Five Year Forward View for Mental Health

Jeff Smith Excerpts

Tuesday 30th October 2018 Westminster Hall

[Jeff Smith (Manchester, Withington) (Lab)]

I beg to move,

That this House has considered the five-year forward view for mental health.

It is a pleasure to serve with you in the Chair, Mr Hollobone. The key purpose of the debate is to represent the recent report of the all-party parliamentary group on mental health, of which I am vice-chair. We published “Progress of the Five Year Forward View for Mental Health: On the road to parity”, which is a report on the progress of the five year forward view at the halfway stage.

I pay tribute to the cross-party group of MPs and peers who took part in the inquiry, particularly the hon. Member for Faversham and Mid Kent (Helen Whately), who is the chair of the APPG; she is with us in this debate and I think she will make some remarks. I also pay tribute to Rethink Mental Illness and to the Royal College of Psychiatrists, which provided us with excellent secretariat support and supported us throughout the inquiry. I thank the Secretary of State for Health and Social Care, who attended the parliamentary launch of the report and engaged in a very helpful question and answer session.

The report is a summary of more than 70 pieces of written evidence, two oral evidence sessions, a focus group of service users and carers, and a visit to a mental health trust. It is a serious and informative piece of work that could help to make a difference in informing the NHS’s long-term plan. There are three main sets of recommendations in the report, including some important ones on joining up work with other services, particularly social care and housing, but this is quite a short debate so I will focus only on two questions.

I am interested to hear from the Minister about the Government’s plans to support people with severe mental illness. The report shows that adults severely affected by mental illnesses such as schizophrenia or bipolar disorder are left behind. We saw no consistent and coherent approach on how to support people diagnosed with personality disorders. The inquiry heard that there are no targets for how long adults should have to wait to access eating disorder services. Those illnesses have a severe impact on people’s day-to-day lives and can be lifelong conditions. It is not acceptable that people who are the most ill often wait the longest to get care.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing the debate. Although I appreciate, as he will, how big a task this is, I welcome the Government’s commitment to mental health funding in the Budget. But I am concerned that we are getting nowhere in reaching parity of esteem. The number of children and young people experiencing mental health problems has risen sharply, and they often go to A&E for help. Does he share my view that funding is needed to ensure that children and young people suffering with poor mental health have safe places in the community to turn to for help and support, without having to rely on A&Es, which are already under duress?

--- Later in debate ---

[Jeff Smith]

I very much agree with the hon. Gentleman. Although I will never say that increased spending on mental health is not good, the announcement in yesterday’s Budget of extra funding for mental health teams in A&Es points to a problem because we should not have to increase spending on A&Es. We should try to cut the number of people who have to go to A&Es at an earlier stage, and we must invest at an earlier stage.

[Rachael Maskell (York Central) (Lab/Co-op)]

I am very grateful for the APPG’s work. One of the biggest concerns is about mental health support in further education colleges, which seems to have gone completely off the radar. Both colleges in York have told me that there is increasing crisis in further education, particularly on self-harm by young people—now that there are more exam-based assessments, that is escalating at a pace. Does my hon. Friend agree that we must focus on prevention in FE colleges, to ensure we have the right health professionals based in those colleges?

[Jeff Smith]

I absolutely agree with my hon. Friend. Child, adolescent and early adult mental health is a big and growing problem.

The five year forward view recognised creating treatment pathways for people with bipolar disorder, adult eating disorders and personality disorders, but halfway through the plan, the inquiry found that those are still to be published. It is vital that NHS England implement in full all pathways recommended in the five year forward view.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate the hon. Gentleman on securing this debate. I draw Members’ attention to my entry in the Register of Members’ Financial Interests. Although there has been a commendable focus on increasing talking therapy through the IAPT—improving access to psychological therapies—programme, that tends to be cognitive behavioural therapy. The evidence base for helping people with personality disorder, particularly emotionally unstable personality disorder, is dialectical behaviour therapy. There is a real paucity of other talking therapies such as DBT available throughout the country, but particularly further north than where we are sitting, in London.

[Jeff Smith]

The hon. Gentleman has great experience and knowledge of those issues and makes an important point. He has anticipated some of the comments I will make and I strongly agree with him.

[John Howell (Henley) (Con)]

We, as MPs, are among the first to come across the sort of patients the hon. Gentleman is talking about. Does he agree that training ought to be provided for MPs, so that we know how to deal with those people when they appear at our surgeries?

[Jeff Smith]

That is an excellent point; some training packages are available for MPs’ staff. I encourage all colleagues to take advantage of that.

The vast majority of people severely affected by mental illness will receive support within a community mental health team, which is the type of core service that provides help to around 700,000 people in England, often with quite complex needs. Although some specialist services have benefited from additional funding and targets, core services for adults severely affected by mental illness have stood still. Core community services did not receive any funding under the five year forward view, and we found that only £50 million was allocated to other core services nationally.

[Mike Hill (Hartlepool) (Lab)]

In Hartlepool, there is no drop-in centre for people in crisis. Crisis teams are stretched to the limit, and often people wait for two hours or more to access them. Given the current funding review, does my hon. Friend agree that we must urgently resolve such situations?

[Jeff Smith]

Again, that is an excellent point and I strongly agree. The report makes it clear that core services are underfunded and under pressure. There has been great success in getting people better access to psychological therapy, but while IAPT is an excellent service it is not designed for people with severe mental illness. Core services are too overstretched to provide timely talking therapies to people with more complex needs, so those who are most ill often have to wait the longest to get help. Simon Stevens, the head of the NHS, said at the Global Mental Health summit that he believed that we must restrike the balance between new talking therapy services for patients with less severe conditions and the core services for those with long-term and severe mental health needs.

We heard many examples of people with severe mental illness struggling to get therapy. One service user came to us; they had a history of psychosis and were told by their GP that if they wanted to access psychological therapy quickly, they should lie to the IAPT team about having psychosis to avoid being rejected for treatment, because it was too difficult to get the treatment they needed for their condition.

In the worst case scenario, people can be hit with the double whammy of being told they are too ill for IAPT but not ill enough for a core mental health team. People are then left struggling. Another service user, Dani, who has a diagnosis of borderline personality disorder, spoke at our parliamentary launch and contributed to the report. She said that she felt it was strange to be called a service user because her experience was mostly of being told that she was not suitable for services, rather than actually using them.

The inquiry saw the consequences of what happens when people do not get timely support in the community. First, there is a rise in inappropriate out-of-area placements. At the end of June this year, there were 645 inappropriate out-of-area bed placements. Secondly, there is a rise in mental health crises. The report notes that attendances at A&E for a mental health problem have risen 94% since 2010. In our inquiry, we heard from service users who expressed their frustration at turning up at A&E and waiting hours to be seen, before being sent home after a brief chat with a professional. Extra services in A&E, as we were promised yesterday, are positive but a much better solution would be intervening so people do not have to go to A&E. A model already exists where mental health calls to 111 or 999 are redirected to a specialised 24/7 support service staffed by experienced psychological wellbeing coaches, social workers and mental health nurses, who can provide assessments and real-time support. That is successful and it could be rolled out as a national standard approach, which is something the report recommends.

Mental health crises should not be considered an inevitability for people severely affected by mental illness. It is entirely possible to stop people having to go to A&E in a crisis if community services intervene early enough to support them. Support across the country is patchy, unfortunately, as core services struggle to meet the increased demand on budgets. We should not be creating a system that steps in only when people reach breaking point. That is why the report recommends that NHS England should increase resources for core mental health services, such as community mental health teams. Will the Minister set out how the Department of Health and Social Care will help people with severe mental illnesses who are being left without support?

Secondly, I would like to focus on the issue of workforce. Will the Minister set out how we will ensure that we have the staff to meet the needs of everyone with a mental illness? Throughout the inquiry, we heard regularly that the issue of workforce is the biggest barrier to achieving the five year forward view. When workforce and funding for them do not meet demand, the thresholds for accessing treatment rise. That is a problem not just in core services, but in child and adolescent mental health services and across the board.

[Dr Poulter]

The hon. Gentleman is again making an important point. It is all very well talking about the aspiration of putting more money into mental health and expanding services, but improvement cannot be delivered without the workforce on the ground to provide care. There are serious recruitment and retention challenges across the mental health workforce. If we are talking about the crisis with young people, there is a real problem attracting people into the CAMHS workforce, particularly to become CAMHS consultants and CAMHS psychiatrists. That is an issue that the report picks up in great detail, but I hope he will join me in urging the Government to address this as a matter of urgency.

[Jeff Smith]

The hon. Gentleman makes another excellent point. Health Education England’s plan commits to 19,000 more people working in mental health by 2021, but between March 2017 and March 2018 the number of mental health staff in the NHS increased by just 915 people. That does not look like progress is on target. One in 10 consultant psychiatrist posts is empty and between April 2010 and 2018 there was a 12% fall in the number of mental health nurses. What are the Government’s plans to tackle the problem of the mental health workforce?

The report makes some recommendations and suggests that Health Education England and the Government look at all measures to increase the mental health workforce. There is a huge interest in mental health among young adults. Until we undertook the report, I did not realise that psychology was the third most popular undergraduate course for students starting university in 2016. We should make it easier for those capable, ambitious and keen graduates to work in NHS mental health services.

The hon. Member for Central Suffolk and North Ipswich (Dr Poulter) made the point earlier that recruiting more psychologists for specific therapies, such as dialectical behaviour therapy or cognitive analytic therapy, would mean that people had a wider choice about the type of therapy they received, instead of, as often happens, just being prescribed cognitive behavioural therapy—if they are able to get a prescription at all—because it is the only therapy available.

[Danielle Rowley (Midlothian) (Lab)]

As well as having more specialists in the NHS, does my hon. Friend agree that to tackle mental health we need good training in schools, workplaces and all the different parts of society? The point was made earlier that we, as Members of Parliament, need to have training, as well as being able to encourage a more positive attitude to mental health.

[Jeff Smith]

My hon. Friend makes an excellent point. I am probably not going to take any more interventions because I want to give the chair of the all-party parliamentary group on mental health time to make remarks and to hear from the Minister. I will rattle through the rest of my comments.

The report suggests that the peer workforce, where people with their own personal experience of mental illness support those who are currently in mental health services, should be expanded. Service users told us that it was invaluable not only in terms of positive role models, but to prevent an “us and them” barrier between patient and professional. It is effective and leads to a reduction in readmissions.

Finally, funding—the elephant in the room, as always. The five year forward view came with a headline commitment of over £1 billion invested each year in mental health by 2021. This has undoubtedly improved lives. However, the APPG heard that it is difficult to be certain that funds are reaching the frontline and that historical underfunding means that mental health is still the poor relation in the NHS. I note that a report from the Institute for Public Policy Research suggests that spending on mental health will have to double from £12 billion to £23.9 billion in the next decade to make parity of esteem a reality.

The mental health investment standard means that every clinical commissioning group has to increase mental health spend in line with its overall increase in health spending. However, last year, 24 CCGs reduced the amount they spent on mental health. Eight CCGs were classed as meeting the mental health investment standard despite the fact that they cut the amount they spent on mental health. We would welcome clarification on what the Government are doing to ensure that each CCG meets that target.

The five year forward view was never intended to solve every problem in our mental health system, but where it has been focused it has made a difference. For example, there has been success in perinatal mental health and improving access to IAPT. This report focuses on where the gaps are. We need to prioritise investment in core services and to ensure that we have a robust NHS workforce. I hope that the Minister, with NHS England, will respond positively to the report and hopefully this will reform NHS long-term planning.