Five Year Forward View for Mental Health

Debate between Jeff Smith and Dan Poulter

Tuesday 30th October 2018 Westminster Hall

[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.

--- Later in debate ---

[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.