Health: Mental Health Strategy

Baroness Greengross Excerpts

Monday 14th February 2011 Lords Chamber

[Baroness Greengross]

My Lords, I join in congratulating my noble friend Lady Murphy on securing this important debate. The strategy is most welcome. It has a lot to commend it, especially the pledge to combat the stigma and discrimination that is still faced by so many people affected by mental illness.

In its opening lines, the strategy, one of whose key areas for action is to identify mental health problems and intervene early across all age groups, tells us that good mental health and resilience—I emphasise that word—are fundamental to our physical health, our relationships, our education, our training and work, and to achieving our potential. The use of “resilience” here and the rhetoric that follows it so early on in the strategy are interesting. They inform us that the main focus of the strategy is the very worthwhile desire to get people of all ages with mental health issues into work and to keep them there—an endeavour that deserves our full support. This might prove particularly hard in the difficult economic circumstances that we face. As chair of the All-Party Parliamentary Group on Corporate Responsibility, I heartily endorse anything that facilitates a better understanding of the contribution that people with mental health issues want to, and can, make to our economic recovery, and the critical role that employers can play in bringing that to pass.

One of the key examples that our group recently highlighted has been the Business in the Community campaign, Business Action for Working Well. Mental and emotional well-being is an important focus of that campaign. I can do no better than to quote Alex Gourlay, the chief executive of the health and beauty division of Alliance Boots and chairman of the BITC campaign, when he said,

“Employers need to take urgent action to promote the mental and physical health of their employees if they are to ensure the competitiveness of their companies in difficult, as well as prosperous, economic times”.

A small charity in south London is one such example. It trains people, some with severe physical as well as mental health conditions, to achieve NVQ qualifications or credits towards NVQ qualifications in IT, office skills and sometimes in horticulture, working in the nearby hospital grounds.

The key to the project’s success and to the achievements of the students is the sort of flexible working that they can cope with, so that fluctuating conditions can be accommodated by giving people certain agreed tasks to complete in a specific time, say one month, and not by measuring their achievements by the usual outcome measurements that we use. That enables their resilience to their conditions to be maximised. The sense of achievement of many of the people who gain an NVQ or part of one is quite remarkable. It can transform their sense of self-worth and, through that, their future.

In welcoming the strategy, I have some concerns that the section entitled,

“Improving outcomes for older people with mental health problems”,

majors on depression in older people, which is very welcome, but sadly gives dementia scant treatment. The document states that improving the quality of care for people with dementia and their carers is a major priority for the Government and that the Government are committed to more rapid improvement in dementia care through the local delivery of quality outcomes and local accountability for achieving them. As chair of the All-Party Parliamentary Group on Dementia, I would say that this is very welcome, but the strategy goes on to report that for every 10,000 people over the age of 65, 500 have dementia, as if in some way this were a low figure and not too troubling. We know that the reality is very different.

Research shows that more people fear being diagnosed with dementia above anything else, including cancer or even death itself. One million people in this country will suffer some form of dementia within two decades, and one in three people of 65 and over will die with it, yet 12 times as much is spent each year on cancer research, and six times as many scientists are working on how to treat tumours. Currently, as many as two-thirds of people who develop dementia are never diagnosed, while the best treatments can only help to reduce symptoms and cannot prevent the degenerative disease progressing. In Annexe A of the strategy an action within objective 4 is to,

“Implement the recommendations of Quality Outcomes for People with Dementia: Building on the work of the National Dementia Strategy”.

We know that in development of a dementia quality standard, the condition seems something of an afterthought in the strategy.

I also have a concern that the strategy might inadvertently imply that some people with mental health issues were unsuited to the world of full-time employment and are therefore, in a sense, second-class citizens.

The wording of the strategy tends to focus on contribution. I feel that that is too associated with condemning older people—those over working age, including those with early-stage dementia—to being in an unstoppable decline into residential care and to never being expected to be resilient or even interested in contributing to society, whereas we know that many people with early-stage dementia could remain engaged, independent and supported at home, making a significant contribution to their communities, perhaps supporting others who are in full-time employment.

My last point is that dementia is still not always treated as a health issue, but rather as a social ill that is funded, especially in the community, mainly through social care rather than as a health condition. Despite the fact that dementia confers a life expectancy of only five to six years, it remains the poor relation to cancer and heart disease in research funding, because it is not seen primarily as a health issue. We must change that, and I hope that the strategy will, because only by changing it can the ambitious challenge of the strategy to mainstream mental health in England be fully and effectively taken up by both commissioners and providers in health and social care.