt that not getting up would be a better idea. I have sometimes wondered whether I was mentally ill. It is getting better, but the taboos of the past meant that if I had sought any help I would have seriously jeopardised my career. It was very much the tradition of my generation that when coming under such pressure one coped with it oneself. One coped with it, frankly, without an education. Perhaps education about mental health would help us to understand it, cope with it better, and help our fellow citizens more.

I believe that we can look to areas of some hope that that would work. Also in my generation the word cancer was almost impossible to express. It was a taboo subject; we did not talk about somebody having cancer. When you knew somebody who had cancer they were almost a non-person. Now, thank goodness, that has virtually disappeared, and as a result there is much more information and people talk to each other about it in a way that is supportive to people who have cancer, which makes early diagnosis and treatment possible.

We have a similar situation with gender issues, which the noble Lord, Lord Oates, spoke about—the culmination, I think, of the new liberal world and gay marriage. The noble Lord, Lord Oates, touched on the issue of talking therapies. I seek assurance from the Minister that the provision of training for talking therapies is not hindered. I understand that it is provided under the auspices of the IAPT. Talking therapies are much more cost-effective in the sense that average workers who are already in the area can be trained to be high value-adding therapists. I hope that there are no inhibitions in the development of these therapies, because, as I understand it, that is one of the limiting factors in spreading them more widely.

I thank the noble Lord, Lord Crisp, for his wider view. I think his most worrying statement was that 50% of providers have little confidence that these additional resources are actually arriving. The noble Baroness, Lady Tyler, reminded us that one in four of the population will have contact in any one year with mental health issues themselves. Once again, I look back curiously at myself and wonder whether I was one of those one in four. She said that the reports taken together suggest a set of documents, thoughts and recommendations, but she put the point to the Minister, which I share: will the resources be there in reality?

The final report on the Mental Health Taskforce, commissioned by NHS England, was published earlier this year. It provides a frank assessment of the state of mental health care and describes a system that is ruining some people’s lives. The report offers several recommendations that could have a significant and progressive impact on the delivery of service to mental health patients. It brings out, as did the noble Baroness, Lady Brinton, that the estimated economic cost of mental ill health is £105 billion in England annually, which is equal to the entire NHS budget in England and accounts for 23% of the disease burden in the NHS. Despite all this, only 9% of the overall NHS budget is spent on mental health.

Since 2014, the Government have announced an extra £600 million for mental health services, £1.25 billion from 2015 to 2020 for children and young people’s mental health, and another £1 billion in the taskforce report. We are concerned that, despite these pledges, the scale of the problem of achieving parity of esteem is extensive. For example, the five-year investment in child and adolescent mental health services equates to barely £1 million per clinical commissioning group each year. This is inadequate when looking at data released in a recent NSPCC report, which stated that out of 186,000 cases referred by doctors from 35 mental health trusts, nearly 40,000 children received no help at all. Does the Minister believe this sufficient not only to tackle the chronic bed shortage and the distribution of such beds across the country but to develop comprehensive prevention and early-intervention programmes?

Before this debate I read the report—not from cover to cover, I have to admit, but parts of it. As the noble Baroness, Lady Brinton, mentioned, the position it describes is pretty terrifying. When I used to run a railway we used to have a suicide attempt a week. About half were successful, so suicides were close to my daily knowledge, as one knew about every event. One would end up giving bravery certificates to staff who had crawled under trains to help people who were not dead. In that sense, suicide has been close to my personal experience. There were 4,882 suicides in 2014. As has been said, that is the leading cause of death in 15 to 49 year-old men. You cannot have a clearer example that something is wrong when people commit suicide. Parity of esteem and the whole issue of equal access are so important.

The challenges of the report have been put to the Minister. I hope that he answers them. I am not too optimistic. That is not a comment on the Minister. We all know that he does his best. But when one looks at the similar debate in the House of Commons, when asked for a response to the report, the Minister for Community and Social Care, Alistair Burt, in the middle of a very long answer, said this:

“I spoke to the taskforce after the issuing of the report. I do not particularly want just to produce a response to the taskforce report; I said that I would prefer a series of rolling responses, as it were, so that when we have responded to a recommendation and when we are moving on and delivering on it, I would say so. That will come in a variety of different forms, but will be related to what the taskforce has done. That may well involve announcements to Parliament, whether by written ministerial statements or other means. I did not want one big bang of a response”.—[Official Report, Commons, 23/2/16; col. 155.]

I think we do want a big bang of a response. We want a comprehensive response to the reports and we want to know what the Government are doing. We want the figures to be much clearer. We want to know that the resources are going into metal health to make parity of esteem a reality.