Mental Health and Well-being of Londoners

Jeremy Corbyn Excerpts

Thursday 12th February 2015 Commons Chamber

[Ms Abbott]

I am grateful to you, Madam Deputy Speaker. As ever, you are punctilious about matters of order.

London boroughs spend about £550 million a year on just the social care costs of treating mental disorders. Another £960 million is spent each year on benefits to support people with mental ill health. Across the population, the net effect of those wider impacts substantially affects London’s economy, infrastructure and population. Mental health is not simply an issue for health and social care; it is an issue for everyone. Mental health conditions debilitate London businesses each year by limiting employee productivity and reducing the potential work force. Every year £920 million is lost owing to sickness absences, and a further £1.9 billion is lost in reduced productivity. Moreover, the costs extend more widely: the staggering sum of £10.4 billion is lost each year to London business and industry as a result of mental health issues.

The London criminal justice system spends approximately £220 million a year on services related to mental ill health, and other losses such as property damage, loss of stolen goods and the lost output of victims cost London a further £870 million. Those costs are already too high, but treatment costs are expected to grow over the next two decades. Mental health issues also prevent physical health conditions from being addressed properly. However, mental ill health remains one of the least understood of all health problems. The problem is exacerbated by the existence of an obstinate and persistent stigma that prevents people from talking about mental health or paying attention to the debate about it, and therefore prevents us as a society from addressing it properly.

I want to say a little about the issue of parity of esteem between mental and physical health. The continuing lack of parity of esteem, in terms of both funding and attitudes, underlies some of the mental health problems not just in London, but throughout the country. As the daughter of a mental health nurse, I am very clear about the fact that there is no parity of esteem between mental and physical health. My mother came here as a pupil nurse in the 1960s, and was part of the generation of West Indian women who helped to build our NHS. She took time off work to bring up a family, but she returned to nursing in the 1980s, and her subsequent career in mental health exemplified the issues involved in the lack of parity of esteem.

The first thing that I want to say about parity of esteem is that those who might be described as the high fliers in health do not necessarily go into mental health. That has always tended to be the case. I shall never forget something that happened in 1987, when I was a brand-new MP. The then chief nurse at City and Hackney told me that I must visit the hospitals in the area. She said that I should meet her at 10 pm, and she would take me to the three major hospitals in hospital: Bart’s, Homerton, and Hackney mental hospital. I met her, and we went around Bart’s. She did not think it in any way remarkable that in Bart’s, even at the dead of night, we did not see a single black nurse. Then we went to Homerton, where there were quite a few black nurses doing the night shift. The chief nurse said to me innocently, “You know, they”—meaning nurses of colour, I assume—“seem to prefer the night shift; our day shift is quite different.”

Then I went to Hackney mental hospital. Although this happened in 1987, I have never forgotten it. The mental hospital was, literally, an old workhouse. It was as grim as anyone could possibly imagine—and, of course, all the nurses there, day and night, were BME. I am afraid that that pointed to a lack of parity of esteem, in the context of the way in which nurses were allocated and the direction in which their careers were leading. I am not in any way detracting from the specialists in mental health, but in respect of nurses there has long been a stratification when it comes to who should work in mental as opposed to physical health.

My mother was a devoted mental health nurse who dealt with geriatric patients with dementia. When my brother and I were older and she went back to nursing, she worked in a hospital outside Huddersfield called Storthes Hall. Thankfully, it has now been closed. It was another former Victorian workhouse, and it looked exactly like a Victorian workhouse. One had only to visit that hospital, see the conditions there and then visit the new Huddersfield royal infirmary in the centre of Huddersfield to see physically demonstrated the complete inequality in services offered to people with physical illness as opposed to people with mental illness.

For a number of years, there has been more focus on mental health in all parties, which is to be welcomed, and more focus on the importance of parity of esteem. However, the financial issues are a challenge. For many years, mental health has been chronically underfunded and it has the reputation of being a Cinderella service. At national level, mental health accounts for 28% of the pressure in the NHS, yet on average clinical commissioning groups spent just 10% of their budget on mental health in 2013. Separate investigations by Community Care and the BBC showed that mental health trusts had their budgets cut by 2.3% in real terms between 2011-12 and 2013-14. The effects of some of those cuts have been felt throughout the system. There have been difficulties in accessing talking therapies. Service provision is creaking at the seams. Over 2,000 mental health beds have been closed since 2011, leading to several trusts with sky-high bed occupancy rates.

There is no question—perhaps Ministers will query this—but that austerity and issues with welfare, access to housing and unemployment have put some of London’s most deprived communities under pressure. Welfare cuts, the lack of stable tenancies and improperly enforced employment regulations must have an effect on the incidence of mental health-related illness. Therefore, on the one hand we have cuts to funding and on the other a rise in the conditions that affect people’s well-being and ultimately their mental health. That is a double-edged sword that spells disaster for the well-being of Londoners.

The specific mental health needs of LGBT Londoners are not discussed often. For a long time, London has been a city where young people come to find themselves. It is an inclusive environment where LGBT people are welcome. London boasts a dynamic gay scene and has successfully hosted World Pride. LGBT Londoners are now able to get married, to raise families and are equal before the law. We must safeguard those achievements by ensuring that they have access to appropriate health care and mental health provision.

It is time to change the stereotype that LGBT people are busy partying and having a good time. Unfortunately, it is not a wholly accurate depiction of the community. There are various estimates about the incidence of mental health problems in LGBT groups, but research I have seen says that sexual minorities are two or three times more likely to report having a long-standing psychological or emotional problem than their heterosexual counterparts; and that two out of five LGBT people will experience a mental health problem at some point in their lives, which is quite a high proportion. In 2014, Stonewall said:

“Compared to the general population, lesbian, gay and bisexual people have higher rates of mental ill health as well as alcohol and drug consumption. Lesbians are also more likely to have never had a cervical smear test, while gay and bisexual men are more likely to experience domestic violence.”

Particularly among young LGBT people, we see rising levels of self-harm. Homophobic behaviour is going unchallenged in the workplace and on London’s public transport system, and hate crimes against LGBT people remain stubbornly high. There are also issues about access to mental health services for LGBT groups.

The situation is even worse for black and minority Londoners who identify as lesbian, gay or bisexual, among whom rates of suicide and self-harm are higher than among than the population generally. Some 5% of black and minority ethnic lesbian and bisexual women have attempted to take their own life in the last year, compared with just 0.4% of men over the same period, and one in 12 have harmed themselves in the last year compared with one in 33 in the general population. What are the Government doing to improve the training of NHS staff on the specific health needs of LGBT people and black and minority ethnic LGBT people, because at present they are both challenged with higher levels of mental health issues but have difficulties accessing services?

There are particular challenges in London associated with the recent reorganisation of the NHS, moving responsibility for public health to local authorities. In principle that move makes it much easier to address the social determinants of ill health, including mental health, but the concern is that because of pressures on local authorities funding for mental health will drop and the ability to provide London-wide services for groups, such as the LGBT community, will weaken.

The House will know that my party is not proposing to put the NHS through a further reorganisation when we return to office in a few months’ time. However, it would make sense for existing structures in London to monitor outcomes for LGBT people throughout the capital, and given the complexity and size of London we cannot simply take a one-size-fits-all approach to LGBT issues.

Young people today are living in a time of unprecedented pressures, with smartphones, the internet, a world of 24-hour communication, new avenues for bullying, new fears and new concerns. The issues are plain to see in the growing demand for services for young people across London, with London hospital admissions for self-harm rising from 1,715 in 2011-12 to 2,046 in the last year. At least one in 10 children in the UK is thought to have a clinically significant mental health problem, which amounts to 111,000 young people in London. The impact of childhood psychiatric disorders costs London’s education system approximately £200 million a year, and in 2013 the Children and Young People’s Mental Health Coalition found that 28% of joint health and wellbeing strategies in London did not prioritise children and young people’s mental health.

What are the Government doing to ensure that joint strategic needs assessments look at, and include information about, the size, impact and cost of local children’s mental health needs, to ensure that sufficient services are being commissioned? Will the Minister ensure that data about BME young people and children will be comprehensively included in the new national prevalence survey of child and adolescent mental health being commissioned by the Department of Health? Concerns have been raised in this House previously about the funding of services for children and adolescents, but it is clear in London in particular that there is an unravelling crisis in relation to young people and mental health.

As I said at the outset, London’s youth, and youth nationally, live in an era of unprecedented pressure. Data obtained from a freedom of information request of top-tier local authorities in England by the mental health charity Young Minds revealed that in 2010-13 local authorities in London cut their children and adolescent mental health service budgets by 5%, at a time of increasing pressure on young people. The latest data show that Southwark cut its budget by 50%, as did Lambeth and Hounslow. Tower Hamlets cut its budget by 30%, and Haringey cut its budget by 10%. Those are some of the most deprived boroughs in London, and if they are really cutting their expenditure on young people’s mental health care to that extent, it is very serious.

[Jeremy Corbyn (Islington North) (Lab)]

I thank my hon. Friend for giving way and congratulate her on securing the debate. She must be aware that the cuts in mental health budgets are, basically, arbitrary because no one knows what the long-term demand will be. No one knows what levels of demand are not being met within communities because people are afraid to come forward even to discuss their need for some kind of help. This is a huge problem and it needs to be given much greater attention by the Department of Health.

[Ms Abbott]

My hon. Friend is right to say that the cuts are arbitrary, and they certainly do not account for unmet need. In my time as a Member of Parliament—my hon. Friend must have had similar experiences—I have met many mothers and other people who are unable to access the mental health care that they need, particularly talking therapies. Cutting provision at a time when we do not even know the size of unmet need is very dangerous.

I want to turn now to mental health care provision for the black and minority ethnic community. I have looked at this issue over many years, and I believe that the manner in which the mental health system fails people of colour is a tragedy that has been consigned to the shadows for too long. As well as talking about parity of esteem between mental health and physical health, we need to talk about a parity of care between all sections of the community, and at this point that is not happening. I hope to set out briefly some of the findings of the research that has been carried out over the decades on black people and mental health, but my central point is that black and minority ethnic people are not getting parity of care and service. This is a long-standing issue that goes back decades, and I call on the Government to do what they can. I shall also call on the incoming Labour Government to pay attention to this issue in a way that has not happened in the past. Governments genuinely need to understand and address these needs.

Black and minority ethnic mental health is a particular issue for London because half Britain’s black and ethnic minority community is inside the M25. Sometimes it is hard to get the data we need, but we know, for instance, that in Lambeth—less than a mile from this Chamber—more than half the people admitted to acute psychiatric wards, and more than 65% of the people in secure wards, are from the Caribbean and African communities. I know from regularly visiting Hackney’s psychiatric wards, and the Hackney forensic unit, that the proportion in Hackney is as at least as high, if not higher, than that. We have accurate statistics for Lambeth, but we only have to walk into psychiatric wards across London to see that the majority of beds in the big mental health institutions such as the Maudsley are occupied by people of colour.

I remember, as a new MP in 1988, raising the disproportionate number of black people on wards with the head of psychiatric services in City and Hackney. I asked, “Why are so many people on your wards black and minority ethnic? It’s way out of proportion even with the population of City and Hackney.” City and Hackney produced three very senior psychiatric doctors to talk to me about this. They turned to each other, paused, muttered, and one suggested that it might have something to do with “ganja psychosis”. Another then ventured the opinion that perhaps more mad people were migrating from the Caribbean. I had to say to him, “It’s hard enough to get into this country if you’re sane; it is to the highest degree unlikely that the authorities are allowing all these mad people to come into the country.” But the striking thing about that conversation was that it was not some casual conversation on a ward; the head of psychiatric services had marshalled the three most senior psychiatric doctors in City and Hackney, and the only explanation they could offer for their wards being full of black people was “ganja psychosis”. I was struck by how low the level of knowledge was and how low the level of interest was.

I also know from my years as a Member of Parliament how many black families are struggling with the consequences of the mental health system’s failure to offer the right support at the right time, and the help and services to which they are entitled. One of the saddest things I see in my work as a Member of Parliament is black mothers, single heads of household, struggling with black males in their household who clearly have chronic mental health problems. I have had women come to see me who have been assaulted by their own son. When they are told that they should go to a GP and that perhaps their son needs to be sectioned, they say,” No, no, no.” That is because there is a terrible fear in the black community of the mental health system. Some women would rather risk assault by their own son and live in fear than consign their son to the mental health system, because their understanding is that once that system gets their child, the child is pumped full of drugs and never comes out again or, if they do, they are not the same. So it is time this Government and any incoming Government give more attention to issues relating to black people and mental health.

Those issues have not altered in decades: there are disproportionate numbers of black people, particularly men, in the system; we are more likely to be labelled “schizophrenic”; we present later to the system, which makes matters worse; we are more likely to come to the mental health system through the criminal justice system, particularly by being picked up by the police on the street and finding ourselves sectioned; and we are less likely to be offered talking therapy. I remember going in the ’90s to a mental health therapy centre in west London that specialised in talking therapy and did excellent work. I noticed that there were no black and minority ethnic people there and when I asked about this I was told, “Oh, we find that black and minority ethnic people don’t benefit from talking therapy.” That is an extraordinary attitude. We need to do more to make talking therapy available across communities, including BME communities. Black people are also statistically more likely to be offered electroconvulsive therapy—in other words, they are more likely to be plugged into the mains. There is also a terrible history of deaths in mental health custody, which are often to do with the type of restraint used and a fear of a violent black male. There is a whole string of such cases, of which Sean Rigg’s is one of the most recent.

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[Dr Offord]

I am grateful for that clarification and I thank the hon. Lady for it.

[Jeremy Corbyn]

I am interested in what the hon. Gentleman was saying about his experience with the police in his borough of Barnet. I have similar discussions with the police in my borough and although many of them are well aware of the vulnerability of people with mental health issues, it seems that there is a lack of consistency in the Metropolitan police training and a lack of continual awareness-raising for police officers, before they attend the scene, on the need to look for a mental health condition when they find somebody behaving in an odd or strange manner on the street.

[Dr Offord]

I thank the hon. Gentleman for that point, which is certainly something that I would be willing to take up with the Metropolitan Police Commissioner. That was not my experience, but as it has been the hon. Gentleman’s, I think it is a useful footnote for me to take back to show that the approach is not the same all over London. I am grateful for that.

I realise that the Minister is a public health Minister and not a Minister in the Home Office, but I am keen that police officers should not be delayed for up to eight hours of their shift by taking people to hospital to seek an assessment under section 136 of the Mental Health Act 1983 only to find that a doctor is not available and no assessment can be made. I have spoken to several custody sergeants who have made the point that I will make again: a police cell is not a substitute for a place of safety in the form of a hospital. I am keen to take that up with the Home Office myself.

The Mayor’s report said that of every £8 spent on long-term health care, perhaps £1 is spent on people with mental health issues. I spent two hours this morning at the Whittington’s wonderful ambulatory care centre opened by the Government, and I congratulate them on that. It is easy to see people who clearly have long-term medical health problems, and one suspects that their mental health might be in the same fragile state as their physical health. If we include the £1 in every £8 spent on long-term health care, that adds another £2.6 billion to the £26 billion that we are spending on health care in London cited by hon. Lady. We certainly need to address that.

I am aware that in west London there has been an initiative as part of the London growth deal to help people to get into employment. Indeed, the local enterprise partnership has secured money from the Government’s transformation challenge award, and I congratulate the Government on that. I want to see more work going ahead.

It is not only people with long-term health conditions who are likely to suffer from mental health issues, but the long-term unemployed as well. I understand that approximately 46% of the people claiming employment and support allowance for more than two years have mental health issues. I speak not as someone judging those people but as someone who has experienced mental health issues in my family and have seen the consequences of that. Indeed, the Daily Mirror was kind enough to publish an article on me and the consequences of mental health issues in my family. Although most of it was wrong, I will put that to one side. I will not use the Chamber as a confessional, but the media have an obligation and a responsibility to report issues to do with mental health in a more positive and indeed less derogatory fashion than they have.

Finally, I pay tribute to colleagues who have worked hard on this issue. My hon. Friend the Member for Halesowen and Rowley Regis (James Morris) was instrumental not only in securing a debate in this House to which I was able to contribute but in promoting mental health issues through some of us writing an article for a pamphlet he published. I am grateful to him for that. I also congratulate my Whip, my hon. Friend the Member for Croydon Central (Gavin Barwell), who introduced a Bill to allow people with mental health disorders to stand in this place.

Although I am proud of this Parliament’s record, I would like Government action on the employment of people with mental health issues, and more Government action to provide people with a place of safety that is not a police cell. I would like the health service to ensure that its mental health professionals are always available, so that police officers do not spend their time waiting in accident and emergency departments for a professional to see a person who has been sectioned under section 136 of the Mental Health Act. I look forward to the Minister’s response.

[Jeremy Corbyn (Islington North) (Lab)]

I congratulate my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) on obtaining the debate. It is a pleasure to follow the hon. Member for Hendon (Dr Offord) and I am delighted that he had such a profitable morning at the Whittington hospital in my constituency. The ambulatory care centre is indeed excellent. It was a product of a community and all-party campaign to defend the A and E department some years ago. We won that campaign, and as a result we have a thriving A and E department and a new and very efficient ambulatory care centre. I attended its opening with colleagues. It is a great place and I am glad that the hon. Gentleman was well treated there. I hope he will write and tell the hospital so.

The point that the hon. Gentleman raised on policing, on which I intervened, is serious. I make no general criticism of the police force as a whole, but I do think that when the police are called to an incident in a shopping centre, or in the street or elsewhere, they need to be well aware that some of the people there may be suffering from a mental crisis, may be mental health patients, and need to be treated with some degree of care and understanding. Many police officers are very understanding and very careful about that; I am not trying to make any general criticism. I just think we need to send a gentle message to the Metropolitan police that within training, there should be as much awareness as possible of the mental health conditions that exist within the community.

We have moved on a long way in debates on mental health in this House during the time that I have been here. When I was first elected, a person with a mental health condition was not allowed to stand for Parliament. The Speaker had the power to section Members of Parliament under the Mental Health Act—may still do, for all I know. Mental illness was generally the butt of humour—of universal jokes—so that people going through a crisis, perhaps depression, felt unable to talk about it and felt it would blight their career prospects in any walk of life if they did talk about it. Consequently, only if they had the money did they seek private help and private counselling; if they did not have the money, they suffered, and might lose their job and end up with a blighted career.

All of us can go through depression; all of us can go through those experiences. Every single one of us in this Chamber knows people who have gone through it, and has visited people who have been in institutions and have fully recovered and gone back to work and continued their normal life. I dream of the day when this country becomes as accepting of these problems as some Scandinavian countries are, where one Prime Minister was given six months off in order to recover from depression, rather than being hounded out of office as would have happened on so many other occasions.

The issues that I shall raise are much the same as those raised by my hon. Friend the Member for Hackney North and Stoke Newington in opening the debate—on the disproportionate extent to which the people one finds in mental health institutions come from the black and minority ethnic communities, and the socio-economic imbalance on mental health issues. People who lead stressful lives, without housing security, without job security, without financial security, frightened about the consequences of what their children are up to or whether their children can get a job and so on, are sometimes affected by levels of stress that the rest of us would not even want to think about.

The access point to mental health services is usually the GP. That is the great thing about the national health service, although sometimes it is the problem of the national health service. A GP surgery at its best is brilliant, recognises the holistic needs of the patient and does its best to accommodate those holistic needs. The GP system at its worst is a single-handed GP who may have been there a very long time, become rather set in their ways, is not very interested in people coming to them with stress or other psychiatric-related problems, and does not refer them for any kind of therapy or counselling.

I am concerned about the length of time people wait for counselling or support. A report commissioned by the British Psychoanalytic Council and the UK Council for Psychotherapy, based on over 2,000 psychotherapists working across the NHS, the third sector and in private practice shows that in the NHS and the third sector

“57% of practitioners said client waiting times have increased over the last year, 52% report fewer psychotherapy services being commissioned in the last year, 77% report an increase in the number of complex cases they are expected to deal with.”

The report continues:

“The strain on publicly funded therapy services means that the private psychotherapy sector is increasingly ‘picking up the pieces’ with individuals who have been failed by the NHS. The vast majority of private therapists (94%) report they regularly see clients who feel let down by the NHS”.

I am absolutely not attacking the national health service. That is the last thing I want to do. I want the national health service to be there and available for all. I do not want it to so ration its services that those with fairly desperate needs are forced to suffer, seek voluntary help if they can get it or, if they can afford it, get private support.

There are excellent local organisations in my area, including iCope—Camden and Islington Psychological Therapies Service, and the Women’s Therapy Centre, which do a great deal to improve the local service and put a lot of pressure on the local health authority. An excellent report was produced by Louise Hamill and Monika Schwartz, who both work in my area and have done a great deal of work on the subject. I urge the Minister to have a look at that report and at the very serious proposals that they put forward.

The network for mental health did a survey which identified the 10 most important issues relating to mental health treatment. I will not list them all, but the most important seems to me to be access to timely and appropriate treatment. If someone going through a mental health crisis or depression cannot get seen by somebody, they become more and more agitated and stressful. If we have target times for cancer treatment, we ought to have target times for being seen and getting the necessary support at times of mental stress. Likewise, reducing stigma and discrimination is important, as is looking at the effects of benefit and welfare system reforms.

I have had far too many anecdotal reports from constituents and others who go for a Department for Work and Pensions availability for work test. If they have a physical disability, it is usually fairly obvious and it can be quantified and, we hope, taken into account in how the interview and test are conducted. If somebody has a mental health condition, it is not so obvious and cannot be so easily quantified. There are far too many cases where the stress levels are unbelievable for people who have been forced into these tests. Their condition has not been taken into account, they have been declared fit for work, and they then go into a crisis of stress because they feel they simply cannot cope. It is place where we could all be, and we should have some respect for people in that situation and do our best as a society to help them get through it.

That leads me on to education and publicity and how these issues are dealt with. The media have got somewhat better. It is now not routine for TV and radio comedians always to make jokes about people being stressed out, mad, depressed and so on. Things have moved on a bit and I pay tribute to colleagues in all parts of the House who have stood up in the Chamber during the annual mental health debate and said exactly that about ending discrimination.

[Ms Abbott]

Does my hon. Friend agree that one of the worst examples of the way in which the media treat mental illness was The Sun which, when the well known boxer, Frank Bruno, had mental health issues, had a front page headline, “Bonkers Bruno”, for which it eventually had to apologise?

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[Jeremy Corbyn]

The Sun has had to apologise for many things, not least that. We need a process whereby we change the mood music still further on the treatment of people with mental health problems.

There is a local project in my constituency called IBUG—Islington borough user group—where people attend meetings to talk about the kinds of stress they go through and the support they get. It is very interesting to talk to those people, who are incredibly well informed and intelligent.

I say to the Minister that I understand all the demands and financial pressures that are placed on mental health trusts across London. I am pleased that the trust in my area, Camden and Islington Mental Health and Social Care Trust, is much smaller than most. That is partly, I suspect, because my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) and I stressed strongly that we wanted to keep the service fairly small rather than go into a huge segment of London, as trusts in other areas have.

We have a number of very good walk-in places that those with a mental health problem can go to. Lunch is provided, or they can cook their own. Art therapy and various other forms of support are available. That is all good. However, if we turn those places into something over-formal where appointments and references are required, and people can go there only if they have been sent, that takes away the feeling of an oasis. I have met people who have recovered well from whatever they have been through, and are working, but sometimes they feel the need to unburden themselves with others who have been in the same situation. It is important to have that kind of walk-in facility. I hope that the Minister will take account of that in the planning of these issues in London.

A couple of days ago, INQUEST launched a report called, “Deaths in Mental Health Detention: An investigation framework fit for purpose?” I have a copy here. INQUEST is a national organisation that is based in my area. It deals with the issue of deaths in custody. It has been around for a long time, is very effective, and does very good work. The report states:

“The number of deaths in mental health detention is high in comparison with other forms of custody. The most recent IAP figures show that out of 7,630 custody deaths recorded between 2000-2013, 4,573 deaths were of detained patients—making up 60% of the total numbers of all deaths in custody.”

It then draws attention to the need for a genuinely independent investigation into these deaths. We have the Independent Police Complaints Commission, although it could perhaps be stronger, and the prison and probation ombudsman to deal with those two areas where deaths in custody take place, but, the report says,

“no such equivalent investigative mechanism exists to scrutinise deaths in mental health settings.”

We should look at that.

In 2003—quite a long time ago—INQUEST submitted evidence to the Joint Committee on Human Rights inquiry into deaths in custody in which it noted:

“Of particular concern is the failure of government or any of its arms length bodies to even collate and publish annual statistical information about deaths of detained patients…we believe”

that as a result

“some contentious deaths could escape any public scrutiny”.

I urge the Minister to look at the report, which is very serious, well prepared and well researched.

The report also expressed concern about the use of restraint methods in mental health institutions and the wholly

“disproportionate number of people from BAME”—

black and minority ethnic—

“communities and/or those with mental health problems”

who

“have died following the use of force, raising questions about discriminatory treatment and…attitudes”.

Very serious questions have been raised.

My hon. Friend the Member for Hackney North and Stoke Newington has done the House a service by securing this debate. We need greater and more effective assessment of the needs of mental health services across London, because there is still a stigma in some areas. Some communities and families are more able to come forward than others. We need to create an atmosphere in which people understand that we can all experience stress and that we all need help at some time in our lives, and the NHS must and should be there to provide that help when it is needed.

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[Jeremy Corbyn]

Would my hon. Friend support an investigation, on the basis of the INQUEST report, with a view to changing the regime of inspection, inquiry and appeal where there are tragic deaths in custody? She must be aware, as must the rest of the House, that many people in mental health institutions are completely alone, never get any visitors or support and are at the mercy of what we, the state, are prepared to provide and do for them.

[Luciana Berger]

I thank my hon. Friend for his important intervention, and for raising the point earlier. It is right to look at this issue. It is very clear from the report that INQUEST has outlined and provided that many serious challenges have not been addressed. Part of the challenge is that people find themselves isolated because they are placed in care and treatment, which can be hundreds of miles away from their homes, families and support structures. This means they are less likely to have visitors. Seeing the footage of one family’s experience—of their child’s in-patient care and the quality of her surroundings—was frightening. I hope that the Minister will address this specific report and share with us what the Government intend to do to look at the issue a lot more closely.

We have heard today that mental health is one of the most unaddressed health challenges of our age. Mental health services across our country are increasingly facing significant challenges, and as we have heard today these pressures are being acutely felt in London. Meeting the mental health needs of London’s population is critical to ensuring the future health and economic sustainability of the capital. In order fully to tackle these pressures, we must end the false economies and the stripping back of preventive and early intervention services that we have seen under this Government, and achieve a new focus on prevention and early intervention. I look forward to the Minister’s response.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

We have, unsurprisingly, had a very thoughtful debate, and this has been a welcome opportunity to discuss such an important topic. I hope that the hon. Member for Liverpool, Wavertree (Luciana Berger) will forgive me if I focus my response on Back-Bench contributions, given that this is a Backbench Business Committee debate. She regularly debates these issues with the Minister of State who leads on care issues.

I congratulate the hon. Member for Hackney North and Stoke Newington (Ms Abbott) on securing this debate on an issue that is important to her and her constituents, and to me as a London MP and my constituents. It is good to see a broad cross-section of London colleagues in the Chamber.

The fact has been well established that at least one in four people will experience a mental health problem at some point in their life. As others have said, that means an estimated 2 million Londoners, and we know that London has the highest rates of mental ill health in the country. Some Members spoke about the reasons for that—those things that we know are responsible—and others suggested alternative reasons. I would slightly guard against the over-use of the word “crisis” and exaggerating to make a political point. To prepare for this debate, as the House would expect, I met some of the leading mental health clinicians in London and put some searching questions to them. I did not gain a sense of crisis, although we all gain the sense that this area has not been given sufficient attention in the past and needs to be given far more attention in the future. We all agree on that, and I hope to outline some of the areas that the Government are paying attention to and working on.

The Government’s commitment to prioritising mental health is encapsulated in the principle of “parity of esteem”, which others have mentioned. This means equal priority for mental, as for physical, health. This commitment was set out in our mental health strategy, “No health without mental health”, in February 2011, and was made explicit in the Health and Social Care Act 2012. Planned NHS spending on mental health is expected to grow by over £300 million in 2014-15, and in our five-year plan for mental health, “Achieving Better Access to Mental Health Services by 2020”, we identified £40 million of additional spending for this year, and freed up a further £80 million for 2015-16. This will for the first time ever enable the setting of access and waiting time standards in mental health services, to which the hon. Member for Islington North (Jeremy Corbyn) alluded.

Looking at the constituency of the hon. Member for Hackney North and Stoke Newington, I am sure she would welcome the fact that the City and Hackney clinical commissioning group has increased spending on mental health services by almost 4% this year, and is investing almost £2 million in a range of new service alliances intended to reduce service variation, reduce inequalities, and improve access and recovery outcomes.

I was glad to hear my hon. Friend the Member for Hendon (Dr Offord) refer to the Mayor’s London Health Commission and the work done by the Mayor’s office. The hon. Lady also referred to the work of the Greater London authority. The commission, led by the Mayor, has identified the mental health and well-being of Londoners as a key priority for the Mayor’s office. Indeed, the Mayor has said:

“Mental ill health is an issue that affects millions of Londoners, yet we are too often frightened to discuss it, worried about what people might think, or unaware of who to turn to.”

That very much captures what was said by my right hon. Friend the Member for Uxbridge and South Ruislip (Sir John Randall).

In a report on London mental health which was published in January last year, the Mayor made clear that mental health is an issue for everyone who lives and works in the capital. The report attempted to quantify, as far as possible, the impact of mental ill health on Londoners in order to gauge the scale of the problem. I shall not repeat the statistics, but they show that there is a considerable impact not only on individuals and their families, but on the economy of our city and everything that flows from it, and on the costs of care. However, despite those substantial costs, diagnosis and treatment rates for mental disorders have remained poorer than those for most physical health conditions. NHS England has worked with partner organisations to establish a strategic clinical network for London chaired by Matthew Patrick. The network’s members include MIND, Rethink and the National Survivor User Network.

Let me now deal with the important issue of race equality in mental health care, to which the hon. Lady devoted much of her speech. The issue is obviously of great concern to her, but it is of concern to all of us, because we all acknowledge London’s incredible diversity, although the degree of diversity in our constituencies varies. Our commitment to tackling inequalities in access to mental health services is set out in our mental health action plan “Closing the Gap”, which was also published in January last year. That plan recognises that people from black and minority ethnic communities are less likely to access psychological therapies. We are working with the sector to find out exactly why that is, and what can be done to change it. NHS England is also working with BME community leaders to encourage more people to use psychological therapies, and to establish the reason for those barriers. In 2012-13, as part of the Time to Change programme, the Department of Health funded a mental health anti-stigma and anti-discrimination project. It ring-fenced 25% of a fund amounting to up to £4 million for work with African and Caribbean communities, which involved building partnerships with trusted BME organisations in BME communities. I think that, to some extent, addresses the point made by the hon. Member for Islington North, who is no longer in the Chamber.

NHS England has worked with Black Mental Health UK, and has established a leadership programme for GP mental health leads for London. A BME taskforce is undertaking a root-and-branch review of mental health services in London, to ensure that they are equitable and free of ethnic bias. I am not sure whether the hon. Lady is in touch with the taskforce, but I am sure that she would want to be. I shall ensure that she is given details of who is leading it, and I should be happy to put other Members in touch with it if they want to know more.

I must put on record that the hon. Member for Islington North is now present. He may not be in the place where he was before, but he is here.

The mental health trust in east London is strengthening families, with a focus on support for BME groups, by helping the families of patients with serious mental health issues, using an approach that treats the condition as being similar to any other long-term chronic illness and providing positive support and advice. That, I think, addresses a question raised by a number of Members: why, in many instances, are such different approaches taken to physical and mental illness?

Members rightly expressed concerns about child and adolescent mental health services. It is estimated that 50% of mental illness in adult life begins before the age of 15 and that 75% of mental illness in adults starts before the age of 18, so—as others have pointed out—early intervention is key. Over the next five years, we will invest £30 million a year in improving services for young people with mental health problems, with a particular emphasis on eating disorders, which were also mentioned. We are investing £54 million between 2011 and 2015-16 in the children and young people’s IAPT—improving access to psychological therapies—programme to transform child and adolescent mental health services. I am glad that my hon. Friend the Member for Hendon mentioned that. Let me also draw attention to his distinguished record in respect of looked-after children; I was very aware of his work when we were both on Barnet council.

Public Health England also plays a role in addressing the mental health needs of Londoners and is engaging with schools, teachers and pupils to promote and build resilience among young people through the London grid for learning. As a partnership, City and Hackney, about which I was briefed in anticipation of the debate, has one of the highest spends in London and England on CAMHS—close to £5 million.

I want to pick up a point that the hon. Member for Hackney North and Stoke Newington mentioned with regard to BME children being recorded in prevalence data. I want to give her some assurance on that. The commissioning of a new prevalence survey on children and young people and mental health is a priority for the Department. Our chief medical officer has identified the need for prevalence data on the mental health of BME children and young people. Therefore, we anticipate that the new survey will look at the prevalence of issues in those groups and we hope to announce the procurement process in the near future.

More than £400 million is being invested over the spending review period to make a choice of psychological therapies available in all parts of England for those who need them. We all acknowledge that we are not there yet, but it is important that as part of the “Five Year Forward View”, NHS England has committed that, by April 2016, 75% of people referred to the IAPT programme will be treated within six weeks of referral and 95% will be treated within 18 weeks of referral; and that more than 50% of people experiencing a first episode of psychosis will be treated with a National Institute for Health and Care Excellence-approved care package within two weeks of referral. Those are important and ambitious targets to secure improvement in this area.

Data on mental health bed occupancy has not been routinely collected across the NHS London region, but NHS London has initiated a process to do that to allow year-on-year comparisons to be made. The first year of the initiative was 2014. The results of that suggested that across the different types of mental health in-patient facilities occupancy rates ranged from 78% to 100% during the period the audit was undertaken, which was September to November 2014.

London’s CCGs are committed to delivering the IAPT access and recovery targets for 2014-15. Additionally, the hon. Lady’s CCG, City and Hackney, is using a range of alliances—I was interested to hear about this—across CAMHS, psychological therapies, dementia, primary care and crisis services to improve the integration of service partners, with a clear focus on involving voluntary sector and social enterprise groups. I am sure that that is mirrored in other parts of London.

The hon. Lady raised the challenges facing LGBT people. The National Institute for Mental Health in England carried out a review that showed that LGB people are at greater risk of suicidal behaviour and self-harm, as others have said, and that the risk of suicide is four times more likely in gay and bisexual men, while the risk of depression and anxiety is one and half times higher in LGB people. I was interested to hear what she said—it mirrors my experience—highlighting the concerns of young gay people from BME communities. I have experienced that too as a constituency MP. Interestingly, some of those people said that the worst prejudice they experienced was from within their community. In that regard, London’s diversity also poses us a challenge sometimes. We as constituency MPs, and in other roles we have in our communities, must try as much as possible to stand up to and challenge that when we acknowledge London’s diversity.

West London mental health trust has a specialised gender dysphoria service, the largest in the country, which is accessed following GP referral to general mental health services with a question as to whether the patient has gender dysphoria. The total annual value of that service is £9.9 million. The London Lesbian and Gay Switchboard provides national information and a listening service over the phone and by e-mail and instant messaging. The helpline operates from 10 am to 11 pm, seven days a week, 52 weeks a year. It is based in London but takes calls from the whole of the UK. I thank all local LGBT support groups. They do such a great job. I look forward to spending this evening with the Wandsworth LGBT forum at one of its film nights. We will watch a new film that addresses issues of particular concern. That organisation provides a great service in my community. I am sure other people have the same experience.

As we have heard, mental health crisis care is crucial. The first national crisis care concordat was published in February last year to improve service responses to people in mental health crisis, and in particular to keep people in mental distress, who have committed no crime, out of police cells. NHS England has signed up to the mental health crisis concordat and is in active partnership in London with the police, the ambulance service, the mental health trusts, CCGs, local government and the voluntary sector, as we would expect. Huge progress has been made in London in reducing the number of people taken to police cells for assessment after they have been detained under section 136 of the Mental Health Act. I am pleased to tell the House that this number has reduced from several hundred a year to less than 20. That is a very welcome process.

Interesting contributions were made by Members on both sides of the House about the conversations we have had with our local police agencies. I, too, had an interesting experience when I went out with two very impressive young officers as part of my rapid response unit locally. They showed great understanding of the challenges they met. It was nice that that was acknowledged in all parts of the House, while also recognising the very considerable concern that the hon. Member for Islington North raised about deaths in custody.

[Jeremy Corbyn]

I am sorry that I was out for a couple of minutes during the Minister’s concluding remarks. The point about deaths in custody is essentially about the powers of investigation—the powers of inquiry. In my experience, too often it is left to the randomness of whether there is a family and community support network or not. If there is not one, absolutely nothing happens; if there is one, something might happen. I am sure the Minister is aware of this, and I would be grateful if she would have a good look at the INQUEST report on this subject. Perhaps her Department might like to study it and come up with some proposals in relation to its very sensible suggestions.

[Jane Ellison]

I will of course bring that report to the attention of the right Minister in our Department, and the hon. Gentleman is correct to highlight it.

I want to give a note of assurance on street triage, which was mentioned by my hon. Friend the Member for Hendon. The DOH has funded nine street triage pilots, with police and mental health professionals working together to support people in crisis. In the areas where the pilots are operating, the number of people being detained under section 136 has dropped by an average of 20%. There are some encouraging results.

On the points made only by the hon. Member for Islington North, we are obviously concerned about the reports of high levels of physical restraint. Restraint should only ever be used as a last resort, and we think that the transfer of police custody health to the NHS and commissioning to a standard specification, together with liaison and diversion services being available in every police station, will help to improve that situation and the care and advice available to people in police custody.

I am proud of the Government’s record on mental health, but we have always acknowledged that there is more to be done, and I would not want to suggest any complacency on the part of Government on this vital issue. I will certainly draw to the attention of my DOH colleague the Minister of State who has responsibility for care, all the issues raised by Members on both sides of the House in this very thoughtful debate. I end by thanking all the people in our constituencies—whether within the NHS, the voluntary sector or all the community groups that Members have acknowledged—who provide care to those experiencing mental ill health. We are grateful to them all for what they do to keep Londoners well.