Mental Health

Baroness Tyler of Enfield Excerpts

Thursday 15th January 2015 Lords Chamber

[Baroness Tyler of Enfield]

That this House takes note of mental health care provision.

[Baroness Tyler of Enfield (LD)]

My Lords, I am delighted to have secured this debate, and with it such an array of knowledgeable and, I know, passionate speakers. I am particularly looking forward to hearing the maiden speech of my noble friend Lord Suri. For too long, the subject of mental health has been ignored, marginalised or left to the realm of social experiment or institutional stigma. Why does this matter? Just as we all have physical health, we all have mental health. Mental health problems affect one in four people in any given year, and the numbers continue to rise. In 2013, referrals to community mental health teams were up by 13%, and up by 16% for crisis services. As a consequence, services are often unable to cope, and people are not getting the support they need.

While 75% of people with a physical health condition get treatment, just 65% of people with psychotic disorders, and a mere 25% of those with depression and anxiety, successfully access treatment. John Lucas, a campaigner for the mental health charity Mind, has been diagnosed with both mental and physical health conditions, and speaks compellingly about the discrepancy between the care people receive for mental and physical health problems. He asks:

“Why does the NHS pull out all stops to stop me dying of physical health problems but does not care if I die of mental health problems?”.

Importantly, mental health problems are estimated to cost the country £105 billion a year through lost working days, benefits, lost tax receipts and the cost of treatment. So there is also a very strong economic case for investing in well-being, resilience and mental health. It is therefore highly appropriate that this debate takes place at a time when, although a lot of progress has been made, there is still much more to be done. We need to ensure that mental health services are equipped to respond to people with all sorts of mental health needs, ranging from preventive work and early intervention through to crisis care. We need to make sure that people who need mental health services, like those who use physical health services, can access care quickly, and have choices about what kind of care they receive.

This Parliament has seen real progress in mental health at national policy level. We have made real strides in awareness and public attitudes towards mental health. I pay tribute to my right honourable friends Paul Burstow and Norman Lamb for all that they have done in this area. Specifically, the cross-government strategy No Health Without Mental Health marked a breakthrough moment for mental health, and led the way for the commitment to parity of esteem between physical and mental health which is now enshrined in legislation and in the Government’s mandate to the NHS.

What has happened as a result? Last year, building on the £400 million investment in talking therapies, the introduction of the first ever access and waiting time standards for talking therapies and early intervention in psychosis, backed up by additional cash, was a welcome and long overdue step towards achieving parity of access to treatment for people with mental health problems. The mental health crisis care concordat should ensure that no one is left without support in a mental health crisis.

All localities have made declarations about working together across agencies to improve crisis care, and progress is already happening on the ground. For example, in Birmingham there has been a marked reduction in the use of police custody as a place of safety. I am sure we can all agree that a police cell can never be an appropriate environment for someone in a mental health crisis.

Of course, good mental health care is not just about treatment, but about empowering people to lead better lives. Recognising this, we now have more peer support workers in mental health trusts, and some 30 recovery colleges in place, to help people with mental health problems develop and achieve their own goals for recovery.

We have seen a real sea-change in the way people think about mental health. The MPs who participated in that famous debate in the House of Commons, and spoke so openly and movingly of their own mental health experiences, deserve much praise. Noble Lords in this House have also been open about their experiences. The courage of those in such positions in being open about their own mental health problems has undoubtedly raised the profile of mental health in Parliament—and, I hope, made it easier for others to speak out. Meanwhile, the Time to Change programme, England’s biggest anti-stigma programme, run jointly by the charities Mind and Rethink Mental Illness, is making a real impact both on public understanding and, perhaps more importantly, on people’s experiences of discrimination.

However, I am a realist, and despite this commendable progress, there is still a long way to go to achieve genuine parity for mental health in the NHS, and an equal chance in life for people with mental health problems. After generations of missed opportunities, I guess this is inevitable. So what are the remaining barriers that need addressing? To put it bluntly, funding for mental health services has faced disproportionate cuts compared with other services. Mental health services have always been known as a Cinderella service because of their chronic underfunding, and mental health receives only 13% of NHS health expenditure, despite making up 23% of what is called the burden of disease. Austerity has hit mental health services particularly hard. Mental health has seen real-terms cuts three years in a row. At the same time, demand is rising. By 2030 there will be approximately 2 million more adults with mental health problems in the UK than there are today.

Early intervention services are often the first target for cuts, but surely this is a false economy, because people’s problems then get worse, and they need more intensive and costly support. With their new public health responsibilities, local authorities have a real opportunity to prevent mental health problems developing in their communities. It is encouraging that some 35 authorities now have a mental health champion. However, research suggests that on average, councils are spending only 1.5% of their ring-fenced public health budget on mental health.

Even when people receive care, it is not always helpful. When we are unwell we are often told to see our GP in the first instance, and 90% of people with mental health problems are treated in primary care. But GPs themselves admit they do not always have the training they need to support people with mental health problems. I think all primary care services urgently need GPs and practice nurses with the confidence and expertise to improve people’s experience of primary care.

Evidence shows that a choice of care improves treatment outcomes, but people often do not receive the type of care they want. Talking therapy is the preferred choice of a majority of people with mental health problems, but only one in seven receive it. That is why I would like to see the right for patients to choose the type of treatment they receive enshrined in the NHS constitution—and for those who would rather have talking therapies than medication, there should be a choice of evidence-based therapies available, backed up by high-quality information.

I suspect that we can all agree that children and young people’s mental health services are a matter of real concern. Some 10% of children aged five to 15 have a mental health problem, yet funding for CAMHS has fallen by over 6% in real terms since 2010, and the commissioning of these services is far too fragmented, resulting in too many children and young people falling through the cracks. Too often they are taken hundreds of miles away from their home for treatment, or are admitted to adult wards. The Government are committed to fund more children’s beds, which is welcome, and have invested £150 million to improve support for eating disorders. We eagerly await the report of the Children and Young People’s Mental Health and Wellbeing Taskforce—a very long title. Can the Minister say when that is likely to be published?

Of course, children’s mental health begins at birth. It is critical to children’s mental health and resilience that they develop a secure relationship with their primary care giver—but are we doing enough to support new mothers who develop mental health problems during their pregnancy? More than one in 10 women will experience mental health difficulties during and after pregnancy, which often go unrecognised and untreated. According to the National Childbirth Trust, only 3% of CCGs report having a perinatal mental health strategy. I suggest that we could improve mothers’ access to mental health support by committing to including measurable objectives in the NHS mandate.

What else could and should be done? Schools have a golden opportunity to protect and promote children’s mental health and emotional well-being, at the same time as helping them achieve good educational outcomes. I would like the next Government to commit to raising awareness of mental health and well-being among young people by ensuring that mental health and emotional well-being form part of an enhanced and mandatory part of the curriculum for all schools, irrespective of their status. Yes, PSHE will be central to this, but such an approach needs to be embedded in the mainstream of the curriculum and the whole ethos of the school. As counselling can be an effective early intervention for young people experiencing mental health problems, and improve students’ attendance, attainment and behaviour, I would like to see all children in England having access to counselling, as children in Wales and Northern Ireland do.

People with mental health problems also face difficulties finding and keeping employment—2.3 million people with a mental health condition are out of work. Almost half of those receiving employment and support allowance are claiming primarily because of mental health problems, yet research shows that the vast majority want to work. It is clear that back-to-work schemes have little understanding of people with mental health problems and often assume that they lack motivation and willingness to work. What we need is personalised and specialist support to help them back into work, designed around the specific needs of people with mental health problems.

Finally, parity of esteem needs to be genuinely inclusive and work for all, including those who find themselves excluded or marginalised from society—those who are isolated or that third of people living with a long-term physical condition who also have a mental health problem. Certain black and minority ethnic groups and people with multiple and complex needs are often overlooked. People with a dual diagnosis—for example, those who have been diagnosed with a drug and alcohol problem as well as with another mental illness—are often denied access to mental health care on the ground that their substance abuse makes treatment impossible. When they are in crisis, they are more likely to be taken to a police cell than a health setting. It should not have to be that way.

Charities working together as part of the Make Every Adult Matter coalition, which I chair, have shown that by effective joint working, better care can be achieved for people with complex needs. I am pleased that the Department of Health is currently reviewing the 2002 guidance on dual diagnosis and hope that the continued rollout of liaison and diversion schemes will also start to address the issue of drug and alcohol abuse.

The next Parliament should set out an ambitious agenda for mental health. What should it be? Here is my starter for 10: mental health is not just a health issue. Therefore, we need a truly cross-governmental mental health and well-being strategy embracing issues such as employment, welfare, policing and criminal justice, housing, education and planning, as well as seeing Public Health England lead with the establishment of a national well-being programme championing preventive action. To lead this charge I would like to see a dedicated Minister for mental health with a cross-government remit and, indeed, the Secretary of State for Health reporting annually to Parliament on progress towards achieving parity of esteem between mental and physical health.

Next, we should rewrite the current system which discriminates against mental health and leads to institutional bias, including: making the NHS constitution fairer; introducing a wider range of access and waiting-time standards, along with entitlement to NICE-approved treatments for mental health problems; revising payment systems to put mental and physical health on an equal footing; and better aligned NHS public health and social care outcomes frameworks which put much greater emphasis on mental health. Finally, and perhaps most importantly, we should rebalance the NHS budget to ensure that mental health services for children and adults receive their fair share of funding and that metal health services see real-terms increases in investment in each year of the next Parliament.

To conclude, much progress has been made in mental health over this Parliament. The next Government—of whatever complexion or, indeed, combination—have a real opportunity to build on this momentum and transform the way in which we approach mental health in this country. It will take strong and courageous leadership both politically and from within the NHS, but the prize in terms of the nation’s well-being could be immense. I very much look forward to hearing what other noble Lords have to say on the matter. I beg to move.

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[Baroness Tyler of Enfield]

My Lords, this has been an excellent debate drawing on the wealth of expertise, knowledge and first-hand experience of all the speakers. I thank all noble Lords who spoke and especially commend my noble friend Lord Suri for his excellent maiden speech. I also thank the many local health organisations that provided me with briefing; I particularly thank Mind for its help.

I do not think that anyone who listened to the debate this afternoon could be in any doubt about the strength of feeling on this issue, the importance of mental health to the country’s well-being or indeed the scale of the challenges ahead. Those challenges are for central government, but also for the NHS, local councils, the voluntary sector, communities and, indeed, families.

I leave noble Lords with one thought: many speakers this afternoon, myself included, talked about or implied that the problem was around the issue of institutional bias against mental health within the NHS. I feel that that sort of culture has started to change, given that one quarter of the population in this country experience mental health problems at one time or another, a quarter of all managers in senior leadership positions have a mental health background and a quarter of all the thinking and doing time in the NHS is spent on mental health.

Motion agreed.