Nursing

Baroness Hollins Excerpts

Monday 14th May 2018 Lords Chamber

[Baroness Hollins (CB)]

My Lords, it is a pleasure to follow the noble Lord, Lord Ribeiro, and to know that, in our own ways, we strove to work collaboratively with nurses throughout our medical careers. I congratulate my noble friend Lord Crisp on this very stimulating debate. I would like to draw attention to the role of nursing in prevention and early intervention to improve mental health worldwide and to think about how nurses globally could learn from nursing experience in the United Kingdom in supporting people with learning disabilities and perhaps people with autism.

In this country, we rightly discuss the issue of parity of esteem between mental health and physical health. However, globally, the lack of parity is even more evident. The World Health Organization recognises the global burden of disease that mental health conditions produce. It reports that depression alone accounts for nearly 5% of the global burden of disease and is among the largest single causes of disability worldwide, with 11% of all years lived with disability globally. This burden is particularly great for women.

The World Health Organization also reports that almost half the world’s population lives in countries where, on average, there is one psychiatrist to serve 200,000 or more people. It states that between 76% and 85% of people with severe mental disorders receive no treatment for their disorder in low-income and middle- income countries. The King’s Sierra Leone Partnership describes how, historically, there has been one trained psychiatrist in the country—although encouragingly it describes that two more have finished their training in the last year. However, for a country of six million people, this produces a very different mental health service to the one we may be used to in this country. In this country, we have 6,000 psychiatrists on the specialist register, making up 6% of all specialty doctors.

What this suggests to me is that mental health policy globally faces challenges rather different from those we face here and that the solutions will therefore also be different. The answer to addressing the mental health gap globally may lie not in the medical schools but with community nurses and health visitors identifying mental illness and delivering psychosocial interventions. Making mental health a core component of any global health policy is essential to prevent it disappearing from view, which, as we know from our own country’s history, can easily happen.

Of all nurses in this country, 16% work in mental health or learning disability services. I suggest that there is an even greater role globally for nurses to lead mental health and disability policy. However, the reports attached to the briefing for this debate referred mainly to child health, infectious diseases, cardiovascular health and the like, with very few explicitly mentioning mental health conditions. I saw reference to diabetes and heart disease and to the burden of infectious diseases such as HIV/AIDS and malaria, but I did not see references to learning disability—or intellectual disability, to use the international term—schizophrenia, alcohol dependence or depression.

I will reflect on the history of learning disability nursing in the United Kingdom and Ireland. It is a condition-specific field of nursing that has developed over a few generations now, the role and function of which is to work face-to-face with individuals with intellectual disabilities, their supporters and their families to empower them in their lives and in their encounters with health services. In the health third sector and private and public agencies, learning disability nurses deliver specialist healthcare and support to people of all ages.

In the United Kingdom, the largest majority of individuals with learning disabilities live in the community, in their own homes with support systems or with their families. But as a group, they have the poorest health, which has a cumulative effect over the lifespan, and this will be true worldwide. They have a different range and pattern of disease and differing health-related behaviours. They have differing leading causes of death —respiratory disease, congenital heart disease and cancers—when compared to the general population. Gastro-oesophageal reflux disorder, sensory impairments, osteoporosis, dental caries, accidents and mental ill-health are all more common in this population group. The average age of death in this country is 20 years earlier when compared with the non-learning-disabled population. Significantly, we know that most of these deaths are unexpected, avoidable and preventable.

There is a challenge, however: half of learning disability nursing courses in this country are considering closure, despite rising numbers of vacancies within the NHS. The nurses who are still available are increasingly working in social care settings as managers, not delivering the face-to-face nursing skills that they have acquired and which are so essential for this group of people. One of our roles could be to consistently challenge policymakers, in this country and abroad, and to ask how the strategies they formulate improve prevention and identification and care for people with mental illness, and perhaps particularly for people with learning disabilities and autism. The role of nursing in transforming healthcare globally is huge, but let us ensure that this reduces, not increases, the disparity between mental and physical healthcare.

I will finish with another challenge: how to respond effectively to both online and offline sexual abuse and its impact on mental health, and the educational and preventative work being done by community nurses in some rural communities in Africa. Nurses are highly respected in all cultures. Their contribution to prevention and their compassionate listening responses could help to reduce the longer-term consequences of sexual abuse and to rebuild the resilience that each person needs in life.