Mental Health Services

Baroness Walmsley Excerpts

Thursday 25th June 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I thank the noble Baroness, Lady Thornton, for introducing this debate. I was delighted that she and her colleagues felt able to support the Liberal Democrat amendment on parity of esteem. The noble Baroness has given a very comprehensive outline of the problems highlighted by the report and I will not repeat them. Suffice it to say that we on these Benches will support anything the Government do to alleviate the problems of young people with mental health issues before and during crisis situations. Early access to treatment is the key to reducing the number of crisis occurrences and good planning of adequate services and information to patients are key to making sure that people in crisis can get the help, as the CQC says, “right here, right now”.

We are proud of the record of our Liberal Democrat Ministers, Paul Burstow and Norman Lamb, in the last Government. They were involved in announcing: parity of esteem for physical and mental health; an increase in funding for mental health, including more in-patient beds; increased focus on child and adolescent mental health; and equal waiting time targets. The Children and Young People’s Mental Health Taskforce report Future in Mind is an excellent blueprint for the five-year national programme of improvement commenced under the auspices of my right honourable friend Norman Lamb and it is part of his excellent legacy in the Department of Health. The mental health crisis care concordat was another great achievement and it is good to know that everyone has now signed up to it and that most local authorities have a plan to deliver it. However, resources have been scarce for most of the past five years so this progress has to be seen in the context of an earlier reduction in the number of mental health beds and years of insufficient focus on children and young people.

I welcome the Government’s proposal to ban the use of police cells for young people in crisis. However, I want to talk about timing. There are times when Governments, in their rush to do the right thing, forget that if they do not put other things in place before acting, they can make things worse. I can think of the spare room subsidy which the previous Government imposed without ensuring that sufficient smaller properties were available for people to downsize. That is why my party put forward a Private Member’s Bill to ensure that tenants would not have to contribute for spare rooms unless they had been offered suitable smaller accommodation and refused it. Sadly, that was defeated in another place. Another potential example is the current Government's plan for seven-day availability of GP services at a time when we have not even got enough GPs to fulfil current demand.

I am concerned that if the ban on use of police cells is brought in before the problems highlighted in this thematic report from the CQC are addressed, we will be leaving young people in crisis with nowhere to go. I do not want to see police officers disciplined for bringing young people into police stations when there are no age-appropriate therapeutic services available for them and that is the only thing they can do. I do not want to see A&E departments trying to cope with these young people, who need time that the staff do not have and a calm atmosphere—which is not going to be found in A&E. I do not want to see young people failing to call for help when they need it because they know that the police cannot protect them—often from themselves—and neither can A&E.

It really does not seem right that people are being turned away from services when they ask for help only to be detained when their condition deteriorates. However, although they are not the appropriate service to help in mental health crises, it has to be said that the police do their best, and many patients in this situation report that they get better help from them than from some other services. Some forces have implemented rather creative strategies. I have heard of at least one force where officers called out after hours to a person who clearly is having a mental health crisis take a community psychiatric nurse with them. These nurses are able to assess the situation and calm the patient, allowing him to be dealt with appropriately. This is an excellent example of thinking outside the box and is to be commended.

I ask the Government to ensure that before this very welcome ban comes into force they have all their ducks in a row, so to speak. My question, therefore, is: how will the Government assess when this is the case so that the ban can be safely implemented once the legislation has gone through?

There is one large group that is particularly at risk in these situations: young people who have recently left care, many of whom develop mental health issues soon after having to live independently. Many of these young people do not have a responsible adult to turn to and do not access services early, and far too many of them suffer a crisis and harm themselves or even commit suicide.

There is evidence that the problems overall may be understated by the official figures. Although only 53 under-15s and 312 16 to 17 year-olds were admitted to adult mental health wards in 2013-14, people were counted only once no matter how many times they were admitted in the year. These figures come from an Answer to a Written Question from Luciana Berger.

Another problem is poor anticipation of a future crisis and poor communication between services. The report we are discussing found that the rate of people admitted to acute hospital via A&E for a mental health condition varied across the country. In 2012-13, more than 4,000 people had attended A&E multiple times—on average, at least once a month—in the five years before being admitted. This is likely to be a sign that local services are not working well together and that people are not getting the specialist help they need. Should there not be guidelines that a red flag is raised when these multiple attendances occur?

Given that the pathways into help in a crisis are several, can the Minister reassure us that local concordat teams are covering all the bases, ensuring good communication and providing services at the right time? Will he emphasise that patients need to know who to call to get help? One of the worst findings in the report was the large number of patients at risk of a crisis who said that they did not know who to call in an emergency—no wonder they land up in A&E.

I realise that the task for local commissioners is a difficult one. They need to predict what crisis services will be needed and at what times, and make those services available. This requires a deep knowledge of the status of patients in their area and a commitment to providing therapies which will prevent problems reaching crisis point. So my final question is: how are the Government assessing how well this is being done?