Drugs

Baroness Walmsley Excerpts

Thursday 4th February 2016 Grand Committee

[Baroness Walmsley (LD)]

My Lords, I thank the noble Lord, Lord Patel of Bradford, for raising this important issue. The increase in the number of deaths from drugs poisoning is a matter of great concern, since every single death is an indication of failure—failure of individual services and failure of the system of health and care to look after that patient. I refer to “the patient” because my party has always believed that individual drug abuse should be regarded as a health issue, and is not always a police issue. The pushers and dealers, however, are a very different matter.

As has been said, although some are suicides, most of these deaths are accidental, caused by lack of knowledge of the strength of the drugs that people are taking, or someone’s lack of understanding of their own body’s ability to process the chemicals. I will return to that point later. Accidental deaths also occur when a person is not in full possession of his or her faculties and has a fatal accident. I have read the various reports that have tried to analyse the statistics, and that is clearly a very complicated and difficult task, because in many cases there are several causal factors and they are hard to untangle. Few of those who die from drug use have one single simple problem. About one-third of patients abuse alcohol as well as banned or prescription drugs, and many have mental health problems. There is clearly interaction between the various issues.

A recent report called “Solutions from the Frontline” by MEAM—Making Every Adult Matter, an alliance of mental health charities chaired by my noble friend Lady Tyler of Enfield—calculated that there are 58,000 people who face homelessness, substance abuse, mental health problems and offending behaviour, distributed all over Britain. Of course, not all of them are at risk of accidental death because of their drug problems, but clearly their risk rises because of their multiplicity of needs and the great difficulty that services find in reaching and helping them. The problems get worse because people experiencing multiple needs are also likely to live in poverty and experience stigma, discrimination, isolation and loneliness—and, of course, loneliness is a great mental health and suicide risk. Although the ONS report indicates a large protective factor when people are in treatment, which is encouraging to know, those services are suffering, as we have heard from the noble Lord, Lord Patel of Bradford.

I shall concentrate my remarks on dual diagnosis, and on offenders and ex-offenders. According to MEAM, people experiencing multiple needs often have ineffective contact with services, as in most cases services are designed to deal with one problem at a time and to support people with single severe conditions. This can mean that people with multiple needs are more likely to access emergency, rather than planned, services, such as going to accident and emergency rather than their local GP. Accessing services in this way is costly as well as risky: estimates suggest that costs for the 58,000 individuals nationally are between £1.1 billion and £2.1 billion per year. So it is absolutely vital that people who are registered as being addicted to drugs, especially the depressive opiates such as heroin, have their mental health needs assessed and addressed. This is not always happening, partly because of cuts and partly because of shortages of staff with the right experience. Many patients claim that mental health crisis services are not there for them and many have to wait far too long for routine therapies. I do not underestimate the difficulty of dealing with these patients but we must make more effort to do so, for their own sake as well as for the sake of the NHS budget.

The recommendations of the MEAM report include asking the Government to ensure that funding structures prioritise recovery and rehabilitation and allow local areas to develop a flexible response. As part of this, they should consider a new national focus on multiple needs. Locally, commissioners should be accountable for ensuring that local areas have joined-up services and identify where people with multiple needs could fall through the gaps. At the front line, services should involve staff and people with multiple needs working together in designing programmes and the environments where they are to be delivered.

As for drug-using offenders, of course there are a lot of treatment programmes in prison although we know that security in many prisons is poor and they say you can access any drug you like in most prisons. It should, of course, be easier to help addicts when you have them incarcerated in prison than it is when they are part of the general population, and a lot of good work is done. However, I am not convinced that the underlying mental health problems are always addressed in the same way. It is difficult for a lay person like me to understand whether it is the mental health problem that brings people to take drugs in the first place or the drugs themselves that cause mental health problems. I understand it can be either way round, but what matters is to accept that dual diagnosis is not always properly addressed; it is very risky, and we need to do something about it.

The other issue that I would like to raise is continuity of services after release. There is supposed to be a seamless transition into community services but too often that does not happen, perhaps because the services are not there, the person drops out, or the professionals concerned are too busy to work with each other and do not realise how important and effective that is. A very senior psychiatrist told me only yesterday that, if someone gets clean while in prison and then comes out and starts using again, they are at greater risk of dying. While they are under treatment their liver stops having to process the poisonous chemicals in the drugs, so it stops being able to do so. If an ex-offender then starts using again, they should be advised to start on a very low dose and build up, but actually they tend to go back on the high dose they were used to using before they went to prison. This is too much for the body to cope with and it kills them. The dose they were accustomed to before prison now becomes an overdose.

Obviously, we do not want ex-addicts to come out of prison to start again at all but, if they do, they should be made aware of the danger and they should have continuity of care until their rehabilitation is well embedded. Often a patient has very good motivation to keep off drugs but, if something goes wrong in their life, such as losing a job or becoming homeless, the mental health problems recur and they do not have the support or resilience to resist self-medication with drugs that make them feel better.

The mention of resilience brings me to my final point. The roots of mental illness often go back a very long way. We must address the issue we are debating today in the very long term. By that I mean that we need to focus on two things in schools: education about the harms of drug and alcohol use and prevention of mental ill-health among children and young people. We need schools to be able to recognise mental health problems and know how and where to get help. They should also positively promote good mental health and well-being and help their pupils to develop resilient personalities. Of course, we should also go even further back in life and provide mental health therapists in all maternity units and help new mothers bond well with their children, given the crucial importance of attachment to the child’s future mental health. I wonder whether the increase in deaths is not because more people are taking drugs—from what the noble Lord, Lord Patel of Bradford, said, that is not the case—but are we getting more mental health problems that push users over the edge?

Good mental health does not happen by accident any more than good physical health. Just as we need to foster good physical health through diet, exercise and avoiding risky behaviours, so we also need to be aware that good mental health can be fostered. This should be part of the healthy community plans of all local authorities as well as schools, but sadly it is often at the bottom of their priority list because they have the money to do only what is mandatory. But by ignoring this we are storing up problems for the future. I would ask the Minister to be kind enough to comment on the points I have made and let noble Lords know how the Government are dealing with them.