Psychosis: Early Intervention

Anne McLaughlin Excerpts

Wednesday 7th September 2016 Westminster Hall

[Anne McLaughlin (Glasgow North East) (SNP)]

I commend the right hon. Member for North Norfolk (Norman Lamb) on securing this debate and on his long-standing commitment to this and related issues. He clearly cares very deeply about them. He is shining a light on some of the problems with the way in which the targets are being handled across NHS England.

The principle of early intervention and access to treatment for psychosis is fundamentally a moral one: at its heart it asks how readily we respond to some of the most vulnerable people in our midst. As others have asked, is there parity with people suffering physical ill health? We know that treating patients early improves outcomes significantly, not only in their mental health by reducing the rate of relapse and boosting recovery, but by reducing the knock-on impact of psychosis in other areas of a patient’s life. The hon. Member for Bristol East (Kerry McCarthy) gave us an insight into the impact on the person themselves and their wider network of family and friends.

If someone is struggling to deal with an untreated episode of psychosis, there can be rapid deterioration in many of their life circumstances, particularly their financial circumstances. I would like to draw attention to the excellent work being done by the Money and Mental Health Policy Institute to look at how mental illness, which includes psychosis, can impact negatively on personal finances. It is investigating ways to support people in those circumstances and is taking expert guidance from people who have been there. The hon. Member for Strangford (Jim Shannon) highlighted the case of an individual whose bills had not been paid—the chances are that he did not even know they had to be paid.

I want to give a simple example of something that the institute has come up with, with the support of the experts it is working alongside. Someone who may well suffer psychotic episodes in the future but is currently well lays out the key signs that they are experiencing such an episode. For example, they may say, “If I try to spend money between midnight and eight in the morning, that is a clear sign that I am suffering a psychotic episode. Don’t let me do it.” The banks are working with the institute and individuals to find ways for people to set parameters for their spending and be given support if that does not work out. As I said, the institute is taking guidance from people who suffer from mental health problems, but also from those who live and work with them, because they are the experts. I encourage anyone who has anything to say on the issue to join the expert panel; all they have to do is go to moneyandmentalhealth.org.

As many hon. Members have mentioned, particularly the right hon. Member for North Norfolk, £15 is saved in the long term for every £1 spent on early intervention. That is a powerful illustration of the importance and efficacy of that approach. It takes courage for Governments to commit to a course of action that might not produce results while they are in power or when they need votes but that will provide better outcomes for those who need them, so I am very pleased that the Scottish Government are now developing a 10-year strategy. I was interested to hear what my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) had to say about that.

As we have heard, many individuals have their first psychotic episode at an early age, but as many Members have said, we cannot exclude those over the age of 35 from the early intervention approach, which appears to have been happening in some parts of England. If roughly one quarter of men and one third of women experience their first incidence of psychosis after 35, CCGs are shifting the goalposts if they are applying the target only to the younger age group.

I hope that some of the progress that we have made on these issues in Scotland may be of benefit to the other nations of these islands, so I will mention a few of the key measures. However, I want to be clear that I am not claiming that all is perfect in the mental health world in Scotland, nor do I seek to set countries against each other. We are not competing. As many hon. Members have said, we should be sharing good practice. I want us to learn from the other countries in the UK and, as others have said, from international examples. However, I do think it is useful that, as my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow mentioned, the Scottish Government have appointed a Minister whose remit is dedicated wholly to mental health. That level of focus is vital and rightly reflects the impact of mental health issues right across society and across all Government directorates. As the right hon. Member for North Norfolk said—although perhaps not in exactly these words—we need a Government champion for mental health.

As I said, the Scottish Government are also developing a 10-year mental health strategy that focuses on early intervention and prevention. That longer-term vision is important for changing the way in which stakeholders across the public sector work and support mental health so that they are tackling issues head-on as early as possible. That is summed up by the principle of “Ask once, get help fast”, which is being put at the heart of the Scottish approach across this Scottish parliamentary term.

However, it is important for healthcare workers to understand that many people with mental health problems do not ask for help. Many of those they see on perhaps a six-monthly basis do not report what is happening to them, either because their mental health problem means that they do not want to be a bother or because they do not want to say what is happening to them. It is crucial that the holistic approach that my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow mentioned is taken so that families are involved and can give the person the support that is needed. Tackling mental health problems is not just the job of a psychiatrist and patient; it involves, or should involve, everyone the patient feels comfortable with.

On waiting time targets, the landscape in Scotland is slightly different in that, as we have heard, we have two key targets for mental health. One is that 90% of all those who are subject to a mental health referral should commence treatment within 18 weeks. I place on record my thanks to the mental health team at NHS Greater Glasgow and Clyde, which is currently meeting that target.

I would like to highlight the impact of Brexit and the British Bill of Rights on mental health provision. I make no apologies for raising those two issues, as it is surely self-evident that the country’s constitutional arrangements will have an impact across all policy areas. The Human Rights Act 1998 protects many vulnerable people who rely on health and social work support, and those safeguards must also be maintained for those suffering from psychosis.

I have a specific question for the Minister. The president of the Royal College of Psychiatrists, Simon Wessely, has stated that the UK’s decision to leave the EU will hamper the development of new treatments for illnesses such as psychosis. He said:

“I don’t believe there is a single scientist who does not think that being in the EU makes it easier to develop new treatments for mental disorder, and then to make them available.”

I would therefore be pleased if the Minister could tell us today how she will ensure that research and targeted funding for mental health from Europe is maintained or replaced.

I speak as someone who has close-up experience of significant mental health problems, including psychotic episodes. I will not say who the person is, not because I or they are at all ashamed or embarrassed but because there is still a lot of prejudice against people in that position. There is a lot of unnecessary fear. All of that only adds to the complications of trying to manage the condition. I mention this only because I hope the fact that someone close to me is currently in recovery from a traumatic psychotic episode, which I believe could have been prevented or at least been less traumatic had the person been able to access the services to which they were entitled, will add some weight to my words. Sometimes we have to look beyond the paperwork, policies and targets, important as they are, and find out what is happening on the ground, because people do slip through the net, and the impact on them and their networks can be catastrophic.

I commend the right hon. Member for North Norfolk again, and I also commend everyone else who has spoken in the debate. I thank my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow and others for the very useful information that I have gleaned from them today. As someone with a close family member who is currently struggling and who initially did not get the help that they needed despite being entitled to it, I want to add my personal thanks to everyone in the room who continues to campaign for people such as my family member.