Mental Health

Jeremy Corbyn Excerpts

Thursday 14th June 2012 Commons Chamber

[Nicky Morgan]

My hon. Friend is absolutely right, and I shall talk about well-being shortly. We often talk about these subjects in very negative ways. If we all talk about our mental well-being, and are regularly asked about it when we see our GPs, that will help a lot to de-stigmatise mental health issues.

I want to touch briefly on secondary care. One of the Sunday Express campaign demands is that all hospitals should be therapeutic environments where people with mental health problems feel safe and are treated with respect and have someone to talk to. In a debate in this House last November, I mentioned patients who abscond from secondary care units, and in particular the tragic case of my constituent Kirsty Brookes, who was able to escape from a unit in Leicester and subsequently hanged herself. I am sure the Minister will remember that debate, and our discussion of the definition of absconding.

The Care Quality Commission has published its first report on absconding levels, and I welcome that, but the picture in respect of absconding and escape numbers is still unclear. The numbers provided in this first CQC report need to be broken down further, therefore, but the report showed that in the year in question—2009-10, I think—there were 4,321 incidents of absence without leave from secondary care. Some of them were, of course, far more serious than others; some will have involved a person missing a bus on the way back to the unit, while others might have ended in tragic circumstances. I make this point not to beat up on secondary care providers and health providers generally, but we must know the scale of a problem before we can begin to tackle it.

The impact of the voluntary and community sector on mental health must not be forgotten either, and I hope Members will talk about that. The sector offers vital support, and it must be part of the commissioning landscape.

[Jeremy Corbyn (Islington North) (Lab)]

I congratulate the hon. Lady on securing this important debate. Many smaller voluntary sector organisations give a very good service and understand their communities. Under the commissioning process, however, they often lose out to very large enterprises—large charities and medical companies—that have no real understanding of the local community, particularly ethnic minority communities. Does the hon. Lady agree that the Minister needs to consider that issue further?

[Nicky Morgan]

I agree; that is an issue. The commissioning structures are being changed, with local GPs now deciding what care they want to buy and where they want to buy it from. I hope that change will allow them to explore the value of smaller organisations, which tend to know particularly well the people they are treating. Although such organisations might not have the clout of large organisations, they are often more successful in terms of patient care. I am sure the Minister has heard that point.

I want to thank one of my regular correspondents, Mike Crump of My Time, a community interest company based in the west midlands. He may well be in the Public Gallery for this debate. My Time provides evidence-based, culturally sensitive professional counselling and support services. He said to me that a great deal of many people’s recoveries

“is owed to therapies based on basic common sense not the miraculous powers of a tablet or the mysterious wonders of the medical profession.”

Let me turn briefly to policing. My chief constable in Leicestershire is also the Association of Chief Police Officers mental health lead. In Leicestershire in 2011-12 there were 444 detentions under section 136 of the Mental Health Act 1983, which gives powers to take a person to a place of safety. Leicestershire police deal with serious incidents involving mental health issues on a daily basis, and it has provided me with a snapshot of what happened on the jubilee weekend. From 8 pm one night to 7 am the next morning they dealt with 10 incidents in which mental health conditions or concerns were clearly prevalent. That night, police officers spent four hours with a man in hospital after he was detained under section 136. I therefore ask this question: are the police the right people to be dealing with such incidents?

I hope Members will talk about the criminal justice system, and the fact that nine out of every 10 prisoners have a mental health problem. The Government are investing more than £19 million this year in diversion services, but it is still taking too long to get prisoners out of prison and into secure hospitals.

Finally, I want to talk about the mental well-being landscape. All of us have mental health; it is just that some people’s is better than other people’s. We need to get to a situation where it is as normal to talk about our mental well-being as about our physical well-being.

Public health policy has a role to play. Local authority public health services are key in promoting good public health. I welcome the Leicestershire joint strategic needs assessment chapter on mental health, which was published recently. It makes it clear that mental health is important and says that it cannot be seen in isolation, as many factors contribute to mental ill-health, including the economic instability at present—which I am sure we will hear about this afternoon—and the welfare reform changes, such as asking people whether they are fit enough to go back to work. I think such questions need to be asked, but I thank my constituent Jo Gibbs, who recently brought me a letter outlining her concerns about these changes and the anxiety and pressure they are causing her and others.

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[Mr Jones]

Yes, that is one of the key roles of those boards. Again, however, it will be important to ensure that we get the right people on those boards—for example, counsellors who really understand mental health. As the hon. Member for Loughborough said, people have empathy in respect of cancer, but do not quite understand mental health. I agree with the Minister that it is important that the boards are the counterweight to ensure that that happens, but I think that central Government also have to play a role in ensuring that it happens. As I say, we have some great opportunities here and the commissioned work that Chester-le-Street Mind delivers is excellent. In addition, it is cheap compared with some of the major contracts in terms of delivery, because it is delivered by well-trained professionals and by very committed and hard-working individuals in the community.

A lot of mental health charities also rely on charity funding from organisations. In the north-east this funding comes from, for example, institutions such as the Northern Rock Foundation, which has now been taken over by Virgin Money. There is real concern that as those sums contract, the money going into mental health services from those groups will also contract. We need to keep an eye on the situation to ensure that, be it through the lottery or through organisations such as the Northern Rock Foundation or the County Durham Community Foundation, where funds are limited because of the economic crisis, mental health gets its fair share of the funding available. I mean no disrespect when I say that people give happily to Guide Dogs for the Blind or to cancer charities, but it is very much more difficult to get a lot of people to recognise and give money to mental health charities, unless they have been through or had a family member who has been involved in mental health issues. We need to be wary of that, too.

I now wish to discuss the welfare benefit changes, which my hon. Friend the Member for Bolton West mentioned. I commend Mental Health North East, a very good group in the north-east that has interacted with the Department of Health. It is an umbrella group of mental health charities that not only campaigns for and raises awareness about mental health but delivers services to mental health charities and individuals. The organisation is run by a very dynamic chief executive, Lyn Boyd, and is made up of paid individuals and a large number of volunteers, many of whom have personal experience of mental health issues. They are very good advocates, not only ensuring that mental health is kept high on the political agenda but interacting very successfully with the Department of Health in consultations and so on.

One piece of work that that organisation has considered is on a matter that I have increasingly seen in my constituency surgeries. There are people with mental health issues who were on the old incapacity benefit and are now on the new employment and support allowance and who are, frankly, being treated appallingly. The way that is being done is costing the Government more money in the long term. I know that it is not the direct responsibility of the Department of Health, but some thought needs to go into how we deal with the work test for people with mental health illnesses. I am one of the first to recognise that, as most of the professionals say, working is good for people’s mental health; it is important to say that. However, we must recognise that certain people will have difficulties with that. If we are to get people with mental health problems into work, we must ensure that the pathway is a little more sympathetic than the one we have at the moment.

Another massive problem is the work needed with employers. If employers are going to take on people with mental health issues, they will have to be very understanding to cope with those individuals.

[Jeremy Corbyn]

Many of those who are taken for work-related interviews by Atos are declared fit for work, only to win an appeal to show that they are not. On many occasions, the levels of stress they have been through in going for the interview, failing it and winning an appeal are very detrimental to their health. Does my hon. Friend agree that the Department must be far more sensitive about that and think a lot more before it starts to call people in for these interviews?

[Mr Jones]

I totally agree and I shall give some examples of that in a minute.

We must try to get a system in which employers, even in these tight economic circumstances, understand the mental health issues and can make adaptations. Whether we support employers who take people with mental health issues on for a certain period or whether we do other things, we need to think it out a bit more than it is at the moment.

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[Paul Burstow]

I hope that there will be cross-party consensus on these issues today, and I shall take the hon. Gentleman’s question in that spirit. He makes a fair point. This is about building on what is working, and ensuring that it can work even better. The work done by my hon. Friend the Member for South West Wiltshire has certainly accelerated the pace.

When the Deputy Prime Minister and I launched the mental health strategy last year, we recognised the need to tackle the root causes of mental illness as well as ensuring that community and acute services provide timely treatment and care. We placed a strong emphasis on recovery from a human, rather than just a medical, perspective. We also made it clear that delivering significant improvements in people’s health and well-being requires parity of esteem between physical and mental health.

I know that some hon. Members are concerned that not enough emphasis has been placed on acute and in-patient care. Let me be clear. Our plans to provide a safe, modern, effective mental health service give equal emphasis to the full range of services, from public mental health and prevention through to forensic mental health services. This is about people receiving high quality, appropriate care when they need it. If services can intervene early—the case for that has already been powerfully made—so that mental health problems can be managed in the community before more serious problems develop, that should result in acute in-patient care being made available more quickly for those who need it.

My hon. Friend the Member for Loughborough mentioned the concerns raised by the Association of Chief Police Officers about places of safety. In partnership with the Home Office and the police, we are examining how to ensure that health services are properly commissioned in custodial situations. I would be only too happy to meet her and the ACPO mental health lead to discuss those issues further.

[Jeremy Corbyn]

Will the Minister look carefully into the circumstances of people who die either in police custody or in a mental health institution as a result of a mental health issue, to determine whether adequate forms of inquest and inquiry exist, and whether adequate lessons are being learned from the experiences? In view of what is going on in one or two inquests at the moment, I feel that there are some quite serious deficiencies in that area.

[Paul Burstow]

I thank the hon. Gentleman for his question. May I undertake to write to him about that matter in more detail? It has come up in our work on our suicide prevention strategy in relation to the nature of suicide verdicts, and narrative verdicts in particular, in coroners’ courts. I would be happy to come back to him on that issue.

In the past year, we have made progress across a broad front. We have committed £400 million to make psychological therapies available for adults of all ages, as well as for people with long-term health conditions and with severe and enduring mental illness. When it comes to our focus on recovery, the latest figures show that 44.4% of those who complete programmes recover and that more achieve lasting improvement. That puts us on track to achieve our target rate of recovery of over 50%.

Given that we know that the first signs of more than half of all lifelong mental illnesses can be detected in adolescence, we have to go further. That is why the Government are breaking new ground by investing in a new training-led approach to re-equip children and young people’s mental health services to offer a range of psychological therapies. I pay tribute to the leadership shown by YoungMinds. Without its support, we would not have come as far in this area as fast as we have.

I want to say something about the necessity of achieving the best possible outcomes for people in mental health crisis. Secondary mental health services across the country have made significant changes, both in community and hospital settings, including the provision of alternatives to psychiatric hospital admission. For example, more than 10,000 people with an early diagnosis of psychosis were engaged with early intervention services last year. That is the highest figure ever recorded. The improvements in community-based early intervention services are driving up standards of care, as well as reducing the demand for hospital admissions. I freely acknowledge that there is more to do and I take on board the point that my hon. Friend the Member for Broxbourne made about the need to look at the variability in the accessibility of mental health advocacy.

The development of recovery-focused services is a critical part of the Government’s strategy. That work is being led by the NHS Confederation’s mental health network and the Centre for Mental Health. They are supporting pilot sites that cover almost half of England and are making the kind of changes that service users have sought for years. The programme has identified 10 key changes to the way in which staff work, the types of services that are provided and the culture of organisations to embed recovery principles into routine practice.

When I visited the South West London recovery college, I heard powerful personal testimonies from people who were living purposeful and fulfilling lives, and who were living with their illness rather than having to be cured of symptoms or illnesses. It is important that recovery is not just seen in medical terms, but is self-defined. Students at the college learn not only how to manage their condition, but skills to help them back to work and to form new relationships. Some become lecturers at the college themselves. I was told that being called a student, rather than a patient, helped people take control of their recovery, gave them more confidence and, crucially, made them feel normal, as opposed to being treated as a helpless, passive recipient of care.

Part of a good recovery is the ability to exercise more control over one’s life. In health care, that means that there must be more shared decision making and choice. In opening the debate, my hon. Friend the Member for Loughborough mentioned the principle of “no decision about me without me”. Undoubtedly, the any qualified provider policy and tariff reform have a part to play in that.

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[Andy Burnham]

I completely agree, and obviously that was one of the major conclusions of the Field report, which the hon. Lady’s Government commissioned. The problem is not just the separateness of the system, although that is one of the factors; rather, it starts much earlier. We need to take that broad view.

More co-location of acute care and mental health care within the same hospital would be a good thing to encourage. We heard on the radio this morning about the RAID—rapid assessment interface and discharge—service in Birmingham, which is an excellent example of that and something we need to follow. That is part of the culture change we need in the NHS. The other part of that change is that practitioners dealing with mental health, particularly GPs, at the primary care level, should not just reach first for medical interventions, rather than social or psychological interventions. However, I am afraid that that is what we do. Let us look at these, more startling statistics. In 2009, the NHS issued 39.1 million prescriptions for antidepressants—there was a big jump during the financial crisis, towards the end of the last decade. That figure represented a 95% increase on the decade, from the 20.2 million prescriptions issued in 1998. Were all of those 40 million prescriptions necessary? Of course they were not.

Prompted by my north-west colleague, the hon. Member for Southport (John Pugh), let me pick up the point about Labour’s successes. We did address some of these issues. The improving access to psychological therapies programme is something I am very proud of taking forward as Secretary of State, because it began to give GPs an alternative to antidepressants and medication to refer people towards. That was an important development, and—credit where it is due—it was Lord Richard Layard who made such an incredible change, by pushing so determinedly for that programme.

[Jeremy Corbyn]

My right hon. Friend is making an important point. Too often GPs reach for medicine when they should be reaching for counselling. They should be offering a more supportive environment, but when we get high-speed GPs with little time to talk to patients, they tend to prescribe medicines when they ought to be doing something else. Does my right hon. Friend agree that we need to go a lot further than we already have?

[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.

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[Jeremy Corbyn (Islington North) (Lab)]

I welcome this debate, and I will do my best to stick to the eight minutes that you have suggested, Mr Deputy Speaker, to ensure that everybody gets to make a contribution. It is valuable to have this debate and to raise the whole issue of the stigma surrounding mental health. I pay a huge tribute to my hon. Friend the Member for North Durham (Mr Jones) and the hon. Member for Broxbourne (Mr Walker) for speaking out, because it is necessary to do so. The public need to understand that everyone knows somebody who has suffered from degrees of depression or many other conditions. I am sure that all of us, even if we do not believe that we have suffered from this ourselves in our own lives and in our own families, know people who have. Public attitudes have come a long way since the late Tom Eagleton was driven out of the US vice-presidential nomination in 1972 because he had had treatment for severe depression. He, to his credit, later went on to become a senator, elected with 60% of the vote, so the timidity of the political establishment in the US in 1972 was overturned by a much more generous political atmosphere some years later. We should remember people like him, who, in many respects, paved the way for it.

We have to understand that about 4,000 people a year in this country commit suicide. The figure varies a bit from year to year, but it is about 4,000. That is a very large figure indeed, which is why I intervened on the Minister on the question of deaths when people are in care or in custody, and I am looking forward to his response. As a society, we have to think a bit more carefully about the terror that some people live their lives in, which ends in a lonely suicide. These are people who were unable to seek help or support from anybody else, and were probably reading in the papers, hearing jokes on television and being the butt of comedians’ jokes about “sad nutters”, “desperate people” and so on. As a society and as a community, we need to reach out to people who are going through their own tensions and their own crises. If we cannot do that, the number of suicides will not fall and is likely to increase.

In my community, we have a good mental health service. We have a trust that operates in Camden and Islington, which is quite a small geographical area for it to operate across. It is certainly much smaller than many others in other parts of the country, and my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) and I fought very hard to ensure that it was operated on a relatively small basis because we felt that that would provide for a better service that was more in touch with the local community. I hope that it will be able to continue in that way, but I am saddened to have to report that this year the trust plans to deliver what it describes as

“£75.1m savings across the acute sector; £46.7m from acute productivity and £28.4m through changes in care setting and other demand management initiatives.”

That is quite a big cut in desperately needed services in an area that suffers from a very high level of need for mental health care and treatment.

My own local Islington borough council, to its credit, instituted the fairness commission after the 2010 elections. The council has said:

“The work of the Islington Fairness Commission highlighted the wide-ranging impacts of challenges to mental health and wellbeing for people, communities and services in Islington, particularly during a period of economic uncertainty and financial hardship.”

A number of recommendations are then made, with the council going on to state:

“Levels of need are exceptionally high in Islington. There were 3,152 patients on serious mental illness primary care registers in Islington in 2010/11, representing 1 in every 65 patients. There are an estimated 31,000 adults and 3,000 children and young people…experiencing mental health problems…There are an estimated 3,500…drug users, and 10,000 problem alcohol users, with 46,000 adults in total drinking at hazardous or harmful levels. Underlying rates of mental health and substance misuse problems in prison reach in excess of 90%.”

My borough contains two prisons. We have to examine those issues seriously as a House and as a society.

The other point I wanted to make was that the economic issues associated with stress are very serious indeed. Obviously, one such issue is unemployment, but others are housing and overcrowding and, often, the domestic violence that results. My hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) and I share the Finsbury Park Homeless Families Project unit, which is based in her constituency but does wonderful work to support families in both our constituencies. The unit’s staff point out that the severe problems of the people who come to see them are usually related to serious overcrowding, housing uncertainty and lack of secure tenancy. Various levels of stress and mental health issues pertain to that. In solving these issues, we must consider the economic factors.

We should also consider very seriously the levels of stress and depression among young people. Growing up as a young person in any community is not easy. They are faced with enormous pressures from a consumerist society to achieve and to have. Many cannot fulfil those ideals and will never be able to fulfil those ambitions. The levels of stress we are forcing on to young people result in some cases—although, thankfully, only a very small number—in serious illness or even suicide.

[Yvonne Fovargue (Makerfield) (Lab)]

To return to the social pressures, does my hon. Friend agree that debt is a considerable social pressure? I ran a scheme where debt advice was provided on prescription and paid for by the PCT. Independent analysis reckoned that at least three suicides had been prevented by early access to debt advice. Does my hon. Friend share my concern that that access might well now be restricted?

[Jeremy Corbyn]

I completely endorse what my hon. Friend has said and the great work she has done in supporting advice agencies and dealing with such issues. My borough recently opened a new citizen’s advice bureau—I congratulate the council on being able to fund and reopen it—and it has been inundated with people with serious debt issues. It offers serious debt advice and a great deal of help. We have also given a lot of support to a credit union that is working very well with a large and fast-growing membership. People are accessing a limited amount of credit and support, and it is far better that it comes from that source than from the high street loan sharks who are appearing all over the country and bleeding people dry with the excessive rates of interest that they charge.

There are some things we can do, but my point is that if a young person worked hard in school, did well, studied hard and got good grades but is still unemployed and after a while becomes almost unemployable, it becomes a source of enormous stress about the future.

I want to bring up two more issues before I conclude. In my part of London and, I suspect, many other parts of urban Britain, many victims of domestic violence, usually women, seek support and therapy. The voluntary sector is often best placed to provide that support and therapy and that was why I intervened on the hon. Member for Loughborough (Nicky Morgan) when she introduced the debate to make the point that when commissioning is done by the primary care trusts or the wider trusts that deal exclusively with mental health issues, it tends to be skewed in favour of the very large and financially burgeoned organisations rather than local charities and voluntary sector groups with a specific base, which are often much more effective and provide a very good service. I would be grateful if the Minister could give us some good news on that, or if he could write to me about how those issues could be brought out.

In my community, we have a number of very effective charities that work with victims of domestic violence and racist abuse, which, fortunately, is not an enormous issue but nevertheless exists. We also have a large number of people who have experienced torture and violence and are either asylum seekers or have achieved refugee status. I thank those charities for the work they do. Nafsiyat, an intercultural therapy centre based in Finsbury Park, has done good and groundbreaking work on cultural values and dealing with stress and the victims of violence. The Maya centre deals with women who have suffered similar problems. We also have the Women’s Therapy Centre, ICAP—Immigrant Counselling and Psychotherapy—which gives enormous support to other people, and the local Refugee Therapy Centre. They all do very good work, all have difficulty coping with the demands placed on them and all have financial issues. When the Government talk about increased money for mental health, they should think very carefully about how the contracts are negotiated, as they often force very low rates of pay on the voluntary sector to undertake the kind of work that is done. The Minister needs to think quite carefully about that.

The housing issue has been referred to and the number of homeless people in this country is rising, as is the number who are suffering from stress. Locally, we have a group called the Pilion Trust which has recently been given a donation—I am grateful to the Amy Winehouse Foundation for that—to help in its work in providing a night shelter, but a night shelter is not a solution to homelessness problems. A solution to homelessness problems is having a requirement regarding re-housing and a much more aggressive housing programme in this country.

I conclude by saying that too many people commit suicide and suffer from mental health issues and stress in their lives. We cannot change all that but we can change the approach to mental health issues. We can look at the good work that is done and support people in that work. We can say to those who have gone through depression and crises, “That is not the end.” Such people are contributing to our society and will succeed later in life. We should recognise the value of everyone and not consign people to a mark that indicates they have become unemployable and have no future. That is as bad as what the asylum system did in the past. We can do better than that and learn from others and the good experience they have had.