Psychosis: Early Intervention

Diane Abbott Excerpts

Wednesday 7th September 2016 Westminster Hall

[Kerry McCarthy (Bristol East) (Lab)]

As ever, it is a pleasure to see you in the Chair, Sir Roger. I also welcome the Minister to her place.

Psychosis is incredibly frightening for friends and family to witness, and I speak from personal experience. It means people in effect having lost control of what is going on inside their head but not realising it, and it is difficult to get through to them. It is also an incredibly frightening experience for the people who suffer such episodes— perhaps not at the time, when they are in the grip of psychosis, but it becomes apparent from talking to them afterwards. One person, a veteran of the first Gulf war who has suffered from psychosis for the best part of 20 years, said, “You never know again whether what you are experiencing, feeling and thinking is true, because other people are telling you your experiences were not true.” It is an incredibly distressing place to be.

Early intervention is crucial. Mothers in particular have come to my constituency surgery, desperate to keep their young adult sons out of the criminal justice system, yet that is often the only alternative. These are big lads who can be quite frightening when they are in the grip of psychosis. The last thing a mother wants is to see her son locked up in police cells for the night, but all too often that has been the only alternative. If the lads are not seen as a direct danger to themselves or to others they cannot be sectioned; the mothers do not want them to be sectioned but they desperately want to get them help.

I pay tribute to the police and crime commissioner in my local area, Sue Mountstevens. She is an independent candidate who has just been elected for the second time, and she has made it an absolute priority to try to get people with mental health problems out of the criminal justice system and to make sure there are beds available so they can get the help they need.

We know that psychosis is particularly prevalent among young men of black Caribbean or African origin. Indeed, the three mothers who have come to me about this issue are all of black Caribbean or African descent. It seems to be an established fact that these young men are more vulnerable, but I do not think we have ever got to the root of why that is the case, and I would like to see more research into that.

I agree with what has been said about parity of esteem; I think all parties now recognise that. Mental health has been the poor relation of physical health, but young people’s mental health has too often been the poor relation of adult mental health. Young people struggle.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Does my hon. Friend agree that overall people of black Caribbean heritage are over-represented in the mental health system? These young men tend to present late. They tend to be less likely to get talking therapy and tend to have poorer outcomes.

[Kerry McCarthy]

I very much agree, and I would love to see more research into the reasons for that. We know that early intervention is crucial and that if there is intervention after the first episode of psychosis, it can be deflected further down the line. It may be that young men’s reluctance or the lack of access to those services means that they go on to develop full-blown psychosis, which then blights their adult lives. There could be all sorts of reason. I have heard my hon. Friend speak about this before. I know she thinks it is a really important issue, and I agree with her.

Young people are even more marginalised. I have the Riverside unit for young people in my constituency at Blackberry Hill hospital. It is part residential, part day placements. I visited it recently. If the spaces are full, a number of young people get sent a considerable distance from home and away from their friends and families for treatment, which is not ideal. If we are trying to deal with young people in very vulnerable circumstances, displacing them from their families and support networks is obviously wrong.

Dr Dominique Thompson, who is in charge of the GP services at the University of Bristol, has given me figures in the past about the proportion of the casework of GPs at universities that is now on mental health-based issues, and it has grown exponentially. That is everything ranging from anxiety, stress and depression right through to severe psychosis. I make a plea that the health services at universities are not the same as ordinary neighbourhood GPs; they need particular support. They deal with young people who are away from home and away from their support networks. We know that GPs are under pressure—particularly in terms of recruitment, which is a debate for another day—and it is important they have the resources to deal with that.

I want to mention briefly one source of help that is available to GPs. I met a group of researchers yesterday who are part of the Avon and Wiltshire Mental Health Partnership NHS Trust and are based at Blackberry Hill hospital in my constituency. They do something called BEST—best evidence summaries of topics—in mental health, which is a web-based service. Basically, these experts look through all the information available and distil it down to easy paragraphs for clinicians, so that rather than having to wade through all the material on the internet, clinicians are given some guidance as to what they are likely to be looking at and the likely best treatments. The funding for that service is under threat. A cross-party group of MPs from the Avon and Wiltshire area met those researchers yesterday. We think that the service should at the very least be piloted, with a view to rolling it out nationally, because it is a really valuable resource. We are going to write to the Minister about that, but I wanted to flag it up today.

Finally, I was looking this morning at the NICE guidance on early intervention in psychosis access. It pays passing reference to substance abuse, saying:

“Around 40% of people with first episode psychosis misuse substances at some point in their lifetime.”

I would like to see more research done into cannabis-induced psychosis. It is clear to me—partly from anecdotal evidence, but there is research out there—that partly because of the stronger strains of cannabis that are now available, more people are presenting with cannabis-induced psychosis. There may be a connection between that and people going on to develop full-blown psychosis, or people may have a cannabis-induced psychotic episode and then recover. Speaking partly from personal observation, I think that in some cases drug use makes it more difficult to diagnose when people are suffering first-time psychotic episodes. I would like to see more research into that.

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[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Roger. I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this very important debate. The House appreciates his engagement with this issue, given all his wisdom and experience as a former Health Minister, and his continuing work since the 2014 paper “Achieving Better Access to Mental Health Services by 2020”.

Every Member of Parliament, on both sides of the House, will have had the experience in their own advice sessions of people coming to see them who either are experiencing mental health problems or are a family member trying to get help for a child or partner with mental health problems. I think that every Member of Parliament will also have somebody struggling with mental health issues within their own family or among their wider acquaintanceship, but it remains the case that the stigma around mental health issues means there is more concealment, more shame and more delay in reaching out to the NHS for the treatment and support that people need. We know that mental health issues are on the rise. We know that there is a relationship between recession, unemployment and mental health issues and we can see it in our communities across the country.

I have to declare an interest because my mother was a mental health nurse until she retired. She worked in a mental hospital called Storthes Hall in West Yorkshire, and like a lot of mental health facilities it was a former workhouse. Despite the dedication of the nurses and doctors who worked there, this former workhouse on the edge of the Yorkshire moors exemplified, in a very physical way, the Cinderella nature of mental health services.

All parties in this House are committed to parity of esteem between mental health and physical health, but this important debate tests that reality. As we heard earlier, mental health is not just an issue for the individuals concerned; it can have a very sad and serious effect on their families. My hon. Friend the Member for Bristol East (Kerry McCarthy) touched on the issue of black and minority ethnic men and psychosis. This subject is not often discussed in this House, so I will be forgiven for saying a little about it. It has been an issue for many decades that black and minority ethnic people are disproportionately represented in our mental health system at every level. If someone goes on to the wards of the Maudsley in south London or of mental health hospitals across London, they will see that a disproportionate number of the beds are filled by people of black and minority ethnic origin. In some cases, nearly all the beds are filled by people of black and minority ethnic origin.

This subject has been examined and studied since the book “Aliens and Alienists: Ethnic Minorities and Psychiatry”, which is by Dr Lipsedge, I think, and goes back to the ’80s. First, the issue is disproportionate representation, but then it is what sort of access to treatment people from black and minority ethnic backgrounds get. The first problem is their presenting late, and one of the reasons why black and minority ethnic people present late is that they are so frightened of the mental health system. I have dealt time after time with mothers who are struggling with sons with very serious psychosis whom they cannot manage and feel physically threatened by. When I say to them that they need to approach the national health service, they are often very resistant because they are so frightened. They believe that if they let their sons go into the mental health system, they will just be pumped full of—

[Sir Roger Gale (in the Chair)]

Order. I am sorry to interrupt the hon. Lady. I understand that she wishes to address the Member who moved the motion, but she is off-microphone and it is making it difficult for the Hansard reporter. That is why, traditionally, Members address the Chair.

[Ms Abbott]

It is true of many communities, and in particular the black and minority ethnic community, as the statistics prove, that they are reluctant to take family members into the national health system. When they finally have to engage with the national health service, their symptoms are much worse and it is far harder to get positive outcomes. I tell the Minister that it is really important to look at this issue of black and minority ethnic people and the mental health system, because it is causing real misery and problems within the community. We are less likely to be offered talking therapies and more likely to be offered electroconvulsive therapy. Again, mental health facilities within the prison service, such as Rampton, have disproportionate levels of black and minority ethnic persons inside those institutions.

[Norman Lamb]

I am grateful to the hon. Lady for giving way. She is making an incredibly important point about the over-representation of black and minority ethnic people in the system. Does she agree that they are also more likely to be subject to coercion—to sectioning under the Mental Health Acts—and more likely to suffer restraint and physical force within mental health settings?

[Ms Abbott]

I am grateful to the right hon. Gentleman for that important point. It is absolutely true that, partly because they are presenting late and often have quite advanced psychotic symptoms, they are more likely to experience coercion and restraint. We know that some of those incidents of restraint have had very unhappy outcomes, and families continue to campaign against the misuse of restraint on mental health patients. All these decades after people first started to look at issues relating to black and minority ethnic communities and the mental health service, we have made little progress. Is the Minister willing to meet me to discuss this issue, which I have looked at for many years? One of the basic problems is statistics. It took years to get the health service to keep statistics broken down by ethnicity within the mental health service, and I am not sure what is happening to those data.

As we have heard, it is vital that psychosis is treated early as that prevents complications, improves outcomes and is more cost-effective. We know that psychosis costs £11.8 billion a year and we also know that mental health problems are on the rise. It is very disturbing to find that the research shows that a quarter of CCGs seem to be ignoring the access waiting time standard for psychosis, and the National Audit Office reports that there are insufficient funds available for the strategy to achieve parity of esteem to have any reality. We know, because we have heard, that too many CCGs cannot even specify how much money is devoted to early intervention; that gives rise to the suspicion that not enough is devoted to it.

The right hon. Member for North Norfolk made the fundamental point that this issue is still not being treated with the same seriousness as cancer standards are. This goes back to the issue that many Members have raised of stigma, shame and an unwillingness of the families of psychosis sufferers to speak out in the way that the families of people who suffer from cancer are willing to go into the public space and to the media to speak out.

[Johnny Mercer]

I wholeheartedly agree with the hon. Lady about that. This week, in Plymouth we have been running a campaign called “Talk Don’t Suffer”, in conjunction with The Herald. I pay tribute to the Plymouth Herald for what it has done. Getting people to come forward and printing their stories is such a powerful testimony for those who suffer with mental health, because they know that other people are suffering too and about the impact on families. To talk about it is very important to improving the situation.

[Ms Abbott]

I again congratulate the right hon. Member for North Norfolk on securing this important debate. He spoke about discrimination and injustice, and that is what strikes people so strongly. There is the human misery of people suffering from psychosis, whether intermittent bouts or lifelong psychosis, and there is the misery and worry of their family members. We need to be a society in which the promise from all parts of the House for parity of esteem between mental and physical health becomes reality. We want to be a society in which people are not marginalised or almost warehoused just because they have mental health challenges, including psychosis, but have some promise of the support they need and of a better life. I look forward to the Minister’s response to questions asked by my Opposition colleagues. I assure her that I will return to this issue—not only black and minority ethnic mental health, but mental health in general.

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[Nicola Blackwood]

As the right hon. Gentleman is aware, this work is in its early stages. He is right that services are working hard to develop this process. NHS England has set out in its implementation plan how the services will need to grow and improve to meet the new standards. In particular, it has noted that the current block contract arrangements can result in poor transparency on spend per patient, as he has seen with his freedom of information request.

NHS England has been looking at alternative funding models that will link an element of payment to achievement of quality and outcomes, including the EIP access and waiting time standard. When there are variations in spend, we will need to consider the reasons for that and ensure that necessary action is taken to address any impact on the quality of care available. I hope that reassures the right hon. Gentleman.

In addition, the Royal College of Psychiatrists College Centre for Quality Improvement has been commissioned to undertake continued assessment and quality improvement work. This will be through a quality improvement network, supported by an annual self-assessment that will be independently validated and scored. All early intervention in psychosis services are going to be expected to participate. The first results will be published in April 2017, but any earlier results will be published before that. It is intended to provide a transparent assessment of services across England. This will give us a clear picture of service provision and enable us to target areas where additional development will be required, so that we can ensure that the standard is met and that people receive the care they need.

The right hon. Gentleman also mentioned the important issue of age caps. The most likely age for a first episode of psychosis to occur is between 14 and 35, as has been pointed out.

[Ms Abbott]

Is the Minister saying that there is currently no way of making sure that CCGs spend the requisite proportion of their funding on mental health?