Psychosis: Early Intervention

Jim Shannon Excerpts

Wednesday 7th September 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to be called to speak in this debate, Sir Roger. I congratulate the right hon. Member for North Norfolk (Norman Lamb) on initiating this debate. I commend him—I have done it in his absence but will now do it in his presence—for the experience and wisdom he brings to these debates, his passion for the subject matter and for letting us take advantage of his knowledge.

This issue is an essential one that needs to be addressed, and this debate is very timely. Just this week, on Monday past, I heard about a constituent who falls into this category. I was contacted by a residents’ group, which expressed concern about a young man. The young man’s parents have died and he is alone. It turns out that he is clearly not taking good care of himself. There is no electric in his home; I suspect that the bills were not paid, and that he was not even aware the bills were there to be paid. There were no benefit checks either. This is a young man who fell between two stools.

Unfortunately, no one was able to help this young man until they were made aware of his problems by the residents and those who lived close by. When the young man was approached, he made it clear that he wanted no help; that was his initial response. The residents’ association worried from afar, and despite calls to the local police, nothing could be done until he was seen with what was perceived to be an offensive weapon. The Police Service of Northern Ireland then intervened, assessed him and realised there was something unusual about his behaviour. It decided he was not a threat initially to anyone other than perhaps himself, and referred him.

I got confirmation yesterday that a social worker has been initiated to come in and assist the young man. Hopefully this is now an example of a response taking place, but there was the delay that Members have mentioned. Indeed, my hon. Friend the Member for Belfast East (Gavin Robinson) gave a very personal example of that. It is about diagnosis and the system that is in place trying to help. That is something we believe has, at long last, happened, but it happened because of the residents’ group—the people who lived close by who had concerns and cared enough to raise them and assist when this man needed it. This is someone who obviously needed help for a long time and yet had fallen through the cracks. It is my belief that the onset of psychosis this young man is going through is not a new issue; it is historical, and yet nothing has been in place to help him in his situation.

Health is a devolved matter, and the Minister is not responsible for health issues in Northern Ireland, but I wanted to contribute to this debate to support what the right hon. Member for North Norfolk and others have said, and to comment about Northern Ireland.

The background information states that some 75% of mental illness in adult life begins before the age of 18 and that 17,000 people a year experience psychosis. It also indicates that many people aged under 16 also suffer psychosis—the right hon. Gentleman referred to that. There is clearly a massive issue to be addressed, and I know that the Minister will respond helpfully. I welcome her to her new position and look forward to her contribution.

The circumstances I have outlined underline the need for this debate. There must be a system in place to enable concerns to be raised and to provide a break for those with psychosis. There must be clear and dedicated guidelines for people to follow to get the necessary help. Without the observation of neighbours and the residents’ group, the person I mentioned would not have received help. The circumstances could have been dire and terrible to contemplate.

On standard waiting times for intervention by psychosis services, I understand that from 1 April 2016 more than 50% of people experiencing a first episode of psychosis will be treated with a care package approved by the National Institute for Health and Care Excellence within two weeks of referral. The previous Prime Minister—this is not a criticism, but an observation for the record—committed £1 billion to mental health; perhaps the Minister will say where that money is. Is it in the system, and has it been used for its intended purposes? If not, with respect to the Minister, we need to know why, and I look forward to her response.

The standard is targeted at people aged 14 to 65. It is two-pronged—both the following conditions must be met for the standard to be deemed to have been achieved: a maximum wait of two weeks from referral to diagnosis and the start of treatment, because it is so important to have early diagnosis and to respond immediately with the necessary help; and treatment delivered in accordance with NICE guidelines and quality standards for psychosis and schizophrenia. I am not sure whether my constituency is different from others, but I know from experience and my workload that I now have more people with mental health issues. Whether I notice them more now or they are coming to the door more, it is certainly a big issue.

Those are the guidelines, but what is happening in practice? Currently, the constituent I referred to has been placed under arrest by the Police Service of Northern Ireland for his safety and the safety of others while social workers and medical professionals determine a plan of action. That is what we need. In Northern Ireland between 2013 and 2014, there were 996 compulsory admissions to hospital under the Mental Health (Northern Ireland) Order 1986, of which 54.7% were of males. I will give some other statistics that give an idea of the gender and age of people involved. Some 45.3% were female, 2.4% were aged under 18, 47.1% were aged 18 to 44, 28.2% were aged 45 to 64, 7.1% were aged 65 to 74, and 15.2% were aged 75 or over.

This issue is massive not just for the NHS on the mainland but for us in Northern Ireland, and indeed for Scotland. The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) referred to that, as will the Scottish National party spokesman, the hon. Member for Glasgow North East (Anne McLaughlin). We must resolve to make the situation more acceptable and ensure that there is adequate funding for earlier diagnosis and response so that people go into the appropriate care system, whether at home with the trauma team or in a dedicated facility.

Recurrent funding of £40 million has been allocated to support early intervention and the psychosis standard for England, in addition to the previous Prime Minister’s commitment to provide £1 billion for mental health. NHS England’s report on implementing the recommendation of the mental health taskforce estimates the cost of treating an additional 10% of people within two weeks at £70 million per annum when fully implemented, including the cost of developing the workforce. The figures do not add up. How does the Minister expect to reach the goal within the specified time without adequate funding? I know she is up to the task, and I am confident that she will give a good response. We need to see action on the ground.

I ask about that for selfish reasons. Those who know me know that I have no problem flying the flag for Northern Ireland in any debate in the House, especially one as relevant as this. In Northern Ireland, the devolved Assembly determined that the appropriate guidelines were that at least 80% of patients should wait no longer than nine weeks for a first out-patient appointment and that no patient should wait longer than 15 weeks. However, it is clear that those guidelines are not being reached. The matter must be addressed at home, but that can come about only if adequate funding is committed by the Northern Ireland Assembly, and by the Government here, to the Department of Health, Social Services and Public Safety.

In an intervention, my hon. Friend the Member for East Londonderry (Mr Campbell) referred to a UK strategy. We have many debates on such issues in this Chamber, and the Minister will know that I always ask whether there have been talks with the regional devolved Governments—the Northern Ireland Assembly in my region, the Scottish Parliament and the Welsh Assembly—to ensure that we have a UK strategy. The right hon. Member for North Norfolk, who moved the motion, referred in response to an intervention to the need to learn from one another’s regions. Where there has been good practice, let us use it. If there has been good practice in Northern Ireland, we should use it here in England, and if Scotland has an appropriate strategy, let us use it in Wales and elsewhere. Let us exchange ideas and work towards ensuring that a UK strategy is in place and that funding is ring-fenced for that purpose. Access to mental health intervention should be not a matter of postcode, but a right. One in five adults in Northern Ireland will show signs of a mental illness. The figures also show that one in four people will experience mental health problems during their lifetime.

We had a conflict in Northern Ireland for some 30 years, and we have the highest level of mental health illness in the whole United Kingdom. The hon. Member for Plymouth, Moor View (Johnny Mercer), who serves on the Select Committee on Defence, served in Northern Ireland and is well aware of the issues facing those who served in the Army and the trauma they sometimes experience. In addition, families and other people in Northern Ireland have experienced at first hand the threat of terrorism. For us in Northern Ireland, mental illness is a massive issue. I cannot underline that enough, and we must be aware of it.

Figures have shown that when matched against 17 other countries, Northern Ireland had the second highest rate of ill health and problems with mental illness in 2015. It was 25% higher than in England. I urge the Minister to take note of that and to work with the devolved Assemblies—the Northern Ireland Assembly and the others— to ensure that in five years, the statistics are different from those in 2015. Let us set a target and a goal for change. If we aim for that, we can achieve some of what we want to do.

A lot of hard work has been carried out to remove the stigma attached to those who need help with mental health problems. Sometimes I wonder whether we can use different terminology. “Mental health” seems to flag up for people that they should perhaps be careful. People may have emotional problems that are not as bad as they seem. Perhaps we could use other terminology.

We need a system in place to deal with the rising number of people with mental health problems, and that is not currently the case. We need a target for reducing that number. Major changes are needed, and that is the reason for today’s debate. I fully support the calls that are being made, and I look forward to hearing from the Minister about how my constituent—she is not responsible for him—and those like him across the entire UK will be able to get the help they need to function and live in society.

Again, I congratulate the right hon. Member for North Norfolk on bringing the matter to this Chamber, and I look forward to the shadow Minister’s response and particularly that of the Minister.