Child and Adolescent Mental Health Services

John Pugh Excerpts

Tuesday 3rd March 2015 Commons Chamber

[John Pugh (Southport) (LD)]

I will certainly observe that time limit, Madam Deputy Speaker, and I congratulate the hon. Member for Totnes (Dr Wollaston) on the report from the Health Committee, which was interesting and important reading.

I want to make a few remarks about adolescents. If we had to be reincarnated, I doubt that anyone in this room would choose to be reincarnated as an adolescent. They are neither fish nor fowl; they are attached to one family but dominated by their peers. They are going through new states of mind and body, which are exciting and disturbing in equal measure. They are no longer a child but are not quite an adult. They are advancing in knowledge and understanding, but hormonally and emotionally confused. It is probably the most difficult stage of anybody’s life to negotiate, and I believe it is quite hard to be genuinely and consistently happy. In a society without clear norms and rites of passage, it is probably doubly difficult.

Should we therefore be surprised that adult mental illness is on the rise—the hon. Lady called it an alarming rise—or does that indicate that we are in a pathogenic, sick-making society? Are we simply getting better at diagnosis, or are we applying clinical language to describe the mood swings of adolescents, which are more normal than we like to believe?

I find the figure of one in 10 surprising, although there are undoubtedly some troubled youngsters out there who will not get back on track or lead a normal life without extensive help. There are those in the early stage of psychosis or in the grip of a debilitating neurosis, or the depressively suicidal—I know a fair deal about that. As hon. Members have said, it is crucial that good services exist for such people, and nobody would disagree that diagnosis should be early and treatment sensitive and effective. I applaud—as does everybody—the new commitment and resources, the drive for parity of esteem, people speaking out and so on.

However, I have one problem with the current enlightened mindset and what I call the myth of the normal. Probably no one here would claim to be in perfect physical health—at least not for long—and we generally cope with the ailments, aches and pains of ordinary life, seeking help only when something dramatic happens or our own immune system cannot cope. I do not see why that should not apply to our perspective and our take on mental health. It is not a black or white issue—it is not an either/or. The world does not divide into those who have mental health issues and those who do not; there are simply those whose lives have been disabled by their mental health issues, and others who, by and large, have coped.

Many years ago I used to teach adolescents about mental health in a Bootle comprehensive school, which was my own idea. I used to discuss the issue as a spectrum, and I hoped to encourage a degree of sensitivity. Children in the playground badly misuse mental health vocabulary. They call one another “psycho”, “mong”, “retard” and so on—the school yard can be an awfully cruel place. As part of our course we went to visit an old-fashioned mental hospital called Winwick in Rainhill. It was a large, relatively benign, caring and good institution of its kind—I had previously worked in a less good institution, Oakwood hospital in Maidstone. I basically wanted the children to understand what mental ill health was like, and for them to have a deeper sensitivity towards it. I vividly recall one episode in a corridor. An elderly and somewhat confused old lady approached the party. She was happy to see young faces reminiscent of her grandchildren. The boys—tough Bootle lads—backed away in fear. They did not know what to do or how they were expected to react. At that stage, I thought I had clearly failed to get something across. We are still failing to get quite a lot of things across. We have a myth of the normal and believe that the world divides into the sane and the insane, the normal and the well, and those with issues and those without.

That is still going strong. The House of Commons applauds with all the enthusiasm of a revivalist meeting when someone owns up to having mental illness, and we pat ourselves on the back for being enlightened. However, when a prominent Member of the House has a memory lapse on TV, which was a mental failing—he said it was an age thing—we scream like banshees, “Bill, Bill, Bill!” at Prime Minister’s questions. That is not a fine example of an atmosphere conducive to good mental health. It is worse than the school yard, but it will be repeated again at 12 noon tomorrow.

The terrifying thing about adolescent mental illness is that the individuals will never have had anything like it happen to them before. There is no frame of reference for what they are going through—it is all new. For them, as they grow up, a chasm opens up between those who can hack life and the small minority who cannot. The dread is that they are doomed to be in the latter category more or less for ever. That is the underlying and horrible fear. Successful peers will surround their failing selves. Their fear is that there will be future adults and future casualties, the copers and the failures.

Those young people buy, as do big chunks of society, into the myth of the normal—the belief that mental illness and frailty is not on a spectrum like physical illness, or something that touches everyone to some extent, but something abnormal, unusual, permanently blighting and for keeps. The truth is that mental illness is not that. Unless we get that across, we will make matters a whole lot worse.