Mental Health Act 1983

Johnny Mercer Excerpts

Thursday 25th July 2019 Westminster Hall

[Johnny Mercer (Plymouth, Moor View) (Con)]

It is a pleasure to serve under your chairmanship, Ms Buck; thank you for calling me to speak. First, I pay tribute and give my thanks to the hon. Member for Bermondsey and Old Southwark (Neil Coyle) for securing the debate. Some of the best days we have in this place are when people recount their personal experiences and what drove them to the interests and causes they have in this place. It was remarkable listening to his experiences, which reinforced why we need to move what we do on mental health away from having a good conversation to actually changing things in a way that means something in the communities we serve.

With a new Prime Minister just two days into the job, it is a welcome opportunity to put this important issue on the agenda before summer recess. I look forward to the Government delivering on the White Paper that they have promised to publish by the end of the year. Mental health is an area that I have been trying to make a difference on since I came into this place. I have spoken openly about my own experiences of obsessive-compulsive disorder. I have said before that while I might like to pretend it is a distant memory, those who know me well know that it is not.

Reforming the Mental Health Act 1983 matters to me because I think it is important that we give specific, considered attention to the people whose mental illness is so severe that the state needs to step in to protect them or potentially other people. When people are unwell they need support. The 1983 Act provides that, but as I recently discussed at an all-party parliamentary group on mental health event on that very topic, that support is not always as beneficial and therapeutic as it might be.

Members will know that I am chair of the all-party parliamentary group on mental health. At the event I mentioned, we were pleased to welcome Sir Simon Wessely as one of our speakers. His speech was very informative about some of the key changes that the review recommends and where we are at politically in making the new vision a reality for those who suffer with their mental health in our communities.

One thing that stood out to me in Sir Simon’s address to the group was that, while rates of detention have increased, the rates of severe mental illness have remained relatively stable. Gold standard studies such as the adult psychiatric morbidity survey show that, so how do rates of detention shoot up by 47% in the last decade when the rate of mental illness among the population is almost unchanged? Something is not working, and I welcome the review’s recommendation to raise the bar and tighten up the criteria for detention.

We were also privileged to hear at that meeting from Georgi Lopez, a young woman who bravely shared her experience of being detained under the Mental Health Act with members of the APPG. Her powerful testimony made it clear that legislative reform is required to change things for the better. I will share some of Georgi’s story with the House to illustrate how the Act negatively affects some people’s lives when they are vulnerable and very unwell. I thank the hon. Member for Bermondsey and Old Southwark for sharing his experiences of the Act. We must keep such stories in mind when we talk about the potential of the forthcoming White Paper.

Georgi is 23 years old. She was first detained under the Act when just 17, and was detained for the majority of the next four and a half years. Georgi was diagnosed with anorexia nervosa shortly after completing her A-levels. She had been preparing her application to the University of Oxford. Shortly after her AS exams, she was taken to A&E, as she was severely dehydrated and malnourished. Her parents were given an ultimatum: to have Georgi voluntarily admitted to a psychiatric hospital or for her to be sectioned. They chose voluntary admission.

For the first few weeks in a psychiatric hospital, Georgi complied with all the treatment she was given, but following her first meeting with a psychiatrist she was told that she would be assessed to be detained under section 3 of the Mental Health Act. She was also put on highly sedative medication. She and her parents objected to her being detained because, up until that point, she had followed her treatment plan as asked, without need for coercion or detention. They were not listened to and she was detained.

Hon. Members can imagine how someone who has done everything that they have been asked to do to manage their condition would feel on having that control taken away from them, with little to no reason given. Georgi dealt with that loss of power by declining to take the medication that she had been prescribed. She was then forcibly injected with sedatives. That experience shows why Professor Wessely’s report is aptly titled “Increasing choice, reducing compulsion”.

I later heard about Georgi’s second experience of detention, which was completely different. She said that she was treated like a human being, and the staff were very interested in her past, her interests and her aspirations. Her care team involved her and her family in every decision about her treatment. Although it took her some time to rebuild her trust in the system and the Act, she believes that she owes her life, health and happiness to that positive experience, where she had choice and autonomy.

Georgi was clearly right when she told our APPG that her first experiences of treatment were neither caring nor conducive to her recovery. I agree with her, but her second experience, where her team involved her in her own care and helped her to rediscover herself and her identity, shows that it is possible to provide good psychiatric care. Georgi is in fact now an aspiring psychiatrist. People think that it gets easier to share your story; it does not—it always takes courage and bravery. I hope that by listening to Georgi’s varied experiences of the Act we can see that, although it is possible to provide care that involves patients in decision making, that does not always happen.

The Act shapes the culture and practice in mental health units. We need to change it so that Georgi’s positive experience of the Act is standard across the country. I fully support reform and I am pleased that the Government have committed to a White Paper by the end of the year. We need to seize the opportunity to get this right, and I am sure that our new Prime Minister will show leadership on this issue, which is important to my party and my constituents.

Mental Health First Aid in the Workplace

Johnny Mercer Excerpts

Thursday 17th January 2019 Commons Chamber

[Johnny Mercer (Plymouth, Moor View) (Con)]

I pay tribute to the hon. Member for Liverpool, Wavertree (Luciana Berger). She is right that it is wonderful to be in this place today with the noise dialled down, so that we can work on and think carefully about one of the most important issues in this country. Mental health is the No. 1 challenge for millions of people in this country every day. If we can meet that challenge in some way by working in the collaborative way that she talked about, that is wonderful. I am really pleased that she has secured this debate and that the Minister is here to listen to it. I also pay tribute to the right hon. Member for North Norfolk (Norman Lamb). The three of us have worked together on a number of issues. Like in any team, there are those who lead from the front and do all the heavy lifting and hard work, and that is definitely not me. I want to say a massive thanks to them for their efforts in getting us here today.

When I came into this place in 2015, I talked about how I wanted to end in this Parliament the stigma around mental health. I have found since then that there is still this—it is hard to understand—air around suicide that people do not want to talk about or address, but it remains the biggest killer of men under 44 in this country. Unless we talk about it, we will not come up with ways that interdict and meet the challenge.

[Liz Twist (Blaydon) (Lab)]

I thank the hon. Gentleman for giving way and congratulate my hon. Friend the Member for Liverpool, Wavertree on securing the debate. Does he agree that we need not only to encourage people to talk through industry schemes such as Mates in Mind; we also need to listen? That is why the move towards mental health first aid workers is so important.

[Johnny Mercer]

The hon. Lady is right. There is no point in getting people to come forward and talk about mental health, which can be very difficult, if we do not have the services or access to them to help them, after they have made themselves vulnerable in that way. That is why I am so keen to keep our foot to the gas and ensure that we start delivering on this. We have made progress—that is undeniable—but clearly there is a long way to go, and I will come on to that.

I want to address the point about legislation. As someone who does a lot of work in the armed forces community and on the armed forces covenant, I know that people will say, “Why legislate?” I have learnt in this place that we can have a number of good ideas and initiatives that we can encourage people to do but, ultimately, this is too big a challenge to be left to personalities involved in companies at different times. Sometimes we have to legislate for it. This is not a problem for the companies that already do this, but sometimes the most vulnerable people in our communities deserve the Government legislating and letting them know that we are on side.

[Tim Loughton (East Worthing and Shoreham) (Con)]

I am sorry that I was not here for the beginning of the speech by the hon. Member for Liverpool, Wavertree (Luciana Berger). I was having my own health and wellbeing check with our excellent service here. The practice nurse was particularly keen to know about my stress levels, given the experience we have all had in the last week, but I am good for another few years.

My hon. Friend may know that I am the co-chair of the all-party parliamentary group on mindfulness, which is a simple way of looking after employees’ mental health. Before Christmas, we held a seminar here involving military figures. He knows, from his experience, the high level of mental health issues among that group. I am glad to say that the Army is now seriously looking at how this measure can be introduced, and why wouldn’t it? This is a win-win situation: if an employer looks after its employees and its workforce, they tend to do a better job, and they look after the company or Army unit better as well.

[Johnny Mercer]

I thank my hon. Friend for his intervention. He is right; the military has come a long way. It gets a hard time, but the Army in particular has come a long way on the importance of mindfulness and how much easier it is to keep a healthy mind than get better from a mental illness. I thank him for all the work he does on that. We all come to this place for different reasons, but there is no doubt that the mental health challenge of a decade and a half of combat operations has ripped apart the circle of friends that I grew up with, so I have a real passion for getting this right.

As the hon. Member for Liverpool, Wavertree says, we need to look at this in a slightly different way in this country. We are very good in this place at talking from the Front Bench about what we are putting into services in terms of money and priority, and that is extremely important, but we need to turn the telescope around and ask what it actually feels like to be in the community waiting for access to child and adolescent mental health services or mental health treatment. That is the true metric of what we do in this place. I strongly encourage the Government to look at that approach.

Why am I so interested in this? As everybody now knows, I have had OCD for a long time. Obviously, I like to pretend that it is some sort of distant memory, but my close friends and family know that it is not. It is much better, but there is no doubt that, if there had been mental health first aid when I was a boy, growing up and going into the military, my life would have been completely changed. We cannot underestimate how important it is to intervene early, when someone is so much more likely to get better. I will never forget the Saturday afternoon when I ended up in the Maudsley, thinking, “How did I end up here? How did this all start?” If policies like this had been talked about 20 years ago, millions of lives would have been very different.

I talk about this because it sends a powerful message: you can get better. People think that they are managing their mental health for the rest of their life, they reach their zenith and that is it. I cannot over-emphasise how wrong that is. Clearly managing a mental health challenge is a difficulty, but it can absolutely be done, and the chances of doing that are exponentially increased by early intervention. If we can get into workplaces and say to people, “We take mental health as seriously as physical health,” we will affect millions of lives, which is ultimately what we come to this place every week to do.

I pay tribute again to the hon. Member for Liverpool, Wavertree and the right hon. Member for North Norfolk, who have done a lot of the heavy lifting on this. There are not many people here today, but in some ways, that does not matter. There will be people following this intensely because they have a mental health challenge. They may be 15, 16 or 17-year-old young boys, like I was, who never talk about it and who learn about what is going on through their phone but do not even talk to their parents. When I spoke about my OCD in the Evening Standard, I had loads of phone calls the next day, but the best one was from a 16-year-old boy who said he had never spoken to his parents or anyone about it.

There will be a lot of people watching this debate who were devastated when it was cancelled before Christmas. They are the people we are here for, and that is why people like me speak out. It is not easy to speak about individual issues in this House, but I want to say to boys and girls who are watching this now and may be struggling: don’t think for a minute that because there are not lots of people here, and there is not the raucous shouting that we have seen in the last few days, this is in any way less important to many of us in this place. Just because we are quieter, it does not mean that we do not hear you.

There is a mental health revolution going on in this country—we have seen it start and people are talking about it. The Government have committed to parity of esteem. We are flicking over from meeting one in four mental health needs at the moment to one in three. Clearly there is a big unmet need and we have further to go, but it is an unstoppable direction of travel, and today is another point on that march.

I sincerely hope that the Government can take forward these recommendations. I slightly disagree with the hon. Member for Liverpool, Wavertree only on one point: parity of esteem does mean something. However, she is right: it does not if people in our communities do not feel it. It is not good enough here to say, “Parity of esteem is a wonderful thing. Haven’t we done well? We’ve put it into Government legislation.” It is meaningless unless the people who use the services actually feel like they are treated in the same way and have the same access to treatments as those with physical health problems. I commend the hon. Member for Liverpool, Wavertree and the right hon. Member for North Norfolk for the march we are taking on this, together with the stuff we have done on money and mental health. In this Parliament of immense turbulence, for those who are watching—the quieter ones, whom I have spoken about—this march will continue. They have some wonderful advocates in this place and we keep going.

Oral Answers to Questions

Johnny Mercer Excerpts

Tuesday 27th November 2018 Commons Chamber

[The Minister for Care (Caroline Dinenage)]

I have met Oliver McGowan’s mum, Paula, on a number of occasions, so I am more than aware of this case. I have spoken to her about the deeply distressing report she has had on Oliver’s death. The NHS is looking into this case and will continue to work with Bristol University to further develop and improve guidance and local review teams.

[Johnny Mercer (Plymouth, Moor View) (Con)]

T4. The Secretary of State and I spent the night together at Derriford Hospital down in Plymouth, so he will be aware of the unique challenges facing that hospital, which has not had an infrastructure expansion since the 1970s. We have a bid in at the moment. Can we hear whether we have done well before Christmas?

Oral Answers to Questions

Johnny Mercer Excerpts

Tuesday 19th June 2018 Commons Chamber

[Justin Tomlinson (North Swindon) (Con)]

17. What steps he is taking to reduce rates of childhood obesity.

[Johnny Mercer (Plymouth, Moor View) (Con)]

19. What steps he is taking to reduce rates of childhood obesity.

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

We are delivering the most ambitious childhood obesity plan in the world, and we are already seeing results. We always said that our 2016 plan was the start of the conversation, not the final word. [Interruption.] Yes, it does say that here, but I have also said it everywhere else many, many times.

[Steve Brine]

I do not think that it is a binary choice. We recognise that child obesity is caused by many different factors, and that no one policy will work on its own. Yes, this is about tackling advertising, and yes, it is about tackling children’s activity and working with schools; and, as I said recently, we will present new proposals very shortly.

[Johnny Mercer]

As the Minister will know, perhaps the two biggest challenges that we currently face in relation to young people’s health are mental health and child obesity. Will he update the House on the progress of chapter 1 of his childhood obesity plan in reducing the amount of sugar in both food and drink?

[Steve Brine]

Since we published the plan, progress has been made on sugar reduction. The amount of sugar in soft drinks has been reduced by 11% in response to the industry levy, and Public Health England has published a detailed assessment of progress against delivery of the 5% reduction for the first year. Progress is good, but it is not good enough, which is why we have said that we will produce chapter 2 shortly.

Mental Health Act: CQC Report

Johnny Mercer Excerpts

Tuesday 27th February 2018 Commons Chamber

[Jackie Doyle-Price]

I was not aware of that report, but the hon. Gentleman highlights the positive influence of CQC inspection. He has highlighted a provider for which things are not going so well, and that will enable an intervention to be made through the CQC to improve performance. In the meantime, the local commissioners in Birmingham can buy services from other providers.

[Johnny Mercer (Plymouth, Moor View) (Con)]

My hon. Friend the Minister is right to highlight some of the concerning figures in this report, but there are some encouraging ones too, and does she agree that those who get a mental health problem in the United Kingdom today have a higher chance of being diagnosed, treated and making a recovery than ever before in our history, and that this is largely due to the brilliant staff up and down this country in tackling this fight?

Oral Answers to Questions

Johnny Mercer Excerpts

Tuesday 14th November 2017 Commons Chamber

[Johnny Mercer (Plymouth, Moor View) (Con)]

Congratulations, Mr Speaker, on noticing that it is actually me behind this extremely impressive facial growth for Movember, which is a serious cause promoting men’s health, particularly this year with the addition of mental health. In 2015, three out of four suicides were young people, and suicide is still the biggest killer in men under 45. Will the Minister commit to renew this Government’s relentless pursuit of parity of esteem between mental health and physical health?

[Steve Brine]

The Mercer moustache is impressive indeed. I am a big supporter of Movember, because it has a positive mindset—it is very honest. As Movember says on its website, one in eight men in the UK have experienced a mental health problem and, tragically, three out of four suicides are men. So we welcome this campaign this month, focusing as it does on raising awareness of prostate cancer and of testicular cancer—“Check your Nuts”, to stay on message. Movember has also built partnerships with mental health services in the NHS and across the charity sector. I wish my hon. Friend well with his growth.

Oral Answers to Questions

Johnny Mercer Excerpts

Tuesday 11th October 2016 Commons Chamber

[Nicola Blackwood]

I congratulate the hon. Lady on her appointment. I am particularly pleased to see her in her place. She has played an important role in the all-party parliamentary group on breast cancer. We are very proud of the childhood obesity plan. It is based on the best available evidence, and it will make a real difference to obesity rates in this country. The Government are also consulting on the soft drinks industry levy, and we have launched a broad sugar reduction strategy. She is absolutely right to say that we must now work hard to ensure that we deliver on that with the NHS, local authorities and other partners as we move into the delivery phase of the plan. We are proud that it is a world-leading plan.

[Johnny Mercer (Plymouth, Moor View) (Con)]

2. If he will visit Plymouth to discuss how its city council has pooled health and social care budgets.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

Plymouth has gone further and faster in integrating health and social care than many parts of the country have done. The integrated fund that it has set up covers housing and leisure as well as health and care. I would be delighted to visit Plymouth and to learn more about how the fund is working in practice.

[Johnny Mercer]

As my hon. Friend points out, Plymouth has taken innovative steps to try to address some of the funding inequalities at play within the Northern, Eastern and Western Devon clinical commissioning group. However, between the calculated spend and the actual spend, there is a funding shortfall of £30 million. Will he agree to work with local MPs, stakeholders and those involved in the wider Devon sustainability and transformation plan to develop a written agreement to address these inequalities?

Psychosis: Early Intervention

Johnny Mercer Excerpts

Wednesday 7th September 2016 Westminster Hall

[Johnny Mercer (Plymouth, Moor View) (Con)]

I pay tribute from the Government Benches to the immense work that the right hon. Gentleman did in government, and to my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who is no longer in his former position as Minister. Does the right hon. Gentleman agree that it is not acceptable to talk about parity of esteem unless that is matched by parity of provision and parity of funding so that those who suffer from mental ill health have the same provision as those who suffer from physical ill health? Parity of esteem means nothing to our constituents unless we actually deliver it.

[Norman Lamb]

I am grateful to the hon. Gentleman for his kind comments. I totally agree. There is an awful danger of a damaging gap emerging between the rhetoric and the reality. The coalition Government legislated for parity of esteem, so it is in the legislation that people should be treated equally, but unless the reality of people’s experience is that they are treated equally, the rhetoric is absolutely meaningless waffle and they lose trust in the Government. That is why I feel so passionately that we must do concrete things to make parity of esteem a reality for people, and that is an example of how we can make a difference to people’s lives.

The standard was announced in October 2014, to be implemented by April 2016—it had to be met by this year. Why is it so important? If we fail on that, we fail so many people whom we have the chance to help and surely it would be scandalous if the NHS neglected a standard accepted by Parliament and introduced by Government that we know makes a massive difference to people’s lives. It gives people the chance of a better life and surely the NHS is fundamentally about giving people the chance to have happy, good lives.

What has happened in that period? We undertook a comprehensive Freedom of Information Act survey—now that I am out of government, I have to rely on such surveys to find out what is going on—and the answers from clinical commissioning groups and mental health trusts are deeply troubling. On the key findings, first the overall conclusion is that the implementation of the standard is just fundamentally flawed. It has failed to deliver what we committed to. If the Minister, on advice from her officials, is tempted to refer to the nationally published data that suggest that the standard is being met, I would discourage her from doing so because the data are a fiction—we have established that through our work.

The first detailed finding is that there is a complete lack of robust commissioning in many parts of the country. The whole purpose of the commissioner-provider split, which of course is fairly controversial in the NHS, is that the commissioners hold the money and are there to design services for their community to meet the needs of that community, yet a third of CCGs could not identify how much funding had been allocated to early intervention in psychosis. That in itself is scandalous. They just say that there is a block contract and that it is up to the mental health trust—a total abdication of responsibility. Later, I will ask what the Government are doing about that, because that is not acceptable and completely contradicts the national guidance that was published.

Incidentally, I should say that one of the excuses used around the country for slowness of implementation is that the final guidance was published in April this year—when the standard was supposed to have been met. That does not demonstrate particularly helpful leadership from the centre. Having said that, the draft guidance had been in place for the best part of a year, so clinical commissioning groups around the country knew the direction of travel and could absolutely have been getting on with the job of preparing for meeting the standard.

When we did the survey back in May and June, well into the financial year, another 18 clinical commissioning groups—that is 11%—were still in negotiation for funding for early intervention in psychosis for a standard that was supposed to have been met in April. The question I will keep repeating is: why is that is not being treated with the same seriousness as the cancer standards? Why do we treat that as less important than someone suffering from cancer? I absolutely support and endorse the cancer standards, because it is critical that people with cancer get access to treatment quickly, but why should not someone with psychosis? It is scandalous. No one stands up for them. The Government have to lead on that. More than one in three clinical commissioning groups could not provide an estimate of the number of people in their area in need of early intervention services, in spite of the national guidance that says that commissioning should be underpinned by estimates of the local incidence to ensure that services are designed to serve the needs in a particular locality fully. If CCGs have no idea because no work has been done to establish the need in that area, how on earth can they commission a service to meet that need?

Next, according to NHS England, the estimated annual cost of providing the full package of treatment is about £8,250 per patient per year. Only 60 CCGs in our study were able to estimate their investment at all and only 11 estimated that they will meet the NHS England guideline on the level of investment. The average investment per patient from those who were able to say was £5,199, but of course an average hides the fact that many are way below that level. To draw an analogy, that is like saying to a cancer patient, “Well, you can have the chemotherapy but we can’t afford the radiotherapy, so you’ll have to put up with what we can offer.” Of course, we would never allow that to happen—the Daily Mail and many others would be up in arms, and they should be about this issue as well because the situation is exactly the same.

On age, which the hon. Member for Upper Bann (David Simpson) raised earlier, as I said in response to his intervention, the access standard is to provide the service to people between the ages of 14 and 65, in line, I should say, with guidelines from the National Institute for Health and Care Excellence, which has done the work and provided the evidence-based guidance. Almost a quarter of trusts—23%—commission services only up to the age of 35, including my own county of Norfolk. How on earth can trusts justify anyone over the age of 35 not getting access to a service that we have deemed it appropriate to provide to people across the country? They are just ignoring the national guidelines. Again, that seems to me to be completely unacceptable. That totally conflicts with the clinical commissioning groups’ responsibility. Out of the 39 CCGs which commission only up to 35, nine said they had plans to expand the service—they have plans, but why are they not doing it now?—and another 10 said that that was under review, but the rest had no plan to provide a service to people over 35. Outrageous, in my view.

Next is staffing and skill mix. We found a widespread failure to provide the full range of interventions required by NICE as part of the package of treatment, which is due to the shortage of staff with appropriate skills to deliver the service. Most trusts reported shortages of staff trained in cognitive behavioural therapy for psychosis and there were many other training shortfalls.

On data recording, NHS England introduced new information standards to support the monitoring of standards so that we could have some confidence that they were being met. Providers are expected to use electronic care record for patients to enable the collection of data and monitoring of performance against the standard. The guidance says that commissioners should assure themselves that local providers have made the necessary updates to the electronic care record system to ensure that clinicians are able to enter the data required to monitor performance against the standard, but we have heard that many trusts have not upgraded their systems and so are incapable of doing what is in the national guidance. We talked to someone who was at the heart of the implementation of the standard in one part of the country who mentioned widespread failure to do that. That means, as I said earlier, that the national data published by the information centre, which we are all supposed to rely on to tell us what is happening in the NHS, cannot be relied on. I put this point to the Minister: can the information centre investigate that further to ensure that the data it publishes tell a true story of what is going on?

There was also a scandalous variation between regions. I met the woman who has been responsible for implementation in the southern region. She was driving a programme of implementation and had a complete handle on the whole of her region. She had enormous variation of performance across her region, but there was someone in charge, doing it. She was an impressive woman. She told me that she was being made redundant; she was told that her job was done, even though palpably it is not. However, in other regions there has been no programme of implementation—no one in charge, to take responsibility for making things happen. The situation in the midlands and east in particular is in my view a disgusting, outrageous shambles, which should not be tolerated.

[Norman Lamb]

I very much agree. We should all be learning from each other—and internationally, as well; but so often we fail to do that in the NHS. People on the outside may think that the NHS is a Stalinist organisation where everyone does the same thing. Far from it—it is too often anarchic. In the context of the NHS England infrastructure that we are considering, there are regions of the country that just have not done their job as they should have, which is scandalous.

[Johnny Mercer]

Does the right hon. Gentleman agree that it is not good enough simply to understand an experience—because it affects someone close to us—when it is part of day-to-day life for the most vulnerable people? In Plymouth we have someone who is intimately involved in the system, and whose daughter is involved in the system, and who really gets mental health. However, it is not good enough in this place just to understand something because it happens to someone close to us. The vulnerable often do not have a voice, and we have to work harder. As the right hon. Gentleman is saying, it is not good enough to push the statistics away.

[Norman Lamb]

I totally agree. Everyone across the country who suffers this damaging, tragic illness has a right, surely, in anything that amounts to a national health service, to get good evidence-based treatment on a timely basis; but, tragically, that is not happening. I appreciate and welcome the fact that the Secretary of State has now taken specific responsibility for mental health. However, if I may be bold enough to offer some advice from my experience as a Minister, I would say that if a new standard of the type in question is to be embedded into the day-to-day life of the NHS, to make it something that happens as a matter of course and that is considered in the Monday morning meeting in the Secretary of State’s office exactly as the physical health standards are, there must be leadership from the top, including from Government. I appreciate that there are changes to Ministers’ roles under the Health and Social Care Act 2012; but they can demonstrate leadership. They can monitor, push, cajole and encourage, and set the moral tone about what is necessary for the approach we are discussing to become standard practice. That level of focus is needed from the Secretary of State downwards.

Will the Government consider the dossier of evidence and data that we have collated, and report back to us on their findings? Will they commit to addressing properly the defects and flaws in the implementation of the programme, as I think is necessary? One thing is clear: the Paul Farmer taskforce report published as part of the five-year forward view process sets out an ambition for mental health—for how we achieve equality for people who suffer mental ill health; however, if the lessons from the flawed implementation are not learned, every other part of Paul Farmer’s programme will fail to deliver the results that are so desperately needed. How will clinical commissioning groups be held to account for failure to implement the programme properly? What is the sanction for those who decided to ignore it—which is unacceptable to their communities? What is the Minister’s response to the findings I have talked about, and how does she respond to the clear evidence that people with mental ill health are not being treated with the same seriousness, or as if they have the same importance, as those suffering physical health problems?

It is time for mental health to come out of the shadows. We have started a national debate about mental health. The issue is much more out in the open than it used to be. However, as the hon. Member for Plymouth, Moor View (Johnny Mercer) said, there is a great danger of a damaging gap, which undermines confidence and trust in Government, between rhetoric and the reality that people experience in their lives. It seems to me that there is an absolute moral responsibility on the Government to ensure that the standard is delivered.

--- Later in debate ---

[Ms Abbott]

I am grateful to the right hon. Gentleman for that important point. It is absolutely true that, partly because they are presenting late and often have quite advanced psychotic symptoms, they are more likely to experience coercion and restraint. We know that some of those incidents of restraint have had very unhappy outcomes, and families continue to campaign against the misuse of restraint on mental health patients. All these decades after people first started to look at issues relating to black and minority ethnic communities and the mental health service, we have made little progress. Is the Minister willing to meet me to discuss this issue, which I have looked at for many years? One of the basic problems is statistics. It took years to get the health service to keep statistics broken down by ethnicity within the mental health service, and I am not sure what is happening to those data.

As we have heard, it is vital that psychosis is treated early as that prevents complications, improves outcomes and is more cost-effective. We know that psychosis costs £11.8 billion a year and we also know that mental health problems are on the rise. It is very disturbing to find that the research shows that a quarter of CCGs seem to be ignoring the access waiting time standard for psychosis, and the National Audit Office reports that there are insufficient funds available for the strategy to achieve parity of esteem to have any reality. We know, because we have heard, that too many CCGs cannot even specify how much money is devoted to early intervention; that gives rise to the suspicion that not enough is devoted to it.

The right hon. Member for North Norfolk made the fundamental point that this issue is still not being treated with the same seriousness as cancer standards are. This goes back to the issue that many Members have raised of stigma, shame and an unwillingness of the families of psychosis sufferers to speak out in the way that the families of people who suffer from cancer are willing to go into the public space and to the media to speak out.

[Johnny Mercer]

I wholeheartedly agree with the hon. Lady about that. This week, in Plymouth we have been running a campaign called “Talk Don’t Suffer”, in conjunction with The Herald. I pay tribute to the Plymouth Herald for what it has done. Getting people to come forward and printing their stories is such a powerful testimony for those who suffer with mental health, because they know that other people are suffering too and about the impact on families. To talk about it is very important to improving the situation.

[Ms Abbott]

I again congratulate the right hon. Member for North Norfolk on securing this important debate. He spoke about discrimination and injustice, and that is what strikes people so strongly. There is the human misery of people suffering from psychosis, whether intermittent bouts or lifelong psychosis, and there is the misery and worry of their family members. We need to be a society in which the promise from all parts of the House for parity of esteem between mental and physical health becomes reality. We want to be a society in which people are not marginalised or almost warehoused just because they have mental health challenges, including psychosis, but have some promise of the support they need and of a better life. I look forward to the Minister’s response to questions asked by my Opposition colleagues. I assure her that I will return to this issue—not only black and minority ethnic mental health, but mental health in general.

Oral Answers to Questions

Johnny Mercer Excerpts

Tuesday 9th February 2016 Commons Chamber

The Secretary of State was asked—

[Johnny Mercer (Plymouth, Moor View) (Con)]

1. What steps his Department has taken to ensure that public health grants are spent only on public health responsibilities.

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

The local authority public health grant is ring-fenced and must be spent in line with published grant conditions set by the Government. Local authority chief executives and directors of public health are required to certify that grant spend is in line with these conditions. In addition, Public Health England further reviews spending information and local authority spend against the grant is subject to external audit.

[Johnny Mercer]

In 2014-15, my city of Plymouth received £47 per head. Portsmouth, which is statistically healthier, received £77 and Kensington and Chelsea got £136. I absolutely understand that this is a legacy issue with the funding formula, and the Government are committed to dealing with it, but I cannot stress enough how important it is that we speed this up. How does the Department plan to achieve this? The current situation is grossly unfair to my constituents.

[Jane Ellison]

I applaud my hon. Friend for being a champion of public health in his community. We have had several conversations on this issue. As he says, there are historical differences, of which I am conscious, in the levels of local public health spending. They mostly arise from historical primary care trust spending priorities. We have made some progress in addressing the matter, but, as regards future allocations, we are considering a full range of factors, including the impact on inequalities and existing services. Those will be announced shortly. As I have told him before, the chief executive of Public Health England is happy to talk to him about the specific challenges facing his community, and that offer remains open.

Mental Health

Johnny Mercer Excerpts

Wednesday 9th December 2015 Commons Chamber

[Johnny Mercer (Plymouth, Moor View) (Con)]

I thank the hon. Member for Liverpool, Wavertree (Luciana Berger) for bringing forward this debate. I truly believe that mental health is the social challenge of our generation. Suicide is now the biggest killer of young men under 50 in Britain. Today, 17 of our fellow men and women in this country will take their own lives. This year, thus far, has seen the greatest number of male suicides ever. Suicide kills more young people than any physical illness.

I am currently trying to visit every school in my constituency before the end of the academic year, and the teachers I speak with have been genuinely struck by the dramatic increase in mental health problems in our young people, even since I left school some 15 years ago. With all those statistics, there is also the classic issue of underreporting of mental health conditions, given the stigma surrounding the whole issue, so the real extent may, if anything, be worse.

I believe that how we deal with this challenge will define the future of communities such as mine in Plymouth. I genuinely believe that our approach to mental health is that important. I am determined to win that battle for those in Plymouth who do not have the strength to fight for it themselves. What do we do? It requires a genuine shift in our attitudes—that most difficult of changes to achieve—and a cultural change in how we view and consequently deal with mental ill health.

As the Secretary of State suggested, interventions in mental health can produce the most brilliant results, whether it is the inspirational staff at Marine Academy Plymouth making talking about mental health a part of the school day; South West Trains employing staff specifically to look out for people on the network who are in that 10 to 15-second trance before they throw themselves in front of an oncoming train; or the Royal Marines in Plymouth taking responsibility to talk about mental health away from the medical chain and putting it with the main chain of command in order to totally de-stigmatise talking about post-traumatic stress and other prevalent mental health conditions in young men.

In any of those examples, early intervention and talking about mental health can have dramatic effects, but even that is not enough on its own, and that is the nub of the problem. The interventions that really work are early interventions, so last weekend I started an executive mental health group in Plymouth to determine a way of producing a project similar to one running in Trieste in Italy. Now, city council chiefs, commissioning group heads, police chiefs and healthcare providers will get together every month in the local police station until we have a 24/7 mental health capability in Plymouth to match our 24/7 capability for dealing with physical healthcare.

[Rehman Chishti]

My hon. Friend is making a brilliant speech. Does he agree that local commissioning group spending should reflect commitments made at a national level on parity of esteem for mental and physical health?

[Johnny Mercer]

I completely agree, and I draw my hon. Friend’s attention to the comment made by our right hon. Friend the Member for North Somerset (Dr Fox) on how important it is to ensure that CCGs ring-fence the funding so that we get the parity of esteem that I am trying to establish in Plymouth, and which I know the Government are committed to establishing across the country. It might take five months or five years in Plymouth, but I and the others will keep going until we get there, because this problem is actually too big to fail at.

We must be the Government who turn the corner on this. If we are to be so—rightly—fixated on a healthy economy to deliver our manifesto pledges, we must be equally as committed to our less high-profile commitments to those who will not make as much noise if we fail but whose need is of equal, if not greater, importance.