Brain Tumours

Lisa Cameron Excerpts

Monday 18th April 2016 Westminster Hall

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

It is a pleasure to serve under your chairpersonship, Ms Buck. I congratulate the hon. Member for Warrington North (Helen Jones) on her dedication to this issue. I am grateful for the opportunity to speak in this important debate. I am also grateful to Stephen Realf’s family, the supporters of the petition and the Petitions Committee for helping to bring this debate to the Chamber.

Although brain tumours are often considered to be one of the rarer forms of cancer, as we have heard, they clearly have a significant and devastating impact. Brain tumours are the biggest cancer killer of the under-40s and children, and they result in more life years lost than any other form of cancer.

The Petitions Committee concluded that brain tumour research is not adequately funded and prioritised in the UK, and that the Government fail to grasp their funding responsibility and the seriousness of the concern. Sufferers have to fight for diagnosis, treatment, support, awareness, and funding. There is little choice in the treatments available, and treatment protocols may be non-existent.

Earlier this year, the Scottish Government announced a new cancer strategy comprising a number of different actions to help to treat cancer, diagnose people more quickly and deliver better care. It includes £10 million of additional support to enable quicker access to diagnostics for people with suspected cancer and a Detect Cancer Early programme.

There is an acknowledged need to include brain tumours in public awareness campaigns and to develop appropriate care pathways. In 2011, the UK’s first brain tumour tissue bank was opened in what is now the Queen Elizabeth university hospital—a service that facilitates co-operation on research for treatments. Glasgow also has the new Beatson West of Scotland Cancer Care Centre, which is one of the most advanced NHS cancer centres in the UK. Importantly, the University of Glasgow has a brain tumour research fund, which supports local research projects—in particular, smaller projects that do not get funding from larger organisations. It also helps to enable a multi-disciplinary approach to research, which includes input from medical staff involved in front-line patient care and the scientific community. Brain tumour research and treatment must be funded appropriately across the UK.

I was contacted by my constituent, Mrs Robinson, whose husband has a brain tumour. She made it clear to me that they want the system to improve for everybody. I would like to comment briefly on the emotional impact of diagnosis. We need better psychological assistance for those affected and their families, and we need to support their mental wellbeing, alongside their physical health.

On early diagnosis research treatment and care pathways, I would like to remind hon. Members of the need for improved palliative care. I recently lost a much-loved uncle, David McGilvray, to cancer. We now have a good local facility—Kilbryde Hospice—to assist families in that situation, but it was unfortunately not opened in time for my uncle to benefit from it. We need such facilities across the UK, so that families can access palliative care at their times of greatest need and people with cancer can die—if they must—with dignity.

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.

Oral Answers to Questions

Lisa Cameron Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Alistair Burt]

There is a growing relationship with the Department for Education—it is better than it has ever been. For the first time, there is a Minister responsible for mental health in the Department, and there is a schools champion for mental health, whom I met the other day at a conference in Cambridge. The Departments work closely together to deliver the vision set out in “Future in mind”. For example, there is a £1 million pilot project, working across 22 schools, to find the right people in schools to deal with mental health issues. There is much greater recognition that, the earlier we pick up these things, the better it is for youngsters and their future mental health.

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

Eating disorders among children and teenagers cause life-threatening health problems and even death. What steps is the Minister taking to enable early detection and intervention, which result in better prognoses and support closer to home?

[Alistair Burt]

There are two things that can help the hon. Lady. The first is the commitment to build £30 million a year into budgets over the next five years to support those with eating disorders, about which I spoke at a conference last week. The second is the earlier detection of eating disorders. We reckon that, by 2020, 95% of urgent eating disorder cases will be seen within a week, with routine cases seen within four weeks. There is recognition of the real danger now posed by eating disorders.

Autism Diagnosis Waiting Times

Lisa Cameron Excerpts

Tuesday 8th March 2016 Westminster Hall

[Jo Cox]

I agree entirely. Let us hope that we have an answer on exactly that point from the Minister. I applaud and bow to the right hon. Lady’s commitment and experience on this issue.

While the average waiting time for children is more than three and a half years, many adults receive a diagnosis only five years after concerns first emerge and often two years after seeking professional help. Some 61% of people who responded to a National Autistic Society survey said that they felt relieved to get a diagnosis when it finally came, and more than half—58%—said that it led to their getting new or additional much-needed support. It is of particular concern that children are having to wait so long for a diagnosis. Not only does that place tremendous strain on their whole family, but it means that many children do not receive the early intervention that could have a big impact on their formative years. Indeed, in many cases, children are being locked out of the services available to them, and that support can be life-changing.

Snowflakes is a nursery for children with an autism diagnosis or who are awaiting an autism diagnostic observation schedule assessment. The nursery is run by my sister-in-law, Stacia. One of its children was lucky and got an early diagnosis aged three. He joined Snowflakes and the team worked with him and his family for two years. The dedicated staff managed to help him into a mainstream primary school with support, and he is still in that school and is thriving. Another child came to Snowflakes because her mainstream nursery was unable to cope with her challenging behaviour. She is now on an 18-month waiting list for a diagnosis, but is due to start primary school in just six months’ time. She is making good progress within the specialised setting and is now a role model for other children. Her parents want her to move on to a primary autism resource, but to get a place she needs a diagnosis.

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

I thank the hon. Lady for securing this important debate, which I feel strongly about. In my constituency, I have had contact with families experiencing exactly the issues that she is raising. Is it not important that more clinicians are trained to diagnose and that teachers are able to pick up very early signs of autistic spectrum disorder?

[Jo Cox]

I thank the hon. Lady for that helpful intervention. I agree with her, and let us hope that the Minister addresses that point in his comments.

To return to the example of a little girl who faces a choice. Without a diagnosis she will be forced to accept a place in a mainstream primary school that will not be able to meet her needs. With a diagnosis, however, she would go to a primary autism resource using the specialised teaching methods she knows and trusts. She would be able to continue her education and in turn increase her life chances.

Many parents tell the National Autistic Society that delays in getting diagnoses have also led to the development of serious mental health problems, both for the individual and for the family. For example, having presented himself to GPs for 20 years, Chris was diagnosed with Asperger’s syndrome in 2007 after finally deciding to go private. Without a diagnosis, appropriate support or an understanding of his needs, he experienced mental health conditions for most of his life, including depression, anxiety, obsessive-compulsive disorder and mild Tourette’s. He was hospitalised when he was 15 and later became suicidal when his needs were not met.

We now know the value and importance of early and fast diagnosis, yet our system continues to fail so many children and adults. Members present will have heard stories from their constituents or family members and will have no doubt been deeply affected by them, as I have. One has to meet only a handful of parents to realise the unbelievable pressures that the waiting times put them under.

I could tell a number of stories from my own constituency—members of some of the families affected are here today—but I want to tell the story of a young man from Batley. He is one of the lucky ones: he now has his diagnosis of Asperger’s syndrome. His mum wrote to me and told me what a blessing the diagnosis has been. It did not just provide access to support and services, but it helped everyone, including him, to understand why he felt and behaved the way he did. He said he wished he had been diagnosed earlier because:

“I always knew I was different, now I know why.”

He is one of the lucky ones, because his parents had the ability to pay for a private diagnosis. They raised £2,500 to fast-track the process, but they should not have had to do that. What about the great many of my constituents who do not have the means to afford a private diagnosis? Another of my constituents, who is also from Batley, has had to give up his job to accompany his son to school every day. Without a diagnosis, the school is not able to fund the additional staff it needs to take care of his complex needs. It is a problem not only in my constituency, but throughout the country.

Mental Health Taskforce

Lisa Cameron Excerpts

Tuesday 23rd February 2016 Commons Chamber

[Alistair Burt]

Yes, we have indicated that we accept all the recommendations by the taskforce. I would like to roll out responses to them over a period of time so that they are regularly brought back to the House. Our commitment to expenditure, training and dealing with the recommendations is clear.

Mr Speaker, you would not want to hear all the private conversations that go on on the Floor of the House, nor would those who report our proceedings, but I see the hon. Member for Liverpool, Wavertree (Luciana Berger) so often at events such as this that it is not unnatural that we have the odd exchange over the Dispatch Box.

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

I declare an interest as a registered clinical psychologist. I thank the Minister for his commitment and the taskforce for its informative report. In considering mental health across the lifespan, the report highlights the fact that 40% of people living in care homes are affected by depression, which contributes to morbidity. Alongside medical and social care, will the Minister commit to funding specialists in older adult psychological treatment, to address the growing mental health needs of our population?

[Alistair Burt]

I thank the hon. Lady for her work in this area, for her commitment to this area since she has been in the House, and for being at the National Autistic Society event last night, where she again demonstrated that interest. May I look at the suggestion that she makes? It is well recognised that with the growing incidence of dementia and other issues, and with those in care homes being increasingly frail, there will of course be a need for further specialised work. May I look at that area in particular and come back to her in due course?

Infected Blood

Lisa Cameron Excerpts

Thursday 21st January 2016 Commons Chamber

[Jane Ellison]

The Government and the NHS have made it very clear that we greatly welcome what we see as a rapidly changing landscape. There is huge commitment on this issue. I am joined on the Government Front Bench by the Under-Secretary of State for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), who is doing a great deal to accelerate some of the newest treatments and their adoption within the NHS. I can absolutely give that commitment that we always want to stay at the cutting edge of medicine. One reason for delaying this consultation, perhaps to the frustration of some, is that we now have a fuller picture of the current state of the available treatments. The last three treatments that are to be rolled out in the NHS were not approved by NICE until 25 November. I want to ensure that we are always up to date with the treatment landscape as it evolves, as we hope it will continue to do.

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

We understand the terrible situation of those who have been affected by the infected blood tragedy, and empathise greatly with them. It is imperative that we take every possible action to compensate where we can, although no amount of money can truly compensate the individuals whose lives have been affected.

It appears from the Minister’s statement that what is being proposed is a step in the right direction, but we must focus on the needs of those affected, offer choice, and ensure that there is medical advancement and evidence-based practice. I understand that payments are made through a United Kingdom scheme, but there is clearly considerable involvement on the part of Health Departments in devolved Administrations.

Let me end by reiterating our support for those affected, and by asking the Minister what discussions she has had with devolved Administrations about consultation arrangements, scheme reform, payments including those recommended for widows or widowers, and other support that is urgently required.

[Jane Ellison]

The consultation is being undertaken by the Department of Health in England, but anyone in the United Kingdom can respond, and we continue to work with all the UK Health Departments. My officials have been working closely for months with officials in devolved Administrations. I offered to speak to my ministerial counterparts on the phone this morning, and had a helpful conversation with both Shona Robison and the Welsh deputy chief medical officer. I note that the chief medical officer for England also contacted her opposite numbers.

As I have said, we are in touch with all the devolved Administrations. Because health is now a devolved matter, they are responsible for providing financial support for those affected in each country, and I know that Scotland is consulting on scheme reform in its own right. However, all the devolved Administrations will have the option of joining our new scheme in the future, and an assessment will be made of the financial contribution that is necessary. I had a useful conversation with Shona Robison about some of the transitional arrangements, and about how we can work together. I said that we would try to be as helpful and supportive as possible, and I have every confidence that we will continue in that spirit.

Childhood Obesity Strategy

Lisa Cameron Excerpts

Thursday 21st January 2016 Commons Chamber

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

I thank the hon. Member for Totnes (Dr Wollaston) for securing this extremely important debate. It is not listed in my entry in the Register of Members’ Financial Interests, but I must declare a terrible sweet tooth, which gives me great experience from which to speak in this debate.

Over preceding decades, there have been profound changes in the UK in the relationship we have with food. Historically, the public health challenges we faced tended to relate to under-nutrition and unsafe food and water. However, in modern society, those issues have largely been replaced by the risks of poor diet. Food is now more readily available and there have been significant changes in how we eat, the type of foods we consume, and how they are produced and marketed. Busy lifestyles and easy access to convenience and processed foods have helped them to become a staple part of many families’ diets.

In general, we over-consume foods high in fat, sugar and salt, and we do not eat enough fruit, vegetables, fibre and oily fish. Our type of diet underlies many of the chronic diseases that cause considerable suffering, ill health and premature death. It is also a major factor in the issue of childhood obesity, heart disease and type 2 diabetes. The recently published findings from the Health Committee’s investigation into childhood obesity highlighted that one in five children is overweight or obese when they begin school. That figure was found to rise to one in three by the end of primary school. There was also evidence of inequality between different sectors of society, with those from deprived backgrounds found to fare significantly worse and to be twice as likely as their more affluent counterparts to be overweight or obese.

These figures are extremely concerning. Obesity is a serious problem that has significant implications, both on the long-term wellbeing of the individual child and on society as a whole. Many of the most serious and potentially life-shortening physical health risks that accompany obesity are well publicised and have been raised already in the Chamber today. I will not, therefore, go into them again.

Instead, I will highlight the detrimental social effects that can impact on individuals’ overall wellbeing and life chances. Research indicates that childhood obesity is associated with mental health issues in both children and adults, such as depression, low self-esteem, social isolation, self-harm and behavioural problems. It is also associated with stigma and bullying. In addition to obesity, a poor diet that includes too much sugar and acidic food substances can lead to oral health issues, which can impact on an individual’s ability to eat and socialise, and this again can adversely affect their mental health and contribute to their social isolation.

Addressing these issues will require a concerted effort to alter health choices, to address cultural and lifestyle issues and to improve our relationship with exercise and sport. It will require a multifaceted response; no single measure will do the trick. We need a response from private enterprise to improve choices and healthy options that are appealing and, importantly, cheap, as was highlighted by my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson). We need to address the effect that marketing can have on children and parents and make sure it is done responsibly, as was mentioned by my hon. Friend the Member for Glasgow Central (Alison Thewliss). We need to enhance skills gained at school and home in cooking healthy meals, and this must be role-modelled at school, with fruit bars, water and other healthy choices that are low in fat, salt and sugar, as was discussed in detail by the hon. Member for Washington and Sunderland West (Mrs Hodgson).

Childhood obesity must also be addressed by local commissioning in areas where fast-food outlets are placed near to schools. In one of my local areas, refuse staff are in place at school lunch times to clear up fast-food packages left by school children in shopping squares. This must be addressed and must not be encouraged. Wider Government initiatives are also required to improve food labelling. We need labelling that is understandable to families and ordinary people and which does not look like gobbledegook.

As debated today, taxation should be considered as part of an evidence-based approach. We also require an increased focus on sports, exercise and healthy pursuits as being integral to our lifestyle; increased funding; and an emphasis on engaging children and young adults in these activities and making them affordable to people from all walks of life. We know from psychological research that education, in itself, does little to change behaviour. We therefore require a Government strategy to reinforce healthy choices. This would be cost-effective in the long term for our health service and quality of life.

[Geraint Davies]

The hon. Lady is making a powerful and excellent speech. She might know that in Mexico the average consumption of Coca-Cola is 0.5 litres a day per person and that children are being fed Coke in baby bottles. Does she agree that the Government need to take action not just on pricing but on marketing? We cannot have this situation where people can buy two litres for 5% more, so that we have these huge stocks of Coke that people feel they have to get rid of before it loses its fizz, and everybody’s teeth fall out.

[Dr Cameron]

The hon. Gentleman makes a good point. I have pinpointed the need to address the effect of marketing on children and parents’ healthy choices.

A clear strategy would benefit our children, society as a whole and future generations. That is surely Parliament’s job. We should not shy away from a bold and effective obesity strategy.

Conception to Age 2: The First 1001 Days

Lisa Cameron Excerpts

Thursday 17th December 2015 Commons Chamber

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

I congratulate the hon. Member for East Worthing and Shoreham (Tim Loughton) and the Backbench Business Committee on bringing this important debate and issue to the House.

“The 1001 Critical Days” document is an extremely important manifesto, attracting support from across the political spectrum as well as from a wide range of professional and third sector organisations. It highlights how vital the early days of childhood are for both parents and children, and the importance of acting early and focusing policies in order to enhance the outcomes for children both over the short term and the long term. This is of benefit for the individual child, their families and society as a whole.

The principle of early intervention encourages a holistic approach to meeting the needs of children and families, including though play, learning, social relationships, and emotional, psychological and physical wellbeing, along with health, nutrition, growth development and safety. Evidence has highlighted that this early part of the child’s life between conception and the age of two is a formative period in all spheres of their development. Although there is little narrative memory of this period, a child’s experiences from this time impacts upon their cognitive, social and emotional functioning and in turn their relationships, behaviour, educational attainment and opportunities throughout the course of their life.

In this regard, “The 1001 Critical Days” manifesto highlights evidence from international studies that demonstrate that when a baby’s development lags behind the norm during the first years of their life, this gap tends to increase over subsequent years rather than to improve. Prior to being elected, I was employed in the NHS as a clinical psychologist and, in the various areas where I worked, I have seen at first hand the long-term impact of adverse childhood experiences on development and on later life chances.

A lack of parenting skills can be a product of intentional or non-intentional conduct by carers, and it is recognised that the period between pregnancy and the first years of a child’s life is a time of great vulnerability. Secure attachment and nurture are crucial to children’s emotional wellbeing and development, and it is important that parents who lack confidence in their abilities or who are struggling should have access to the support, mentoring and skills building opportunities that they need. Parenting skills classes have therefore been rolled out across Scotland.

Babies are disproportionately represented in the child protection system and statistically more likely to die prematurely than older children. In addition, any neglect or abuse occurring during this period can have life-changing effects, owing to infants’ bodies being fragile and their brains being at a crucial stage of their development. Because of the additional pressures of parenthood, parents are also at risk of perinatal mental health problems and of coping difficulties during this period. Individual, social and environmental factors can have an impact in this regard.

However, as well as being a time of vulnerability, this period of a child’s life is also a time of great opportunity when it comes to providing support and changing patterns. In this regard, I note it has been reported that during pregnancy and the first year of a child’s life is an ideal time to work with families, as it is a time when parents are particularly open to support and motivated to change, and when firm foundations for family life can be established. There is a growing body of evidence that intervention in early life can transform the lives of babies and of their parents.

“The 1001 Critical Days” manifesto states that it aims for every baby to receive sensitive, appropriate and responsive care from their main care givers in the first years of life, with more proactive assistance from the NHS, health visitors, children’s centres and other public bodies that are engaged in a coherent preventive strategy. My own experience tells me that additional monitoring and early assessment does not happen often enough in cases where there could be developmental disorders such as autistic spectrum disorder. That can have a negative effect on children, as well as on their parents, who might find it difficult to cope and therefore require additional support at an early stage. Early assessment of developmental disorders can ensure that the right resources are swiftly put in place, which will improve a child’s chances and their adaptation.

Our party agrees that the early years are a crucial time for development and intervention because, when it comes to breaking the cycle of inequality, we recognise that prevention, resources and support are key. Throughout our time in government in Scotland, we have promoted an early years framework and been committed to strategies aimed at promoting and facilitating a stable and nurturing environment for children. In recent years, the Scottish Government have developed and introduced legislation in the form of the Children and Young People (Scotland) Act 2014, which gives Scottish Ministers and public bodies a legal requirement to issue reports on how they take the United Nations convention on the rights of the child into account. It also extends free pre-school provision from 475 to 600 hours a year of early learning and childcare for all three and four-year-olds and for just over a quarter of all two-year-olds—those from low- income households. It also gives children and young people access to a named person service. In the early years, that is the health visitor. The named person is a single point of contact who can help to co-ordinate support and advise families, and those working with them, when required. This can involve the monitoring of emerging perinatal mental health difficulties.

In 2010, through collaboration with a wide range of experts, the Scottish Government also launched their pre-birth to three strategy, based on four main areas: the rights of the child; relationships; responsive care; and respect. Those strategies are not all-encompassing, and there is room for continued improvement. However, the Scottish Government understand the importance of the early years of children’s lives and the benefit to society as a whole of trying to prevent future issues through early intervention. A child’s sense of interaction with the world develops at this time, alongside its learning of emotional regulation and well-being, and the development of its neurological functioning. As such, we are committed to continuing to make early years the key priority it deserves to be, focusing funding accordingly and trying to ensure that all children have the best start in life possible.

My party will work collaboratively across this House to ensure that in Scotland and across the UK children have the very best start, which they deserve. I am impressed and pleased that we have guidelines from the all-party group on foetal alcohol spectrum disorder and I am happy to share those with the Scottish Government and to look at key recommendations.

In finishing today, I would like to thank sincerely all of the House staff for their extraordinary efforts this year. I wish all Members of the House, the House staff and of course, you, Madam Deputy Speaker, a very merry Christmas and a happy new year from my party.

Mental Health

Lisa Cameron Excerpts

Wednesday 9th December 2015 Commons Chamber

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

I congratulate the hon. Member for Liverpool, Wavertree (Luciana Berger) on initiating such an important debate. It is a privilege to contribute to it.

I must begin by declaring a professional interest, having worked as a forensic and clinical psychologist for 20 years in the NHS and beyond, specialising in mental health, at consultant level for 10 of those years. I continue to maintain my skills and engagement in line with the professional requirements of my registration with the British Psychological Society and the Health Care Professions Council. Earlier in the year, I had the privilege of contributing to the evidence taken by the Youth Select Committee during its inquiry into child and adolescent mental health services.

I want to say a little about three topics: the adult mental health service and strategy, child and adolescent mental health services, and mental health services for veterans. Mental health is an extremely wide field, ranging from major mental illnesses such as psychosis and depression and anxiety disorders to trauma and eating and adjustment disorders. Developmental disorders such as attention deficit hyperactivity disorder and autistic spectrum disorder are also sometimes included in the sphere of mental health, and I would welcome future debates about those important conditions, because I fear that we shall not have time to do them justice today.

The British Psychological Society has reported that one in four people in the UK will experience a diagnosable mental health problem, with mental health problems accounting for up to 23% of all ill health in the UK and being the largest single cause of disability. In Scotland the figures are currently one in three. Mental disorders are strongly related to risk of suicide, and it should be known that high levels of comorbidity with substance disorder and physical ill health are prevalent.

Mental health services across the UK are not the finished article wherever you go. We are continually striving towards improvement, and that should always be guided by patient need and by research underpinning most effective clinical practice.

When I started practising in the 1990s in Scotland, the funding of mental health services severely lagged behind other areas of NHS funding. That resulted in far too few practitioners and what seemed to be never-ending waiting lists for both patients and clinicians. At the start of my career, patients routinely waited to see psychologists in mental health specialties for six to 12 months, and in some areas for over a year. That was clearly ineffectual, often meaning that problems were exacerbated over time and that a mainly medical model persisted. That is not what patients wanted, nor did it fit with best practice; evidence indicates that patient recovery is improved with access to talking therapies alongside medical management. That is evidenced clearly in National Institute for Health and Care Excellence guidelines.

In 2014, the HEATs—health improvement, efficiency, access targets—were adopted in Scotland and across the UK, meaning that patients should be seen from referral to assessment in 18 weeks. In Scotland in 2014, 81.6% of patients were seen in 18 weeks and the number of people seen was 27% higher than in the same quarter the previous year. Demand is increasing, which is a good thing: it means that we are starting to tackle stigma and that access is improving.

Matched stepped care involving psychological therapies and practitioners at differing levels, depending upon clinical effectiveness of therapy type for different disorders, was rolled out in all boards within NHS Scotland, and NHS Education for Scotland took a primary role in workforce capacity modelling and training. Use of self-guided help has also been developed. Technological advances are important in terms of access for patients in this modern world and in relation to early prevention. Suicide rates have been brought down and the target met of training high levels of front-line staff in suicide prevention and risk identification. Quality ambitions have also been developed as benchmarks in relation to person-centred, safe and effective care.

I fear, however, that demand on mental health services will continue to increase dramatically. Evidence suggests that recession increases mental health problems, including depression, suicidal behaviours and substance abuse. Unemployed individuals, particularly the long-term unemployed, have a higher risk of poor mental health compared with those in employment. Stress is now the most common cause of long-term sick leave in the UK and the more debt an individual has the more likely they are to suffer a mental health problem. A social and policy climate of austerity, affecting the most vulnerable to a greater degree, is a likely aggravator of mental ill health.

I welcome pledges from both the Westminster and Scottish Governments to increase spending on mental health significantly: the figure is £100 million in Scotland. Mental health services, however, have not achieved parity with physical health services over the decades since I started in the field and we need to be clear that much more is needed to fill the gap. I commend Ministers and MPs to visit mental health services and spend quality time with clinicians on the front line. Managerial statistics often occlude a multitude of issues and it is only with that front-line insight that the true patient journey and daily clinical barriers can be identified. Those often include excessive paperwork, repeated reviews and service changes that diminish morale.

Mental health problems in childhood are extremely serious. They can destroy educational potential at worst and impede it when problems are less severe. Difficulties must be assessed and recognised at an early stage. HEATs for child and adolescent mental health services were set at 18 weeks as of December 2014. NHS Scotland data suggested a significant reduction from 1,200 waits of over 26 weeks in 2008. In the quarter ending June 2015, 76.6% of CAMHS patients were seen in 18 weeks and the average wait was nine weeks. In the past two years, there has been a 35% increase in demand due to productive work completed on stigma and in improving access, and since 2009 £16 million has been invested in the CAMHS workforce; it is at its highest ever level. To improve waiting times further, £15 million more has been pledged to CAMHS in Scotland. Widespread staff training has been undertaken in modalities such as cognitive behaviour therapy, family therapy, interpersonal therapy and specialist interventions such as for eating disorders, with a focus on seeing patients as close to home as possible. More progress is required across the UK and in Scotland to meet the 90% target.

I must say that in-patient treatment for children and adolescents should be a last resort. It takes children away from family and pathologises their difficulties. Best practice highlights intensive outreach approaches enabling children to be seen at home and treated in their natural environment, so maximising key family and peer supports. Children who need in-patient services suffer psychosis, intractable eating disorders, severe obsessive compulsive disorder and a variety of neurological conditions and neuro-developmental disorders. Currently there are 48 beds available in Scotland and this year £8 million was pledged to build a unit for children and adolescents with mental health problems in Dundee. My clinical experience suggests a lack of available beds in forensic and in learning disability child and adolescent mental health services. Constituents who have contacted me have also suggested that further work needs to be done to improve access to specialist eating disorder in-patient care outwith the private sector.

Increases in the number of children presenting with self-harm and receiving brief overnight admission have been high. Clinically, this is quite a difficult decision. Often, clinicians are faced with the issue of sending adolescents for a brief stay miles and miles from their home—which makes it difficult for carers and parents to visit them—or admitting them briefly overnight. Surely the optimum treatment would be to see and assess them and to ensure that children are safe and able to go home with the strongest possible package of care as quickly as possible.

[Chloe Smith (Norwich North) (Con)]

I value greatly the contribution from the hon. Lady, who has huge expertise. I get the feeling that there is much medical expertise to come from the paper she may have been citing a lot in her speech. As the Front-Bench spokesman for her party, could she explain whether she thinks the points made in amendment (a) were valuable? In the absence of that, does she support the motion as it stands? How does she urge Members to vote today?

[Dr Cameron]

I do not support the motion and how it reflects Scottish Government care. As I have said, for children who have mental health difficulties, clinicians have to make a sensitive judgment regarding the length of potential stay, and whether the problems are intractable and the children should be admitted to a specialist unit, which can often be some miles from their home. Many of cases of self-harm attempts require psychiatric assessment and monitoring, overnight care and monitoring, and then a package of intensive home care to try to reduce the chance of another such incident. I hope that answers the hon. Lady’s question.

Recommendations, however, do have to be made in relation to CAMHS. They include having a wider appreciation of children’s mental health beyond any problems, providing education and awareness in schools, and having access potentially to mental health clinicians in school settings and not just clinics. As with diet and exercise, good mental health should be normalised. Those are all fundamental living skills that impact on all aspects of functioning and deserve more of a health and well-being slant, rather than a pathologising label.

[Carol Monaghan (Glasgow North West) (SNP)]

Does my hon. Friend agree that it is invaluable to have these services in schools as that normalises the feelings of low self-esteem that many of these young people are experiencing, and does she also agree that to have counsellors based in the school is very important for young people’s mental health?

[Dr Cameron]

Yes, access to such mental health services in schools is certainly merited, as well as mental health awareness and training, and particularly training for staff in schools so that they can pick up at a very early stage if someone is experiencing a mental health problem and then try to access services at that very early stage. Specialist training for teachers would be a positive step forward so that they recognise the signs of mental distress in children. We also need to modernise our approaches to mental health for children and adolescents and embrace the IT and social media method of communicating with young people, because that is the modern world and that is often where they communicate from.

There is a project in Scotland called SafeSpot, an application, website and school intervention to promote positive coping skills, safety planning and access to information about mental health services for young people. The project is going very well and the app is freely available on iTunes and in Android stores. The SafeSpot app and website will be used within Greater Glasgow and Clyde health board, and Dundee health board is also looking at access to it. It was designed by a clinician, Dr Fiona Mitchell, specialist registrar in child and adolescent psychiatry, and I commend her on her innovative work in that regard.

There remains a lack of empirical data regarding effective interventions for young people with comorbidity issues, by which I mean mental health coupled with learning difficulties or substance use, and that requires to be built upon. Looked-after and accommodated children are some of the most severely disadvantaged in terms of services and magnitude of difficulties, particularly those who also may have violence-risk needs or self-harm needs. Further service provision for specialist groups and underpinning research will be crucial.

Given that the weight of evidence for child and adolescent mental health services is in favour of psychological, rather than pharmacological, interventions for the majority of child mental health presentations, clear structures should be in place to support the delivery of effective, evidence-based psychological therapies for children and adolescents. Those from socially disadvantaged backgrounds have always tended to have a poorer uptake of CAMHS. An assertive outreach may be required so that some of the most vulnerable and disadvantaged children and families do not slip through the net.

Specialist service delivery in areas of developmental disorder such as autism, children in the criminal justice system, and children with comorbidity requires to be thought through and planned, so that those children and their families are able to access facilities without feeling they are being passed from pillar to post. It is extremely difficult for families in particular to access early diagnosis of developmental disorders such as for those with autistic spectrum disorder, which means that their needs can go unmet for years and their attainment may diminish.

I continue to believe that the mental health of veterans is an area that is underfunded across the UK and that those who have been willing to lay down their lives for their country should have consequent health, including mental health, needs prioritised. The Minister agreed a few months ago during my Adjournment debate that much more would be done. I would like to have a statement on what more is being, and will be, done, particularly as we are now in a new conflict and the numbers of those in our armed services who witness or experience trauma will increase.

As a clinician in mental health, I make the following plea to the House. To me, mental health services are beyond party politics and it is crucial we tackle this meaningfully in a cross-party manner that brings about real continued progress on the ground for service users and staff, and that we share best practice across the UK and a “what works” philosophy.

I welcome the announcement of improved access to data, which is also crucial in terms of taking forward and ensuring best practice. I say in conclusion that I sense a real note of collegiality across the House and a will to take this important issue forward. I look forward to fully partaking in that, and my party wishes to see mental health services continue to improve in Scotland, the UK and beyond.

Gay Conversion Therapies

Lisa Cameron Excerpts

Tuesday 3rd November 2015 Westminster Hall

[Mike Freer]

My hon. Friend makes an extremely powerful point. I am not surprised to hear those figures.

Anyone who is conflicted and in need of support while coming to terms with their sexuality is experiencing some difficult feelings. If they are told that they can be cured—I am yet to find a case of the cure being proved successful—they then have to deal with those feelings as well.

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

I speak as a Member of Parliament and as a psychologist. In all my experience and practice in the NHS, this is not something I am familiar with, although the hon. Gentleman says that there are a number of cases. It is important to recognise that such therapy is without any evidential basis—not surprisingly, given that most of the research findings indicate an adverse impact on people’s mental health, rather than a cure per se.

[Mike Freer]

The hon. Lady makes a good point. I have to say that no one I know has come forward to support such psychotherapy, yet if there is such violent agreement, why are we struggling to get aversion therapy banned? There is this conundrum: we all agree that it is harmful and that it should not be done, yet we do not seem to be able to get it banned.

I accept that my hon. Friend the Minister has difficulty in regulating the sector in terms of setting legal definitions for what would constitute illegal therapies. The legal situation is fraught, but it is not acceptable to leave vulnerable men and women susceptible to aversion therapy. There can be no justification for pursuing therapies that put a person’s mental health and, in some therapies, their physical health at risk. It is time to say that such therapies have no place in our society and no place in our healthcare system. It is time to say simply that aversion therapy has no medical merit and can be harmful and it is time to say that it is going to be illegal. It is also time to ensure that psychotherapy has statutory regulation, so that those who do not comply and continue to perpetuate such cure therapies face stricter and harsher penalties than those currently available under a voluntary code.

The Royal College of Psychiatrists contacted me last week to reiterate that

“the college remains in favour of legislative efforts to ban such conversion therapies.”

In its letter, it said that

“there is no scientific evidence that sexual orientation can be changed.”

It also said that

“so-called treatments of homosexuality can create a setting in which prejudice and discrimination flourish, and there is evidence that they are potentially harmful.”