Health: Mental Health Strategy

Baroness Hollins Excerpts

Monday 14th February 2011 Lords Chamber

[Baroness Hollins]

My Lords, I am grateful to my noble friend Lady Murphy for securing this debate, particularly as it is the first debate on mental health since my introduction in November. I, too, declare an interest. Although I began my medical career as a general practitioner, I have worked for probably 35 years as a psychiatrist, particularly working with people with learning disabilities and complex mental health problems.

As a former president of the Royal College of Psychiatrists, I am quite accustomed to arguing the corner for mental health. I remember writing to Gordon Brown when he was Prime Minister suggesting that when he spoke about health, it would be a good idea to use the phrase “physical and mental health”. When the word “health” is used, people, including doctors, tend to think about surgery and surgical interventions, but not about mental health. Gordon Brown and the rest of the ministerial team then referred to physical and mental health for about six weeks. I wondered why it did not last any longer and came to the conclusion that it was because of the difficulty in trying to understand the complexity of mental health problems, plus the discrimination associated with mental illness and the fear and ignorance which go along with that.

There was a time when cancer was spoken about in hushed tones. No one had the language or the confidence to speak openly about it. In many ways, mental illness today is where cancer was all those years ago. My vision is of a time when mental illness will be spoken about more openly by politicians, the public and medical professionals; when everyone has a language and the confidence to express what needs to be said and what needs to be done; and when people with mental illness and learning disabilities will be more fully accepted and included in society. I am delighted that these are the objectives of this excellent new mental health strategy, No Health without Mental Health. I applaud its public health focus and the determination expressed within it for parity of esteem.

At the end of my presidency in 2008, the Royal College of Psychiatrists launched its manifesto, A Fair Deal for Mental Health. At the time, the campaign pointed out that only 12 per cent of NHS spending was on mental health, a share that did not accurately reflect the human and economic cost of mental illness. I therefore welcome the recognition in this strategy that mental health problems cost England £105 billion every year and that these costs are incurred across several government departments, including health, education and criminal justice. The challenge will be to address the imbalance between investment in physical health services and investment in mental health services at this time of financial constraint.

The failure of commissioners and managers to make provision for the overlap between mental and physical conditions leads to expensive and unnecessary investigations, such as for medically unexplained symptoms, and for missed opportunities to treat, for example, depression associated with heart disease. People who are depressed are much more likely to die from heart disease even when their depression has been effectively treated. This points to an interrelationship between physical and mental health which is rather overlooked. I always say to medical students, “Have you noticed that the brain and the heart are in the same body?”. There is plenty to research in this interrelationship, but the separation between physical and mental health has not allowed us to look at it properly.

I did not see much mention of research funding in the strategy document, although I may have missed it, but research will be a critical friend in the move towards better mental health services. Here is the rub: for every £1,000 of charity funding for cancer research, just £26 is available for mental health research. The stigma associated with mental illness has a negative impact on charitable giving for mental health research. Mental Health Research UK, the first mental health research charity, is struggling to establish itself and would benefit from proper funding so that it can begin to be a significant player in the research arena. Government sources such as the National Institute for Health Research need to start giving priority to mental health research in order to redress the inequity.

Finally, I should like to comment on the provision of appropriate treatments for all patients with mental health problems. I welcome the proposed increased investment in the Increasing Access to Psychological Therapies project, in particular the expansion to engage with harder-to-reach groups, but I am concerned that there are still no plans to extend talking therapies to people with learning disabilities who, again as far as I can see, receive no mention in the strategy documentation.

The nuts and bolts of how to provide effective treatments for people with complex mental health needs, such as those with learning disabilities, are often poorly understood. Face-to-face appointments are clearly an essential component of treatment, but the specialised supervision, consultation and multidisciplinary liaison that is needed behind the scenes is expensive, although crucial to enable success. Highly specialist teamwork is the only way of both managing risk and enabling patients with complex needs to access appropriate treatments and reach better mental health outcomes. The pathway from primary care treatments for people with common mental disorders to specialist mental health services for those with complex problems needs to be commissioned carefully.

I know that the noble Earl and the rest of the health team are determined to improve the quality of mental health outcomes, but I seek assurances that established complex needs services for people with severe mental illnesses, including services for those with learning disabilities with a dual diagnosis of mental illness, will not be cut to pay for the new public mental health programmes.