Mental Health

Baroness Morgan of Cotes Excerpts

Thursday 14th June 2012 Commons Chamber

[Nicky Morgan (Loughborough) (Con)]

I beg to move,

That this House has considered the matter of mental health.

I am particularly grateful to all members, old and new, of the Backbench Business Committee for allocating time for this debate in the Chamber. The effort to secure the debate has been done jointly with my hon. Friend the Member for Broxbourne (Mr Walker), the chairman of the all-party group on mental health, which he has led so well, and with my hon. Friends the Members for Worthing West (Sir Peter Bottomley), for New Forest East (Dr Lewis) and for Halesowen and Rowley Regis (James Morris)—I hope I have pronounced that one correctly—and the hon. Members for Dagenham and Rainham (Jon Cruddas) and for Foyle (Mark Durkan).

We were quite clear when we put in our bid that we wanted a full debate on the Floor of the House. Why? It is at least four years, and probably slightly longer, since the general topic of mental health was debated in the Chamber. That is a long time, given that 25% of the population—one in four people—will experience a mental health problem at some point in their lives. Just imagine if this were a physical health condition and it had not been talked about by Members in the House of Commons other than in very specific ways such as Adjournment debates for a very long time.

Mental health comes at an economic and social cost to the UK economy of £105 billion a year, yet mental health has been a Cinderella service—poorly funded compared with other conditions and not spoken about nearly enough either inside or outside this House. It is the largest single cause of disability, with 23% of the disease burden of the NHS, yet the NHS spends only l1% of its budget on mental health problems.

[Mr Kevan Jones (North Durham) (Lab)]

Does the hon. Lady agree that it is not only a matter of the effects on individual mental health because mental health issues can lead to physical disabilities, leading to extra costs to the NHS on top?

[Nicky Morgan]

I entirely agree with the hon. Gentleman. The Centre for Mental Health has shown that for a person who has a physical and a mental health condition, the costs of treatment are increased by 45%. Those are additional costs around mental health problems, which are often untreated initially and then have to be treated at a later stage, so the hon. Gentleman is absolutely right.

According to the Centre for Mental Health, only a quarter of people with mental health conditions—children as well as adults—receive any treatment. I have no reason to doubt that statistic, and I find it shocking that three quarters of people with mental health conditions are not being treated. We should ask ourselves why that is.

Recent figures have shown that depression alone is costing the economy £10 billion a year. As we all know, we do not have a lot of money to spend, so we should be working as hard as we can on preventive measures. One in every eight pounds spent on dealing with long-term conditions is linked to poor mental health, which equates to between £8 billion and £13 billion of NHS spending each year.

I welcome the Health and Social Care Act 2012. I hope that today’s debate will be conducted on pretty non-partisan terms, but I realise that that may strike Opposition Members as a controversial comment. I welcome the opportunities that the Act offers for the commissioning of mental health services. I spoke in the Third Reading debate, and I especially welcomed the Government’s acceptance of an amendment tabled in the other place to ensure parity between physical and mental health. Although those are only words in a Bill, they are very important words, and they send a very clear signal not only to sufferers from mental health conditions and their families, but to those working in the NHS. I hope that, in his annual mandate to the national commissioning board, the Secretary of State will insist that the board prioritise mental health.

How are we to achieve parity between physical and mental health conditions? The question is about money, certainly, but it is also about awareness. Confessing to having a mental health condition carries far too much stigma. That is part of the reason for our wish to hold a debate on the Floor of the House. If we do not start to talk about mental health in this place, and encourage others to talk about it, how can we expect to de-stigmatise mental health conditions and enable people to confront their problems?

I find it interesting that, when I was preparing for the debate, a few people who had initially said to me “Yes, go ahead, mention my name” came back after thinking about it for a couple of days and said “Actually, I would rather you didn’t, because I have not told my employer,” or “I have not told all my friends and my family.” It is clear that mental health conditions still carry a considerable stigma. Admitting to having been sectioned is traumatic, especially when the information appears on Criminal Records Bureau checks connected with job applications.

I welcome the work of Time to Change, which has been funded partly by the Department of Health as well as by Comic Relief. I also welcome the Sunday Express campaign on mental health. However, the de-stigmatisation of mental health conditions is down to all of us, and it is especially important for those of us who are employers not to discriminate against people who may be working for us and who tell us that they have a mental health condition. I hope that today’s debate will constitute another firm step on the path to ensuring that mental health conditions are de-stigmatised, because I think that without that de-stigmatisation, successful treatment will be very hard for a person to achieve.

We asked for today’s debate to be kept deliberately general, so that Members in all parts of the House could raise many different issues on behalf of their constituents and, perhaps, themselves or their families as well as looking at the mental health policy landscape. Mental ill health is no respecter of age or background. It can strike anyone, often very unexpectedly. That includes people in senior positions such as Members of Parliament, company directors and school governors. I am sure that my hon. Friend the Member for Croydon Central (Gavin Barwell) will refer to the private Member’s Bill that he will be presenting, which would end discrimination against people in such positions who have mental health conditions.

I expect that during today’s debate we shall hear about new mums with post-natal depression. For them, a time of life that should be one of the happiest is often one of the most difficult. I welcome the recent Government announcement that health visitors will be properly trained to recognise signs of post-natal depression, which I think was long overdue. I expect that we shall also hear about veterans from our armed forces who suffer from mental health conditions, and about older people who suffer from dementia. Particular issues affect our black and ethnic minority communities, as well as those who find themselves in the criminal justice system. I am sure that we shall hear from the Minister abut the Government’s widely welcomed framework document “No health without mental health”, which was published last year. We now await the detailed implementation plan on which the Department of Health is working alongside leading mental health charities.

I want to talk, very briefly—I have noted Mr Speaker’s strictures about time limits—about three specific matters: listening to patients, integrated care, and the wider mental health well-being landscape. We made it clear during the passage of the Health and Social Care Act that one of the developments that we wanted to see, as a Government, was “No decision about me without me.” That means patients having a voice in their care. It seems to me from my discussions with those in the mental health system who have been sufferers that once the initial crisis has been dealt with, they tend to want choice and involvement in their treatment. They are facing a lifetime condition. They will have to self-medicate, look after themselves and identify the point at which they may be deteriorating or potentially reaching crisis point for years and years to come. They want a voice. They want to be heard by the health care professionals, and I think that it is up to us as a Government to help them to achieve that.

[John Pugh (Southport) (LD)]

The hon. Lady has just said that people who suffer from mental health problems have a lifelong condition. I think that many people have an occasional mental health problem.

[Nicky Morgan]

I am not sure that I entirely agree with the hon. Gentleman. I agree with him that people often enter the system at a time of crisis and experience a single episode, but others who experience episodes will get better. For years they may have no problems at all. The hon. Gentleman shakes his head, but I can tell him on the basis of the experience of constituents and family members that it is possible to go in and out of the system. One of the hardest things for people to accept when they are diagnosed with a mental health condition is that they will be on drugs for years and years. That is often difficult for people to admit, particularly when they are striking up a new relationship or working for a new employer. I think that that is why people want to have a voice in the way in which they are treated.

According to Mind, people are three times as likely to be satisfied with their treatment if they are presented with a choice of treatments, and failure to stay on medication is the main cause of relapses, when people often have to re-enter the system at a time of crisis. There is a need to work with and trust health professionals. According to a recent study by the university of Kent,

“Low levels of trust between mental health patients and professionals can lead to poor communication which generates negative outcomes for patients, including a further undermining of trust”,

and

“trust can play a significant role in facilitating service users’ initial and ongoing engagement with services, the openness of their communication, and the level of co-operation with, and outcomes from, treatment or medication.”

In 2009, a mental heath in-patient survey by the Care Quality Commission revealed that in some mental health trusts as few as 40% of people diagnosed with schizophrenia felt that they were involved as much as they wanted to be in decisions about their care and treatment. I am no health professional—I hope that some Members who are health professionals will speak later this afternoon—but what people have said to me suggests that medication is not always the answer, at least in the long term. Research by Platform 51 has found that a quarter of women have been on anti-depressants for 10 years or more, that half of women on anti-depressants were not offered alternatives at the time of prescription, and that a quarter of women on antidepressants have waited a year or more for a review of their medication

I welcome the Government’s investment of £400 million in treatments under the improving access to psychological therapies programme. I should add, to be fair, that that builds on announcements made by the last Government. I also commend the report by the Centre for Social Justice on talking therapies, which calls for a broadening of therapies. Every patient is different, and patients will respond differently to different medications and therapies. Mental health patients must have real choice, and I think that Any Qualified Provider and Payment by Results must be extended to them in the way in which they are being extended to patients with physical health conditions. We must also ensure that patients’ voices are heard within the management structures of both clinical commissioning groups and health and wellbeing boards, whose job it is to hold services to account for the care that they are giving.

I expect that Members will refer to integrated care: the need for all services to work together. Poor mental health has an impact on every area of Government policy: health care, benefits, housing and debt, social exclusion, business and employment, criminal justice and education, to name but a few. One person with a mental health condition may need help from many different agencies, but too often care is not joined up, and each agency deals with its own bit and passes the person on. Sometimes there is no follow-up, and the person is lost in the system.

In a 2011 survey, 45% of people contacted by Mind said that they had been given eight or more assessments by different agencies in a single year. YoungMinds, which campaigns on behalf of children and young people with mental health conditions, has called for one worker to be allotted to each child needing support for a mental health condition, so that children can avoid multiple assessments and need not re-tell their story each time they see a new person in the system. However, there must be a clear care pathway, whatever the point at which access is gained to the mental health system.

The other thing patients are calling for is the ability to self-refer. We need to do all we can to prevent people from reaching crisis point, and often it is patients themselves who are best able to tell when they are about to reach that point. My West Leicestershire clinical commissioning group is developing an acute care pathway in partnership with Leicestershire Partnership NHS Trust. It plans to replace the many and varied access routes to secondary care and mental health services with a single access point, in order to provide speedy access at times of greatest need. That move has come out of both patient and GP feedback.

[Mr Robert Buckland (South Swindon) (Con)]

I congratulate my hon. Friend on securing this debate, and I am particularly interested in the proposed single access point for services. That could be useful not only for acute services, but for non-acute services and well-being provision. Does my hon. Friend agree that well-being provision is an important part of mental health provision?

[Nicky Morgan]

My hon. Friend is absolutely right, and I shall talk about well-being shortly. We often talk about these subjects in very negative ways. If we all talk about our mental well-being, and are regularly asked about it when we see our GPs, that will help a lot to de-stigmatise mental health issues.

I want to touch briefly on secondary care. One of the Sunday Express campaign demands is that all hospitals should be therapeutic environments where people with mental health problems feel safe and are treated with respect and have someone to talk to. In a debate in this House last November, I mentioned patients who abscond from secondary care units, and in particular the tragic case of my constituent Kirsty Brookes, who was able to escape from a unit in Leicester and subsequently hanged herself. I am sure the Minister will remember that debate, and our discussion of the definition of absconding.

The Care Quality Commission has published its first report on absconding levels, and I welcome that, but the picture in respect of absconding and escape numbers is still unclear. The numbers provided in this first CQC report need to be broken down further, therefore, but the report showed that in the year in question—2009-10, I think—there were 4,321 incidents of absence without leave from secondary care. Some of them were, of course, far more serious than others; some will have involved a person missing a bus on the way back to the unit, while others might have ended in tragic circumstances. I make this point not to beat up on secondary care providers and health providers generally, but we must know the scale of a problem before we can begin to tackle it.

The impact of the voluntary and community sector on mental health must not be forgotten either, and I hope Members will talk about that. The sector offers vital support, and it must be part of the commissioning landscape.

[Jeremy Corbyn (Islington North) (Lab)]

I congratulate the hon. Lady on securing this important debate. Many smaller voluntary sector organisations give a very good service and understand their communities. Under the commissioning process, however, they often lose out to very large enterprises—large charities and medical companies—that have no real understanding of the local community, particularly ethnic minority communities. Does the hon. Lady agree that the Minister needs to consider that issue further?

[Nicky Morgan]

I agree; that is an issue. The commissioning structures are being changed, with local GPs now deciding what care they want to buy and where they want to buy it from. I hope that change will allow them to explore the value of smaller organisations, which tend to know particularly well the people they are treating. Although such organisations might not have the clout of large organisations, they are often more successful in terms of patient care. I am sure the Minister has heard that point.

I want to thank one of my regular correspondents, Mike Crump of My Time, a community interest company based in the west midlands. He may well be in the Public Gallery for this debate. My Time provides evidence-based, culturally sensitive professional counselling and support services. He said to me that a great deal of many people’s recoveries

“is owed to therapies based on basic common sense not the miraculous powers of a tablet or the mysterious wonders of the medical profession.”

Let me turn briefly to policing. My chief constable in Leicestershire is also the Association of Chief Police Officers mental health lead. In Leicestershire in 2011-12 there were 444 detentions under section 136 of the Mental Health Act 1983, which gives powers to take a person to a place of safety. Leicestershire police deal with serious incidents involving mental health issues on a daily basis, and it has provided me with a snapshot of what happened on the jubilee weekend. From 8 pm one night to 7 am the next morning they dealt with 10 incidents in which mental health conditions or concerns were clearly prevalent. That night, police officers spent four hours with a man in hospital after he was detained under section 136. I therefore ask this question: are the police the right people to be dealing with such incidents?

I hope Members will talk about the criminal justice system, and the fact that nine out of every 10 prisoners have a mental health problem. The Government are investing more than £19 million this year in diversion services, but it is still taking too long to get prisoners out of prison and into secure hospitals.

Finally, I want to talk about the mental well-being landscape. All of us have mental health; it is just that some people’s is better than other people’s. We need to get to a situation where it is as normal to talk about our mental well-being as about our physical well-being.

Public health policy has a role to play. Local authority public health services are key in promoting good public health. I welcome the Leicestershire joint strategic needs assessment chapter on mental health, which was published recently. It makes it clear that mental health is important and says that it cannot be seen in isolation, as many factors contribute to mental ill-health, including the economic instability at present—which I am sure we will hear about this afternoon—and the welfare reform changes, such as asking people whether they are fit enough to go back to work. I think such questions need to be asked, but I thank my constituent Jo Gibbs, who recently brought me a letter outlining her concerns about these changes and the anxiety and pressure they are causing her and others.

[Julie Hilling (Bolton West) (Lab)]

I congratulate the hon. Lady on securing this debate, and on her speech. On welfare reform, does she share my concern that people with mental health issues are being kicked off disability support allowance? Increasing numbers of people in that situation are coming to see me. Recently a constituent came to me who is bipolar on the Asperger’s spectrum and who scored zero in the assessment for that allowance.

[Nicky Morgan]

I thank the hon. Lady for her intervention. I am sure we will all have similar constituency cases. A survey by Mind found that most people with mental health problems want to work but may not be well enough. For some people, employment—the right employment with the right employer and the right support—is the right way forward once they are better. For other people, however, employment is not the answer. The hon. Lady is right that assessors have not always understood the mental health needs of certain people. The Government have tried to address that through the two Harrington reviews. The system is never going to be perfect. That is where Members of Parliament come in; we will be making arguments on behalf of our constituents. I understand the hon. Lady’s point, however. We need to do more, and we need to promote awareness of these issues.

Other aspects of modern life do not help, such as loneliness and isolation. We live in an ever busier world, but people lead more isolated lives. We must not forget the question of families either. Sometimes they can be the cause of a person’s problems, but at other times they can be the solution. I commend the Centre for Social Justice for its work and its report, “Completing the Revolution”, about the importance of families and how significant family breakdown can be in respect of mental health problems.

This is an important debate, but it is only one step along the path of giving mental health the priority that Members clearly feel is needed given the number of them present today. I look forward to hearing their views. We need to talk about mental health far more openly, and we need to make it much easier for people to find out information about how they can get help before they need it. It is too late when people reach crisis point.

I look forward to the no health without mental health framework being implemented. Talking must never stop, but we must now also start implementing. I thank everybody who has contacted me in the run-up to this debate and shared their often very personal stories about their experiences in the mental health system. The House is all too often known for Members shouting at each other. I hope today shows that we are about more than that, and I hope we can all agree with the motion before us, as mental health is a huge priority for Britain and for our constituents, whether they are sufferers or carers. Working together, we can come up with integrated care that responds to the needs of patients and gives our mental well-being the prominence it merits.

--- Later in debate ---

[Mr Jones]

I totally agree and I shall give some examples of that in a minute.

We must try to get a system in which employers, even in these tight economic circumstances, understand the mental health issues and can make adaptations. Whether we support employers who take people with mental health issues on for a certain period or whether we do other things, we need to think it out a bit more than it is at the moment.

[Nicky Morgan]

One statistic that I did not use in my speech was that only 1% of the access to work funding, which employers can use to help to smooth someone’s path back into employment, is used for mental health facilities. It could be used for counselling or support workers, but only 1% is spent on such provision in the context of the prevalence of mental health issues in the general population.

[Mr Jones]

The hon. Lady makes an important point that should be considered. That is where we need to join up the two relevant Departments.

Mental Health North East has carried out a survey and I thank that organisation and Derwentside citizen’s advice bureau for the examples I am going to use. Like the hon. Member for Loughborough, I asked whether I could use names. One person said that I could, but late last night she rang me to say no. I am sure that people will understand why I use letters to refer to these individuals rather than their names.

The first case is that of Mr A, a 50-year-old man who lives alone and received ESA. He suffers from depression, anxiety, agoraphobia and anger issues. Despite the support he is getting and the drugs that he is taking, he was called by Atos to a work-related interview. He got no points at all even though he finds it very strange to go outside the house, let alone to interact with people. He decided to appeal and attended the appeal. There is a huge backlog in the appeals system that is adding to people’s anxiety as they are having to wait a long time, and the pressure on citizen’s advice bureaux and local welfare rights organisations to support those appeals is creating a crisis in some of them. When I give some of these examples, Mr Speaker, you will see that they should never have gone to appeal in the first place.

This case was very interesting. Mr A turned up at the appeal, which, as my hon. Friend the Member for Islington North mentioned earlier, caused him huge stress as he thought he was going to lose. He turned up in the afternoon, and his appeal had been heard that morning without his being present and his award had been granted on the basis of the medical evidence. If the appeal hearing could do that, why could Atos not do so? The reason is that Atos is not taking medical evidence into account at all.

The second individual is from Stanley in my constituency and I have known this young lady since she was in her early 20s.

--- Later in debate ---

[Nicky Morgan]

I am sorry that in the short time available, I will not be able to mention all the fantastic speeches we have heard this afternoon. We can definitely say that we have considered the motion fully—and we should all be very proud of that achievement.

I shall make a few brief points to draw the issues of the debate together. First, we all agreed that the debate was somewhat overdue and that it was time that mental health was discussed more often in the Chamber. I hope that we have shown the House of Commons at its best. I certainly think we have; I think this is one of the best debates I have attended since I was elected just over two years ago. We were right to hold out for a debate in the main Chamber, which was an important issue.

Secondly, we have shown that Members of Parliament are not immune to mental health experiences. I would like to pay particular tribute to the speeches of the hon. Member for North Durham (Mr Jones) and of my hon. Friends the Members for Broxbourne (Mr Walker), for Totnes (Dr Wollaston) and for South Northamptonshire (Andrea Leadsom), who should win an award for bringing the name of Harry Potter into her speech.

We have shown this afternoon why it is so important for my hon. Friend the Member for Croydon Central (Gavin Barwell) to introduce his private Member’s Bill. I am sure that we all wish him well with it and look forward to working with him on a cross-party basis—another significant achievement from today’s debate. I thank both Front-Bench teams for their support for my hon. Friend’s private Member’s Bill.

I think it was the Minister who said that this issue is not about them and us; it is just about us. Mental health affects everybody within society, and it is up to all of us to challenge stigma. Mention was made of media leadership, particularly of the campaign run by the Sunday Express. Mention was also rightly made of the importance of using the right language when we talk about mental health. That is certainly something that I shall take away from this debate.

The point has been made that many different treatments work and that we should respect that. I entirely take the shadow Secretary of State’s point about moving the NHS into the 21st century. His point about the physicality and the separateness of our mental health trusts and buildings was a good one. I had not considered that point before; the right hon. Gentleman was absolutely right.

The hon. Member for Lewisham East (Heidi Alexander) talked about the many challenges faced by local mental health services and those working in them, and her speech perhaps best summed them up. We have also heard concerns about the work capability assessments.

My hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) argued that different parts of the Government needed to work more closely together in the sense that a number of different Ministers could have sat on the Front Bench to talk about this issue.

Finally, I want to thank all the speakers, the Backbench Business Committee for securing the debate, everyone who has watched it outside and, as my hon. Friend the Member for Bracknell (Dr Lee) mentioned, everyone working within the mental health system.

Question put and agreed to.

Resolved,

That this House has considered the matter of mental health.



business of the House (19 June)

Ordered,

That, at the sitting on Tuesday 19 June the Speaker shall put the Questions necessary to dispose of proceedings on the Motion in the name of Secretary Theresa May relating to immigration not later than four hours after their commencement; such Questions shall include the Questions on any Amendments selected by the Speaker which may then be moved; proceedings may continue, though opposed, after the moment of interruption; and Standing Order No. 41A (Deferred divisions) shall not apply.—(Michael Fabricant.)