Mental Health

Chris Ruane Excerpts

Thursday 14th June 2012 Commons Chamber

[Andy Burnham]

I completely agree. I do a lot of work shadowing, and I recently shadowed a GP. What amazed me was how many of the people coming through his door were the people who also come through our doors on a Friday and Saturday. They are not necessarily looking for something to take to the chemists; they are actually just crying out for help, in one way or another, with a problem they are struggling with. That GP was very good and did not prescribe, but referred lots of people to the IAPT service, as I sat there with him. However, he said that across Coventry, where he was based, many others were not doing the same.

[Chris Ruane (Vale of Clwyd) (Lab)]

The Minister mentioned the number of prescriptions that have been issued. I received a parliamentary answer a couple of days ago which said that in 1991 there were 9 million prescriptions. The Minister mentioned the figure of 42 million, but from 2010 to 2011 the number went up by 4 million. In the years before that the increase was usually 2 million a year, but in one year the figure increased by 10%, or 4 million. When I asked the Minister what his assessment was of the reason for those increases, there was no conclusive answer. We must get to the bottom of why these prescriptions are being issued and why they have gone up by 500% in a 20-year period.

[Andy Burnham]

We must. Perhaps I am about to make more of a political point, but as has been mentioned so eloquently today by my hon. Friend the Member for North Durham, as well as the hon. Member for Strangford (Jim Shannon), although the trend is upwards—that is happening come what may: I mentioned the financial crisis, during which the rate has jumped up, including in our time in government—the cumulative effect of some of the benefits changes on some of the most vulnerable members of society, coupled with the withdrawal of social care support by councils, means that, right now, some people out there are suffering very badly indeed. That is part of the explanation for the worrying figures that my hon. Friend has just given the House. The Government need to have a look at what is happening out there and whether or not some people are struggling with mental health problems because of the extra stress that other factors, particularly financial, are putting upon them.

I welcome the Minister’s commitment to the improving access to psychological therapies programme, but I hear that waiting times for it are increasing in parts of the country where GPs face much longer referral times. Indeed, a Mind survey of 2011 said that 30% of GPs were unaware of services to which they could refer patients, beyond medication. That tells us that we still have quite a long way to go. IAPT needs protecting and nurturing; it needs to come with a national direction in the operating framework. In the new and changing NHS world, we cannot allow it to be simply whittled away. More broadly, we need to look carefully at commissioning and find out whether GPs have the right skills to commission properly for mental health. We need to consider what the precise commissioning arrangements for mental health are, as there is still some confusion out there about them.

--- Later in debate ---

[Chris Ruane (Vale of Clwyd) (Lab)]

Most of the contributions we have heard so far today have concentrated on mental ill health, but I also wish to address mental health and well-being, and not just for those who have experienced mental health problems, but for the whole population in general.

Over £400 billion worth of illegal drugs are traded around the world ever year, which is the same amount that is spent on energy, or 8% of the world’s wealth. When that is combined with the amount spent on alcohol, cigarettes, legal drugs to help us over depression, over-eating and the amount spent trying to fix all those problems, we are probably talking about 20% of the world’s wealth being spent on, essentially, escaping from reality. That is a modern reality that has many causes. We need to look at the debate in the round and consider all the factors, including nutrition, advertising, the farming industry and work practices, because they all have an impact on what certain Members have so eloquently described today. We should look not just at the pinnacle of the problem, but what is behind it.

Statistics show that 29% of US school children have mental health problems. At what point will American society say, “Enough is enough”? Is it when 39%, 49% or 59% of their children are mentally ill? The UK is not far behind. We follow the Anglo-American pattern, because 22% of our children experience mental health problems, and they are the lucky ones, because 74% of children in care homes experience mental health problems, as do 46% of those who are fostered. Some 90% of prisoners have mental health problems. Obesity is also a problem. At age five 10% of UK children are obese, but by age 10 the figure is 20%. What is happening in that five-year period to make those kids consume the sugars, fats and salts that will react with their bodies? Those fats will react with the fats in their brain and their myelin sheaths and neural pathways. It is an epidemic that is growing out of control, and we will be picking up the costs, including the financial costs and health costs for the individual and their families, for decades to come.

I recently received an answer to a parliamentary question. It showed that in 1991 almost 9 million prescriptions for antidepressant drugs were dispensed in the UK, but by 2011 the figure had increased to over 46.5 million, a 500% increase. When I asked the Minister for his assessment of why that was so, he replied:

“We are unable to provide a conclusive account for the increase in the number of prescription items dispensed.”—[Official Report, 30 April 2012; Vol. 543, c. 1286W.]

We do not know what is making the kids obese and we do not know what is turning our population into legal addicts. Those statistics are just for antidepressants and do not take into account the other drugs taken to help us sleep, keep us awake, keep us happy or manage our sex lives, although I never use them. There are other ways, because drugs are just one way of handling it. One-to-one counselling is another way, but it is very expensive. There is a third way: self-help. One of the best ways of self-help is mindfulness.

Mindfulness has been around for 2,500 years. To give a definition, mindfulness means paying attention in a particular way; on purpose, in the present moment and non-judgmentally. In other words, it means someone just focusing—not being chased by their past or worried by their future, but experiencing what they are experiencing there in the moment.

Mindfulness has been taught very effectively in America over a 30-year period and more recently in this country over a 10 to 12-year period. It involves an eight-week course, two-and-a-half hours’ taught lessons a week and 45 minutes’ meditation at home for six days a week, and it is taught in groups of eight to 20, so the costs are minimal and the benefits are unbelievable. It is out there, but it has not been taken up—even when NICE recommended it as a more effective means of treating repeat-episode depression. In 2004, it recommended the programme as being better than pills, but it has not been taken up. GPs and, dare I say it, Ministers do not know about it. I have quizzed Irish and British Ministers, and they do not know about it.

[Mr Kevan Jones]

I am listening carefully to my hon. Friend, but my experience is that, although group therapy might work for certain individuals, for many it does not. One thing that my right hon. Friend the Member for Leigh (Andy Burnham) did in the previous Government, and which has made a real difference, was to open up cognitive behaviour therapy treatments, as they have been a substitute for drugs. So no one treatment is a silver bullet for mental illness.

--- Later in debate ---

[Chris Ruane]

Absolutely. Cognitive behaviour therapy is fantastic, and mindfulness has now been tacked on to it to make it even more effective. The group therapy lasts only for eight weeks; after that the individual can handle it themselves. I have practised it for five years now, and I have been on the formal course.

It was Descartes who said that the mind is separate from the body and the body separate from the mind, but in eastern philosophy and medicine that is not the case: body and mind are inter-related. Mindfulness can be used to combat pain, stress, eating disorders, addiction, anxiety and psoriasis, but it has been recommended in the UK only for the treatment of repeat depression—and it has not even been used for that.

In America they use it in the prison service, in the police, fire and emergency services, including on those with witness trauma, in the health service for a range of medical conditions, to improve heart and cancer treatment and, even, in Congress. Congressman Tim Ryan, its expert on the subject, has just written a book, “A Mindful Nation”, about how mindfulness can be used across the board.

So there are other ways that we have not explored, but they have been around for 2,500 years and proved to be effective. There are experts in mindfulness, such as Jon Kabat-Zinn who pioneered it in America, and experts in positive psychology, such as Martin Seligman. Freud believed that if a person was mentally ill the most they could achieve was wellness, not happiness, but Martin Seligman, who headed the American Psychological Association, turned that around 20 years ago and developed positive psychology in America.

We have our own experts: Professor Richard Layard, a Labour Lord in the other place; and Felicia Huppert, the mother of a famous Liberal MP based in Cambridge, who has a theory that if we shift the whole wellbeing curve, including on the right-hand side those who are mentally ill and on the left-hand side those who are positive, across and make the whole population happier, the greatest impact will be on the unhappiest—on those with mental health problems.

There are also impacts on the policies that we develop throughout society and on what makes people happy. On the Office for National Statistics’ list of what makes people in the UK happy, No. 1 is living next to a park or having access to a swimming pool; No. 2 is having access to cultural services such as libraries; No. 3 is being physically healthy; No. 4 is having time to relax and enjoy oneself; No. 5 is living in a fair society; No. 6, the only one involving money, is having enough money to do what one wants; No. 7 is freedom; No. 8 is being content with one’s situation; No. 9 is people looking after each other; and No. 10 is the smell of freshly ground coffee.

Only one pertains to money, yet our whole society is geared to making money. Those are the values that we and Governments of both parties have adopted, but now we need to develop policies that recognise the situation and the position of mental health in society. It is the No. 1 issue affecting our society, and we need to look at it in the round.