Mental Health and Long-term Conditions

Khalid Mahmood Excerpts

Thursday 16th May 2024 Westminster Hall

[Mr Khalid Mahmood (Birmingham, Perry Barr) (Lab)]

It is a privilege to be under your guidance, Sir Robert. I thank my hon. Friend the Member for Bootle (Peter Dowd) for securing this debate on a very important issue.

I declare an interest: I suffered from kidney failure and was very fortunate to get a transplant. A very good friend of mine gave me his kidney as a live donor, which is extremely rare; most patients are not that lucky. The problem with the donor card system for organ donations is that it depends on the next of kin. If the next of kin does not abide by the deceased’s decision, no organs can be taken. There is still a real issue to address there.

Transplants change your life. I went through dialysis for almost four and a half years, but I was then fortunate enough to get a transplant from a very good friend who used to be in this place and was then in the European Parliament. He is now living in north Wales, having a fantastic time, and is doing some consultancy as well. It was Siôn Simon, who is still a very good friend and a great person; I pay tribute to his courage. More people should do as he did, because unless we have other issues, a lot of us can survive on one kidney. He is certainly a great example of that.

Kidney failure is very sudden—you do not realise until it is upon you—but it can be avoided by some simple tests. A simple urine test at the GP or in hospital can give an analysis of someone’s kidney function so that hopefully they can take preventive action to make sure that they do not lose a kidney. People can also go for blood tests. Those are very easy preventive measures that can save someone’s physical health.

Just as important is mental health. Once someone is a kidney patient, they have to seek dialysis of some sort —peritoneal dialysis or haemodialysis. I had haemodialysis, which is done through a machine that circulates the blood. Peritoneal dialysis, which can be done at night, circulates the impurities out of the system using a fluid bag and an exit bag. One of the main problems when people get such a difficult health condition is that they think, “Why me? What have I done to deserve this?” My experience, unfortunately, is that people in the dialysis unit can find it very difficult to come to terms with from a mental health perspective and to justify why it is happening to them.

When someone goes on dialysis, they have four-hour sessions at least three times a week. It reduces their blood pressure significantly. Having fluids in their system is one of the last things they should do: they should drink as little water as they possibly can, because it will be extracted through the process. When their blood pressure drops, it causes a huge physical issue. Their heart rate increases and they can pass out: I did so a couple of times and was very grateful to the people at the unit who acted very swiftly to support me. I pay great tribute to all the medical staff—the doctors, the consultants, and particularly the nurses—in the renal units, who do a fantastic job to support us all.

During that period, I saw a number of people going through real mental health struggles in coming to terms with turning up to a unit every week and knowing that they would be there for four hours. Getting there, getting ready, coming off and being picked up or taking their own transport can take at least six hours of their day. It is a huge amount of time, and they are stuck in that cycle.

One thing people can do, and which I resorted to in the end, is home dialysis: I was able to dialyse myself, with support, at home. That made it slightly easier, but it is a hugely debilitating condition. A number of people have really difficult mental health problems in coming to terms with this debilitating disease. There are lots of questions. A friend’s son who was there with me, and was a lot younger than me, unfortunately passed, and I have seen other people who passed because of this. Part of that is to do with staying strong mentally. When there is no support for that, it becomes increasingly difficult.

My hon. Friend the Member for Bootle raised the important issue of how diabetes and other long-term illnesses can put someone’s mental health quite severely at risk. The longer it goes on, the more it becomes a huge risk. I thank my hon. Friend for securing this debate and giving me the opportunity to say this.

In 2022, a Kidney Research UK survey found that 67% of patients with kidney disease had experienced symptoms of depression, 27% had considered self-harm or suicide, 36% could not fully look after their physical health because of their mental health problems, and 68% had not been offered any mental health support despite their precarious position. That is how difficult it is for people to make their way through. It is very important that mental health issues be addressed.

In 2023, Kidney Research UK and the Centre for Mental Health published a joint report, “Addressing the mental health challenges of life with kidney disease: the case for change”. They made a number of recommendations, including the adoption of a tailored approach to mental health that becomes more specialised as the need increases. The need increases because patients’ physical health deteriorates, and it becomes extremely difficult to do some of those things that are normal for all of us.

The report also recommended the recruitment of renal psychologists for every renal centre in the UK. We do not have that facility, so even if it is picked up in a renal unit that a patient is having these issues, they have nowhere to go. All that can be done is for the patient to be signposted to the main central mental health facilities, which are very difficult to engage with. As it all increases, the patient’s own health position gets worse. That is why it is very important to have psychologists in every renal health centre in the UK.

Another recommendation was:

“Investment into all renal services to ensure that staff are trained and supported to assess and refer patients for further mental health help.”

Once they can do that, they can put patients on a pathway to resolving most of these issues. A further recommendation was:

“Increased government funding for research into the relationship between kidney disease and mental health to enable the ongoing development of essential services.”

When someone has a medical condition and, on top of that, mental health issues brought about by the severity of their condition, it causes a huge amount of problems.

I thank my hon. Friend the Member for Bootle again for making his case and giving me the opportunity to speak. This is a really important issue for those who cannot have a transplant and are still suffering from kidney disease: they are having to choose dialysis and then deal with it for most of their life. It is very difficult for them.