Mental Health

Andy Burnham Excerpts

Thursday 14th June 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I begin by giving my apologies to the hon. Member for Loughborough (Nicky Morgan) for missing the beginning of her speech, and by congratulating the Minister on his excellent and thoughtful speech, to which I can hopefully add something.

I have high hopes for the debate. I hope it will help us to confront a major paradox: how can a subject that is so central to the big public policy challenges we face as a country—the challenges are not just of public health provision, but of worklessness, benefits, the criminal justice system and addiction—still exist on the fringes of our national debate, getting so little airtime and attention? As other hon. Members have acknowledged, the House, sadly, rarely applies itself to mental health. Perhaps that reflects our national stiff-upper-lip tendency not to talk openly about mental health, which in turn might help to explain why our public services are designed for the 20th century rather than the 21st.

[John Pugh]

The right hon. Gentleman seems to be forgetting that we had appreciable mental health legislation in the last Parliament—the Mental Health Act 2007.

[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.

[Jeremy Corbyn]

My right hon. Friend is making an important point. Too often GPs reach for medicine when they should be reaching for counselling. They should be offering a more supportive environment, but when we get high-speed GPs with little time to talk to patients, they tend to prescribe medicines when they ought to be doing something else. Does my right hon. Friend agree that we need to go a lot further than we already have?

[Andy Burnham]

I completely agree. I do a lot of work shadowing, and I recently shadowed a GP. What amazed me was how many of the people coming through his door were the people who also come through our doors on a Friday and Saturday. They are not necessarily looking for something to take to the chemists; they are actually just crying out for help, in one way or another, with a problem they are struggling with. That GP was very good and did not prescribe, but referred lots of people to the IAPT service, as I sat there with him. However, he said that across Coventry, where he was based, many others were not doing the same.

[Chris Ruane (Vale of Clwyd) (Lab)]

The Minister mentioned the number of prescriptions that have been issued. I received a parliamentary answer a couple of days ago which said that in 1991 there were 9 million prescriptions. The Minister mentioned the figure of 42 million, but from 2010 to 2011 the number went up by 4 million. In the years before that the increase was usually 2 million a year, but in one year the figure increased by 10%, or 4 million. When I asked the Minister what his assessment was of the reason for those increases, there was no conclusive answer. We must get to the bottom of why these prescriptions are being issued and why they have gone up by 500% in a 20-year period.

[Andy Burnham]

We must. Perhaps I am about to make more of a political point, but as has been mentioned so eloquently today by my hon. Friend the Member for North Durham, as well as the hon. Member for Strangford (Jim Shannon), although the trend is upwards—that is happening come what may: I mentioned the financial crisis, during which the rate has jumped up, including in our time in government—the cumulative effect of some of the benefits changes on some of the most vulnerable members of society, coupled with the withdrawal of social care support by councils, means that, right now, some people out there are suffering very badly indeed. That is part of the explanation for the worrying figures that my hon. Friend has just given the House. The Government need to have a look at what is happening out there and whether or not some people are struggling with mental health problems because of the extra stress that other factors, particularly financial, are putting upon them.

I welcome the Minister’s commitment to the improving access to psychological therapies programme, but I hear that waiting times for it are increasing in parts of the country where GPs face much longer referral times. Indeed, a Mind survey of 2011 said that 30% of GPs were unaware of services to which they could refer patients, beyond medication. That tells us that we still have quite a long way to go. IAPT needs protecting and nurturing; it needs to come with a national direction in the operating framework. In the new and changing NHS world, we cannot allow it to be simply whittled away. More broadly, we need to look carefully at commissioning and find out whether GPs have the right skills to commission properly for mental health. We need to consider what the precise commissioning arrangements for mental health are, as there is still some confusion out there about them.

[Paul Burstow]

One of the key aspects of the NHS Commissioning Board’s work in authorising clinical commissioning groups will be to assess their capacity to commission in mental health. As I am sure the right hon. Gentleman knows, the Royal College of General Practitioners is currently exploring what the extra year of education and training will involve, as we move forward to ensuring that mental health is part of it. I think it is a very important innovation.

--- Later in debate ---

[Andy Burnham]

I welcome what the Minister has said, but I say clearly to him that we are going to be vigilant about this. We do not want to see things slipping backwards, as we fear they may well do under this NHS reorganisation.

The hon. Member for Strangford made an important point about service personnel. I would like to pay tribute to the organisation Combat Stress, which has done a wonderful job—voluntarily, I think, for many years—giving some help and hope to people who come back here only to find that the statutory services are not providing anything for them. We have to absorb what it has done and the changes it has made into the mainstream to provide much better support. It is beginning to happen, but there is further to go.

On benefits appeals, I echo a point made by my hon. Friend the Member for North Durham. As he said, the number of employment and support allowance cases going to appeal is ridiculous. In 2009-10, the first full year of the ESA regime, 70,535 cases went to appeal at a cost of £19.8 million. In 2010-11, there were 176,567 cases at a cost of £42.2 million. If the Government want to cut waste from the benefit system, they have to get a grip on that. What we find is that 38% of cases—almost four in 10—are overturned on appeal; those cases should not have to go to appeal. My hon. Friend also mentioned the human cost. The financial cost is bad enough, but the stress that people with mental health problems are put through as they go through that process is, in many cases, unbearable. The Minister really needs to talk to his Department for Work and Pensions colleagues to encourage them to get a grip on this important problem. The Atos system is simply not working; it is actually making life a lot harder for some of the most vulnerable people in our society. Ministers need to look urgently at it.

Let me conclude with a point about stigma. I have picked up from today’s debate the fact that the hon. Member for Croydon Central (Gavin Barwell) is bringing forward a private Member’s Bill along the lines of the Bill introduced in the other place by Lord Stevenson, to whom this House should pay tribute. It is wonderful to hear that the hon. Gentleman will introduce that private Member’s Bill. Currently, a person who has had a serious breakdown and has been sectioned under the Mental Health Act 1983 is barred from being an MP, a juror, a school governor or a company director. What message does that send out? It says that recovery is not possible—a message that we might have put out about cancer in the ’50s or ’60s: “Once you have had it, it is a black mark; that’s it, you’re finished.” We urgently need to change that. Today’s debate has probably achieved some change. The Minister indicated his full support for the private Member’s Bill and I can pledge the full support of the Opposition for it. We wish the hon. Gentleman all good luck with it.

I think that today’s debate can begin to change social attitudes in the broader debate on mental health in this country. For the reasons I have set out, I think our debate has been historic, but we have a long way to go. When the Norwegian Prime Minister, Kjell Magne Bondevik had to take some time off, he publicly admitted that it was for depression. That was the reason he gave. Imagine a Prime Minister doing that! But he did so, and he changed the culture in Norway. Moreover, he went on to be re-elected and to become Norway’s longest-serving non-Labour Prime Minister since the second world war. That constituted incredible bravery and political leadership, and I think that we have seen two more examples of those qualities today in the speeches of my hon. Friend the Member for North Durham and the hon. Member for Broxbourne. That is the kind of leadership that changes social attitudes to mental health. Both Members deserve enormous credit for what they have said today, and I think that both have taken a major step towards changing the political debate.

I believe that we must all go back to first principles. I mentioned the start of the NHS. In 1948, the World Health Organisation defined health as

“a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

Whatever differences we may have about precisely how we should construct the NHS, I think that today Members in all parts of the House can unite behind that definition, with the emphasis on prevention and well-being. I think that we can all commit ourselves to making major changes in the way in which mental health is seen in the House of Commons, the Government and the country, and begin to create a system of care for the 21st century that recognises the difficult, stressful lives that people are leading and gives them support when they need it so that they can fulfil their potential.

[Several hon. Members]

rose—

--- Later in debate ---

[Sir Peter Bottomley (Worthing West) (Con)]

It is a delight to congratulate the hon. Member for Vale of Clwyd (Chris Ruane) on his speech. We are having a debate of which the previous speakers and the Backbench Business Committee should be proud. I missed out on a lunch the other day and went with my hon. Friends the Members for Broxbourne (Mr Walker) and for Loughborough (Nicky Morgan) and others to appear in front of the Committee. They were tough and they were clear. We made our point that the subject needed a debate, and the issue then was whether it should be in Westminster Hall or in the Chamber. I think that if it had been in Westminster Hall, the impact would not have been so great.

When I was first elected to the House of Commons, if a Member of Parliament was thought to have gone mad, the Speaker would refer them to two people nominated by the Royal College of Surgeons. One of my early interventions was to suggest that psychiatrists might be rather more useful. If the Bill taken up by my hon. Friend the Member for Croydon Central (Gavin Barwell) gets through, perhaps that approach will be thrown away in turn.

Again when I was first elected, The Times and The Daily Telegraph would report debates and pick up a good point from everyone’s speech. If that happened after today’s debate, people’s understanding of the experiences of the lack of mental health, and of more extreme, occasionally disabling mental illness would become greater, deeper and wider. That would give comfort to the hundreds of thousands of people who care for people who are experiencing the lack of mental health.

[Andy Burnham]

I apologise for interrupting the hon. Gentleman so early on, but he is making such an important broader point about media coverage of mental health. Would he want to pay tribute to the Sunday Express, which has led a campaign that was mentioned by the hon. Member for Loughborough (Nicky Morgan)? One would not necessarily expect a newspaper to run a mental health campaign, yet it has. That is precisely the kind of media leadership that we need to see on this issue.

[Sir Peter Bottomley]

I join the right hon. Gentleman in saying that. I was trying to say things that had not been said already, and there has already been a tribute to the Sunday Express. I would add that several journalists have been prepared to speak about their own medical conditions that have challenged their ability to live or to work effectively. I am not saying that we should all have to spend our time saying what our physical or mental experiences have been, but it does help if it is regarded as being as normal to talk about having had an episode of depression as of having had a basal carcinoma removed or having recovered from a broken hip.

I pay tribute to the hundreds of thousands of people who care for those experiencing the lack of mental health. I also pay tribute to the professionals, particularly to Lisa Rodrigues, who is chief executive of the Sussex Partnership Trust. She has spoken of the services it provides across East Sussex, West Sussex, Brighton and Hove and Hampshire, and the 27,000 young people with whom she and her colleagues come into contact each year. They are not all experiencing real disability, but some will.

When I became roads Minister, one of my ambitions was to try to get the number of road deaths down below the suicide rate. Young people’s suicides number about 900 each year. The total number of road deaths among adults and young people is 1,800. The road deaths figure has come down from 5,600 a year to 1,850. Would it not be good if we could do the same thing for self-destruction and the penalties that that imposes—not only the shortened life but the damage to those around the person who has died?

My wife was a psychiatric social worker before she became a Member of Parliament, a Health Minister, and then Secretary of State for Health, when she took mental health issues very seriously. She worked with those at the Maudsley Institute of Psychiatry where, with one of her colleagues, Peter Wilson, she ran a support service for teachers. If we are to start being concerned with young people, we need to make sure that those who are in contact with them—parents, and teachers in primary and secondary schools—have an understanding of what is normally unhealthy, if I can put it that way.

One young person in four experiences some kind of mental health episode. We need to know how much of that involves a relatively normal experience from which they will recover. We also need to identify the one in 10 who will probably need help from someone with experience or specialist qualifications, and the 2% or 3% for whom the experience will be disabling.

YoungMinds is an association with which Peter Wilson was associated—I think he might have created it. It has a manifesto in which young people say that if they can get help when they are young, many more of them could be kept out of prison and psychiatric hospital, and kept in work and leading the kind of life that contributes to society.

I once met someone who had had experience of schizophrenia. There was a fine mental health project just outside my former constituency, and he told me that he was glad to have got to know about it. He became a client of the project. Six months later, he became a volunteer. A year later he wrote to tell me that it was the proudest moment of his life, as he was now a taxpayer with a paid job. He was given the opportunity to take those steps forward, in an environment in which everyone knew what was happening and could share in it and give support when appropriate. Those opportunities matter.

Had there been more time, I would have been tempted to talk about a range of issues, giving a sentence or two to each, but I do not think that that will be possible. I would say, however, to those who suffer at times, or constantly, from depression, anxiety, obsessive compulsive disorder, phobias, bipolar disorder, schizophrenia or personality disorders—I could go on—that information on most of those conditions is available on the websites of the organisations that provide help.

About 31 years ago, I was appointed to the council of Mind, formerly the National Association for Mental Health. The reason for that was that the then Conservative Government wanted to give the organisation their support, and its then general secretary was thought to be left-wing; I was there to provide balance. I am not sure how my Whips would regard that decision today.

The Mental Health Foundation does good work, and I also pay tribute to the Samaritans for the help that they give to people about whom they are concerned. Their website contains information on how we can help someone, even if we are untrained. It suggests avoiding the “Why?” question, as that can be regarded as challenging. Instead, it suggests asking:

“When—‘When did you realise?’ Where—‘Where did that happen?’ What—‘What else happened?’ How—‘How did that feel?’ In an ideal world what would you like to happen next? Would you like me to come with you?”

Standing beside people in that way can be a pretty effective approach.

I want to give the House one or two examples from the weekly newsletter from Lisa Rodrigues of the Sussex Partnership Trust. I try to send it on to two or three other people each week, to whom some of the points might be relevant. One week she talked about cancer, describing how, in the 1950s, Sir Richard Doll and others had started to examine the causes of lung cancer, and to realise that asbestos could also have a serious effect on breathing. She wrote:

“So why am I talking about cancer? It is because today dementia is where cancer was all those years ago…Why Sussex? Because we have the highest percentage of old people in the country living here. And why me? Because specialist mental health services hold the key to unlocking the potential in primary care, acute hospitals, local authorities, the voluntary and nursing home sector to provide better treatment and care to people with dementia, and support for their families.”

Lisa Rodrigues also recently attended a conference on how to get the various groups to work together more effectively, which is vital for people and their families and carers. If only they could find a one-stop shop to refer them to a place where they could be embraced as a person, a household or a family unit. She said that if we could get our mental health services working more effectively, our physical health services would have far less to cope with. That point has also been developed by other hon. Members this afternoon. She also wrote in her newsletter:

“We have a dream. In our dream, our psychiatrists, nurses, social workers, psychologists, therapists, care staff, receptionists and anyone else who comes into contact with the 100,000 people we serve each year will have the best possible tools to do their jobs. This will include a small, lightweight…portable device via which they can access patient records”

and the background of all the people they are in contact with. Up to now, that has not been possible.

Lisa Rodrigues talks every two or three weeks about employees who have done something special. In one example, she talks about the staff who have worked on a clinical reception and their helpfulness to patients and other visitors. She goes on to mention a person whom I have not met called Jackie Efford, a nurse in the health team at Lewes prison, who

“works flexibly so that, when prisoners arrive late into the night, she comes in to assess them and respond to any urgent physical or mental needs. Imagine being a prisoner and what a difference it would make to have a meeting when you first arrived with a compassionate and effective nurse.”

Lisa Rodrigues also talks about the child and adolescent mental health services. She says that the name is

“no longer fit for purpose. The word adolescent has negative connotations. And young people don’t respond positively to the term mental health.”

We must find the right language, not for political correctness, but to help people more effectively.

It would be easy to say more on this issue. However, I want to end by saying that if we have to wait another year to develop these themes, Parliament will not be doing its job properly. We should not have to rely on the pleading and cajoling that we provided at the Backbench Business Committee. Debates on this matter ought to be built in, rather than bolted on.