Mental Health

Andrea Leadsom Excerpts

Thursday 14th June 2012 Commons Chamber

[Andy Burnham]

I am proud of the improvements we made in the last Parliament, but I did not come here today to say that everything the previous Government did was right and wonderful. I will talk a little about those improvements, but given my failure to sing about Labour achievements, I am grateful to the hon. Gentleman for doing so.

We are reticent to talk about mental health as much as we should. There is a complacency in the public debate—that is not to make a political point, because it involves hon. Members on both sides of the House. The complacency goes throughout the civil service and the Government. To reflect on my time in government—not just in the Department of Health, but in the Treasury and the Home Office—it is remarkable how few submissions or meetings I had relating to mental health, given that it underlies the spending of hundreds of millions of pounds of public money. Indeed, £105 billion is the estimated cost of the full burden of mental health to this country.

That complacency is not shared by everybody and I congratulate the hon. Lady on introducing this debate. We have heard two unbelievably powerful speeches, from my hon. Friend the Member for North Durham (Mr Jones) and the hon. Member for Broxbourne (Mr Walker), to which I will turn at the end of my remarks. My hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott), who leads on these matters for the shadow health team, has rightly pointed out how mental health lies under the whole public health challenge. We will soon introduce Labour’s public health review.

We are beginning to wake up from our complacency. I am leading the debate for the Opposition to show that that comes from the top. We see the mental health challenge as central to health policy. Indeed, I made a point of making my first speech on returning as shadow Health Secretary on the subject of rethinking mental health in the 21st century at the Centre for Social Justice.

I must be honest: I shared the complacency about the mental health debate, or perhaps did not give it enough attention, but two things changed that when I was a Health Minister. First, I spent a day work-shadowing an assertive outreach team in Easington. I will never forget what one of the team told me about the early ’90s, when the mines closed and GP referrals for support were piling up on clinic desks, but there simply was no support to offer people. She said that that lay behind the social collapse in those mining communities. People facing difficult times were given no help.

A second thing made me think differently. When I became Health Secretary in June 2009, I inherited Lord Bradley’s report into mental health problems and learning disabilities in the criminal justice system. I will never forget sitting in my office at Richmond house reading that about 70% of young people in the criminal justice system have an undiagnosed or untreated mental health problem. If that is not truly shocking to every Member and does not make us do something, frankly nothing will. That was the moment that changed how I thought, and I have tried to follow it through ever since.

I mentioned that we had a public service designed for the 20th century, rather than the 21st century, and I want to illustrate that point with reference to my own constituency. The world that gave birth to the NHS was a very different place. When the NHS was set up, Leigh, like Easington, was a physically dangerous place to live and work in. Working underground exposed people to coal dust, explosions and accidents, and people had no choice but to lock arms, look out for each other and face the dangers together—that is how it was—and that spirit of solidarity was carried over into the streets above.

Like many places in this country, then, Leigh in the ’50s was a physically dangerous place but emotionally secure, because people pulled together. In the 21st century, however, that has completely reversed. We now live in a physically safe society—our work does not generally expose us to dangers—but it is emotionally far less secure than it was for most of the last century. The 21st century has changed the modern condition. We are all living longer, more stressful and isolated lives, and have to learn to cope with huge and constant change. Twentieth-century living demands levels of emotional and mental resilience that our parents and grandparents never needed, yet the NHS does not reflect that new reality; essentially, it remains a post-war production-line model focused on episodic physical care—the stroke, the hip replacement, the cataract—rather than the whole person. That is the issue to confront.

The demands of this society and the ageing society require a change in how we provide health and social care. We need a whole-person approach that combines not only the physical but the mental and social, if we are to give people the quality of life that we desire for our own families. That one in four people will experience a serious mental health problem makes this an issue for all families and people in the country. It also means that mental health must move from the margins to the centre of the NHS.

I shall say a couple of things about that necessary culture change. How can it be that an issue that causes so much suffering and costs our society so much still accounts for only a fraction of the NHS budget? It cannot be right. We also have to consider the separateness of mental health within the NHS. This has deep social roots—the asylum, the separate place where people with mental health problems were treated, the accompanying stigma and suspicion about what went on behind those four walls. Essentially, we still have the same system in the NHS, with separate organisations—mental health trusts—providing services on separate premises. That maintains the sense of a divide between the two systems and raises a huge health inequalities issue.

The wonderful briefing that Mind, Rethink and others have prepared for this debate contains this startling statistic: on average, people with severe mental health problems die 20 years earlier than those without. What an unbelievable statistic! Why is that? It is partly—not completely—explained by the separateness within our system. If someone is labelled a mental health patient, they are treated in the mental health system, and consequently their physical health needs are neglected.

[Andrea Leadsom (South Northamptonshire) (Con)]

Is the right hon. Gentleman aware that, right from the very start, the way in which a baby’s brain develops—whether development is healthy, through a loving bond, or not—can have profound implications for future physical health, and therefore life expectancy? It starts as early as that.

[Andy Burnham]

I completely agree, and obviously that was one of the major conclusions of the Field report, which the hon. Lady’s Government commissioned. The problem is not just the separateness of the system, although that is one of the factors; rather, it starts much earlier. We need to take that broad view.

More co-location of acute care and mental health care within the same hospital would be a good thing to encourage. We heard on the radio this morning about the RAID—rapid assessment interface and discharge—service in Birmingham, which is an excellent example of that and something we need to follow. That is part of the culture change we need in the NHS. The other part of that change is that practitioners dealing with mental health, particularly GPs, at the primary care level, should not just reach first for medical interventions, rather than social or psychological interventions. However, I am afraid that that is what we do. Let us look at these, more startling statistics. In 2009, the NHS issued 39.1 million prescriptions for antidepressants—there was a big jump during the financial crisis, towards the end of the last decade. That figure represented a 95% increase on the decade, from the 20.2 million prescriptions issued in 1998. Were all of those 40 million prescriptions necessary? Of course they were not.

Prompted by my north-west colleague, the hon. Member for Southport (John Pugh), let me pick up the point about Labour’s successes. We did address some of these issues. The improving access to psychological therapies programme is something I am very proud of taking forward as Secretary of State, because it began to give GPs an alternative to antidepressants and medication to refer people towards. That was an important development, and—credit where it is due—it was Lord Richard Layard who made such an incredible change, by pushing so determinedly for that programme.

--- Later in debate ---

[Andrea Leadsom (South Northamptonshire) (Con)]

I congratulate my hon. Friends the Members for Loughborough (Nicky Morgan) and for Broxbourne (Mr Walker) on what has turned out to be a fantastically refreshing debate, which has been part debate and part group therapy.

I want to add my own personal contribution. Like my hon. Friend the Member for Totnes (Dr Wollaston), I suffered from post-natal depression. It is unbelievable how awful you feel when you are sitting with your tiny baby in your arms and your baby cries and so do you. You cannot even make yourself a cup of tea. You just feel so utterly useless. Looking back on that time, I genuinely agree with my hon. Friend that going through that experience makes you a better person. It also makes you determined to do something for other people in that situation.

Post-natal depression is a key issue for women as individuals. Like many others, I got over it with the help of a good family and husband, and by going back to work. Many people do not get over it. Although the consequences are profound for those women, the consequences for their babies are often even more profound.

I want to talk briefly about the experience of a baby. When babies are born, they are about two years premature. Their brains have barely developed. They have all of the neurones but none of the neural pathways are laid down. That happens only during the first two years of life. The peak period for the growth and development of a baby’s brain is between six and 18 months, and that growth is literally stimulated by a loving relationship with an adult carer—usually their mum, of course. If a baby’s mum has a lovely, smiling face and always picks them up, cheers them up, hugs them, feeds them and changes them whenever they cry, their brain becomes hard-wired to understand that the world is a good place. They will go on to be a person who can deal with life’s ups and downs, and who retains the idea that the world will be good to them.

It is like Harry Potter. He had loving parents until he was two, but then along came Lord Voldemort and murdered them, and he had an unspeakable experience until he was into his teens and escaped to Hogwarts. What kept him on the straight and narrow, and understanding right from wrong, was his secure foundation. I put it to the Minister that that is how to secure good emotional health for our society.

If babies do not have a secure bond—usually with mum, but it can be with another parent or with adoptive parents—their brain develops in such a way that they expect to have to fight or withdraw. Those babies are the people who go on to fail to cope with what life throws at them. They struggle to make friendships, and they are the people who are bullied or become victims, or indeed become bullies themselves at school. Babies at the acute end, where there is real neglect and abuse, are the ones who go on to become drug addicts or violent criminals. In fact, research shows that 80% of long-term criminals have attachment problems stemming from babyhood.

A sad truth about our society is that research shows that 40% of children aged five are not securely attached. Of course, that does not mean that they all go on to become psychopaths or murderers, but it does mean that we are raising generations of babies and young children who do not have the emotional capacity to meet the ups and downs that life throws at them. They will have a much greater tendency than other people to mental illness. They will struggle to have all the things that we perhaps take for granted, such as a secure family and a decent job, and they will be less robust in their emotional make-up.

There is much that we could do to support people. We heard yesterday in the debate on early intervention about how much more could be done to support social workers and destigmatise going to children’s centres and seeking help. One very good example came from the right hon. Member for Birkenhead (Mr Field), who has talked about it for a long time. Why do we not ensure that people go to a children’s centre to register their baby’s birth, and then to get their child benefit? That would instantly mean that most people would use children’s centres, so it would destigmatise them.

Children’s centres should not just be places where people go for antenatal and post-natal check-ups; people should be able to go there for psychotherapeutic support such as that offered by the Oxford Parent Infant Project, the charity of which I was chairman for nine years. It provides psychotherapeutic support for families who are struggling to bond with their babies. Social workers, health visitors and midwives love it because it is somewhere to which they can on-refer people. We hear a lot of talk about training for health visitors, but no talk about what they should do when they spot attachment problems and what help they should provide to families to turn the situation around. OXPIP has shown how incredibly easy it is to do so, because both mother and baby are extraordinarily receptive to being supported in such a way as to develop the attunement and empathy that they need for a good relationship with each other.

Mums who adore their babies do not allow partners to stub cigarettes out on them. They do not shake them to death or neglect and ignore them when they are crying. It is all about building an early relationship. It is greatly in the interests of our society for sound relationships to have been built by the age of two so that we do not constantly have to deal with the consequences of failed attachment later in life.