Mental Health Taskforce Report

Lisa Cameron Excerpts

Wednesday 13th April 2016 Westminster Hall

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Wilson. I congratulate the hon. Member for Halesowen and Rowley Regis (James Morris) on bringing this important and timely debate to Westminster Hall.

Although the report pertains to NHS England, the Scottish National party very much welcomes it. It is an opportunity to share best practice recommendations right across the UK. I would like to declare an interest: I worked in mental health as a psychologist for 20 years prior to coming to the House. I am particularly glad that the report has been produced. It is excellent, and I commend the work of those involved. The report is detailed, thorough and, importantly, based on inclusivity and service users’ views. It addresses key issues of prevention, access and parity.

In terms of prevention, we know that half of mental health issues are established by the age of 14, and three quarters by the age of 24. A new focus on young people and effective interventions designed for that age group via CAMHS are clearly required. More widely, we should look at mental health awareness training for teachers, so that we can pick up on early warning signs and refer on. Mental wellbeing could also be part of the curriculum, so that young people can develop positive, adaptive coping strategies, which are key to preventing the onset of mental illness.

We are dealing with the young generation, so the use of technology and modalities that young people like and use—for example, apps, which I am not particularly familiar with—will be really important. We have to get up to speed. Evidence-based interventions are required in particular for self-harm, eating and conduct disorders, depression and anxiety, which are common problems within the younger age group.

I welcome the fact that crisis teams will be locally based, 24/7, but I wonder if we could have some more detail. Will that involve specialist clinicians, nurses or doctors on call in each area who are trained in working with young people? More widely, in order that people present, should we have more public health awareness campaigns to reduce stigma?

Mental health care needs to be targeted across the lifespan, from younger people in CAMHS to adults and older adults. The report establishes that 40% of older adults in care homes are affected by depression, yet I read little information in the report about services provided or required for older adults, who may have co-morbid dementia, physical frailty or have suffered stroke, adjustment problems or loss. That area needs some more work and detail. Access to psychological therapies in the community, in hospital and in residential care appear to be key. Experts in psychological therapy for older adults are likely to be required, because people will be working with complex presentations.

I welcome the taskforce report’s recommendation of an integrated approach, looking at housing, employment, social needs and physical health. That suggests the need for integrated and holistic assessments in mental health, as well as in physical health settings. We need a formulation-driven approach, with an understanding of the precipitants, problems and exacerbating factors, but also of the protective factors. All those factors need to be targeted and integrated into treatment, in order to evidence improvement. Fundamentally, we are talking about a biopsychosocial approach, which means a change in assessment procedures across the system. We will have to evidence how that will happen and how it will be implemented across both mental and physical healthcare, but it links well to the integration agenda of health and social care.

I caution that although obtaining work is a very positive step in reducing depression for many people, pushing someone who is acutely unwell into work will invariably set them back, so this is about clinical judgment and timing. One of the major differences since I began working in the NHS more than 20 years ago is that there are now waiting time initiatives in Scotland and across the UK. That is significant. It challenges services to focus, and monitoring leads to an improvement in standards, but it must have ongoing underlying investment.

I welcome the recommendation that crisis care be provided 24/7. However, that will require specialists to be trained to work with individuals who have co-morbid substance abuse and mental illness problems. All too often, people are turned away because they are intoxicated at hospital when they present. I understand that it is difficult to properly assess people in that condition, but unfortunately research indicates that that may be when they are at highest risk of suicidal behaviour and at their most impulsive.

I particularly welcome access to psychological therapy for new mothers. One in five have depression, which impacts on the self, the family and the baby. I also suggest the extension of counselling to those who have suffered miscarriage or stillbirth, and who experience great trauma in that regard.

I am unsure of the fit of the recommendation on specialist GPs from my reading of the report. Does that mean treatment through minimal interventions or assessment by GPs? Does it mean specialist nursing staff in GP surgeries who could engage in treatment? My concern is about the cost-effectiveness of GPs engaging in therapeutic work, but training and assessment at a primary care level is a welcome idea.

The report highlights that nine out of 10 people in prison have mental health problems or drug or alcohol misuse issues, but it does not clarify how recommendations on criminal justice will be implemented. Cross-party and cross-Government agreement on how to implement the recommendations will be required across the country. Is it about access to psychologists in prisons? Again, more thought is needed on the detail of integration.

I will sum up, because I am running out of time and I want the Minister to be able to respond. I am pleased to see the inclusion of technology in the report, which I believe will be one of the key issues in transforming mental healthcare. The use of Skype, email and online treatment packages can increase access and links to therapists and improve access for rural communities.

Data collection is excellent. We need it, and we need to evidence outcomes and waiting times, but I appeal for balance. Drowning mental health staff in paperwork is not the answer. That reduces time for clinical work and time with patients, and we do not want this to become a tick-box exercise.

In conclusion, there is much to welcome. There is much to do. We need more strategy on integration plans. We need more detail on older adults and criminal justice. I was not able to touch on learning disability today, but that is another area to be considered. We do not want a postcode lottery, so it is important to look at local commissioning and share best practice, to ensure high-quality mental healthcare across the UK.