Autism Community: Mental Health and Suicide

Liz Twist Excerpts

Thursday 30th November 2017 Commons Chamber

[Liz Twist (Blaydon) (Lab)]

First, I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron)—sorry for my pronunciation—for her thoughtful and comprehensive speech, and for setting out the difficulties that people with autism face. I am tempted to say, “What she said,” but I do not think that does justice to the situation.

I just want to touch on a few points. Earlier this year I met Autistica, a charity that does research into autism. If other hon. Members have not seen its report “Personal tragedies, public crisis”, which looks into why people with autistic spectrum disorders die early—up to 16 years early, as the hon. Lady said—I would encourage them to do so. It makes shocking reading. The key points include the point that autism in itself is not a mental health problem, but that eight out of 10 autistic people will face mental health difficulties, such as anxiety and depression. Four out of 10 children with autism have two or more mental health problems. The research also shows that suicide is a leading cause of death among people with autism. Autistic adults without a learning disability are nine times more likely than others to die by suicide, and autistic adults with a learning disability are twice as likely to be die by suicide. Those are shocking figures. Suicide is preventable, and we need to do much more to reduce those figures.

We also need to recognise some of the specific problems people face. As other Members have said, many mental health problems can look different in autistic people. We need to recognise that and make sure that the issue is addressed, and that people have the appropriate treatments and are dealt with properly.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

My hon. Friend is quoting from an excellent piece of research, but is she aware that the autism commission I chair has conducted a piece of work about the spectrum of obstacles and the difficulty that people with autism face in getting through to the right people in the health service? Those two pieces of research are so powerful.

[Liz Twist]

I thank my hon. Friend for that intervention, and I absolutely agree that the two pieces of work go together and can help us to improve services for people with autism spectrum disorders.

As others have said, it is becoming increasingly obvious that some mental health therapies are not right for people with autism and do not work in the same ways as they do for other people, and we need to do more research into those areas.

It can be difficult for autistic people to approach services for support, and we have already heard about the issues with going to a GP surgery. Autistic people and their families are also left fighting the system too often, because information is not shared.

We need to do a number of things. First, as others have said, we need to diagnose autism much earlier so that appropriate interventions may be offered to people with autism and their families. Secondly, we need to record people who have autism on GP records and collect data so that we can identify the issues and develop appropriate services. It is good that, in the Westminster Hall debate in September, the Government committed to gathering data. I hope the Minister can update us on progress on that.

Next, it would be useful to hear from the Minister what progress is being made on developing the autism care pathway proposed in the “Five Year Forward View for Mental Health”, and whether it will address suicide specifically.

There is concern that suicide prevention measures are not well designed for autistic people. I hope that the Minister will look at what needs to be done differently to reach and support autistic people in crisis.

Finally, none of the recent cross-Government suicide prevention strategies makes reference to autism. Given that we now know that the risk of suicide is so high in the autism community, and that there are very different issues to be considered, as we have heard, will the Minister commit to ensuring that the next strategy looks directly at how to help autistic people in crisis?

[Mr Kevan Jones (North Durham) (Lab)]

I join right hon. and hon. Members in congratulating the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) on securing the debate, and thank the Backbench Business Committee for granting it. The hon. Lady pointed out, as did my hon. Friend the Member for Blaydon (Liz Twist), that the percentage of people who take their own life is nine times greater among people with autism than the general population. As my hon. Friend said, autism is linked to depression and anxiety.

I welcome the debate because it is another example of this House talking about mental health. People know that I think the more we talk about it, the better the debate gets. I think people should be congratulated on that. I place on the record my thanks to the charities and the army of volunteers who work with adults and children with autism, because they are unsung heroes.

I want to raise two points. One is about waiting times; the other, which the hon. Member for East Kilbride, Strathaven and Lesmahagow raised, is about how we develop pathways. In Durham, we currently have a two-year waiting list for autism diagnosis. I have tried to get to the bottom of why that is. It is only when you meet some of the parents of the young people that you see what a tragedy it is. The pressure on those families is so great that I suspect some are developing mental health issues. I am really concerned about the lost opportunity for those children, because everyone only gets one chance at education, and there are cases where children have been out of school for nearly a year, waiting for diagnosis. I am aware, as I think we all are, of the pressures that there are on child and adolescent mental health services and social services, but we must try to streamline the pathway to early diagnosis.

The hon. Member for Bexhill and Battle (Huw Merriman) spoke about schools. The most appalling thing I have seen is that a school excluded a child with autism, even though he had a diagnosis, because “he was too difficult”—and clearly affecting the league tables. We should monitor that, because it is a disgrace. Thankfully, the local authority stepped in and put that right, but the pressure on that parent and the child is unacceptable.

We are talking about mental health and a Health Minister will reply to the debate, but this issue is wider than just health. We have made great strides in terms of parity of esteem, and the point that the hon. Member for Berwick-upon-Tweed (Mrs Trevelyan) made is right. We are winning that battle. Now we need to win the next battle, and that is how we hardwire mental wellbeing into public policy. That is not just health; it is education, housing, social care, local authorities—

[Liz Twist]

And employment.

[Mr Jones]

And employment, as my hon. Friend says from a sedentary position.

There is another big problem that a lot of individuals with autism encounter. They go through the school system. Education finishes and they transition into work. I know of quite a few examples of this from my constituency. A lot of these young people, who are perfectly capable of engaging in some type of employment, seem to get lost in the system. The pathway that the hon. Member for East Kilbride, Strathaven and Lesmahagow mentioned must therefore continue from diagnosis all the way through an individual’s life and involve a cross-section of services, not just health. To get that idea hard-wired into the system, the Government must make sure that, from Cabinet Committee level downwards, consideration of mental health and mental wellbeing forms part of the process of policy making in each Department. The last Labour Government did something similar with veterans.

Deafness and Hearing Loss

Liz Twist Excerpts

Thursday 30th November 2017 Westminster Hall

[Liz Twist (Blaydon) (Lab)]

It is a pleasure to serve with you in the Chair, Ms Buck.

I am sure most of us know many people who are affected to some degree by hearing loss, and we know the impact it has on their lives. In my own case, both my parents were affected. My dad, who died a couple of years ago, had industrial deafness caused by his work in a factory. The effects of that lasted a long time. I welcome the comments from the right hon. Member for Hemel Hempstead (Sir Mike Penning), recognising the industrial injuries aspect. My mum resisted hearing aids for many years, but the difference they made to her life when she finally gave in was, and continues to be, immense. It is immense to us as well, of course.

That is why I was so concerned to hear from Action on Hearing Loss, which I met recently, that some clinical commissioning groups are proposing restrictions on the prescription of hearing aids to people with mild and moderate hearing loss. Indeed, some have already done so, including North Staffordshire CCG, which was referred to earlier. Not only do hearing aids make a real difference to people with mild and moderate hearing loss, but research shows that they reduce social isolation and depression. New evidence also suggests they can reduce the risk of developing dementia; a study in The Lancet recognised hearing loss as potentially the largest modifiable risk factor for dementia. We can do something about it. I hope the Minister will make clear that hearing aids must be provided where they are needed.

As my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) has clearly set out, the cash limit on the Access to Work scheme has also had a significant impact on many people with hearing loss, limiting their ability to do their job properly, or in some cases meaning that they might not be offered jobs because of the shortfall in financial support. I ask the Government to look again at removing or raising the cap. I also echo my hon. Friend’s call for further work on implementation of the action plan on hearing loss. As he described, some good work has been done already, but I ask the Minister to ensure that the Government step up their work on implementing the plan.

In the summer, I met Erin, a young woman campaigning with the National Deaf Children’s Society to have British Sign Language recognised as a GCSE and made available to all students. I join Erin, and the hon. Member for Waveney (Peter Aldous), in calling for BSL to be a GCSE subject.

Mental Health: Pharmacists

Liz Twist Excerpts

Wednesday 25th October 2017 Commons Chamber

[Mr Jones]

As I have said on other occasions, I think that mental health in the workplace is one of the big issues that we do not talk about. I think the hon. Gentleman’s suggestion should be considered, but what struck me about this case was that it involved not a small employer but a huge multinational company, which should have had the capacity within its organisation to provide assistance.

[Liz Twist (Blaydon) (Lab)]

Does my hon. Friend agree that all employers could benefit from having policies to support staff when they are at work, and when, sadly, an employee dies by suicide? Should not employers be encouraged to take up programmes such as those developed by the Samaritans, Business in the Community and Public Health England for the benefit of staff?

[Mr Jones]

I agree with my hon. Friend. I know that she is involved with the Samaritans, and I congratulate her on the work that she does. Yes, there are a lot of tools out there for companies to use, but they must take them seriously rather than treating them as a tick-box exercise. Policies of this kind must actually be used in the workplace, and people must be trained so that if they encounter a case like Alison’s, they do take it seriously. That is what I would have expected from a large company such as Boots.

Anyone who has looked at the details of this case cannot but be moved by its tragic nature, and by the failure of Boots to exercise its duty of care at a national level. Mr and Mrs Stamps are certain that the long hours and the workload that Alison faced were a contributory factor in her death. I have spoken to representatives of the pharmacists’ trade union, the Pharmacy Defence Association. They made it clear that there are increasing demands on pharmacists, not only in terms of workload but as a result of staff cuts. Last year an article in The Guardian highlighted the situation at Boots, including many emails from Boots’ pharmacists claiming that profit was being put in the place of pharmacists’ health, and that they were increasingly being asked to hit targets for medicines use reviews—the company is paid £28 per review by the NHS—rather than concentrating on dispensing and the care of patients.

Those pressures are putting an increasing strain on pharmacists who work for companies such as Boots, but, like Alison, many choose not to complain, because they fear that if they do so they will lose their jobs or their professional qualifications will be withdrawn. That is a particular issue in the context of mental health, and in professions such as pharmacy. People remain silent for fear of the consequences of speaking up. I think that pharmacists need a system like the one that has been introduced for GPs. Many GPs also do not want to talk about their mental health problems because they fear that they will be disciplined. I think that that was Alison’s fear: she feared that if she raised issues relating to her mental health, she would be taken down the disciplinary route and lose her job.

I suggest to the Minister that that needs to be looked at. Pharmacists should have a system similar to that for GPs. I have done some work on this with GPs. The NHS has the GP health service, which is a confidential service for both GPs and trainees. I have met some of its staff, and it works very well in allowing GPs to self-refer confidentially. The GP health service can help doctors with anything to do with mental health, including stress and depression. The effort that has been made to ensure that there is GP support needs to be replicated for pharmacists, because I can say from a personal point of view that, with the best will in the world, giving someone with depression a helpline to ring is not the answer. People do not ring them; I can say from personal experience that I would not have done so when I suffered from depression. The work done for GPs offers a way forward that I ask the Minister to explore.

I also have to raise questions with the Minister about the role of the General Pharmaceutical Council. Following Alison’s death and Mr and Mrs Stamps coming to see me, I wrote to the GPC asking for its opinion of the case. It wrote back saying that its role was to protect patients by

“setting and upholding standards for individual pharmacists and pharmacy technicians.”

I understand that the GPC has been aware of complaints concerning Boots’ working practices for pharmacists, but has taken no action against that company or—so far as I can see—any other company about how pharmacists were being employed. That raises the question of what this regulator is actually doing.

It is also disappointing that the regulator sees itself as a peripheral player on the issue of workplace pressure and stress, and the pressures put on pharmacists. This stance by the regulator allows employers such as Boots to preside over poor working conditions without any threat of sanction. It says that its job is to protect patients, but if a pharmacist has a severe mental health problem that is being created by workplace pressures and stress, that must be putting patients at risk. The potential danger of mistakes being made will be heightened if pharmacists are under such pressure.

In response to Alison’s death it seems as though Boots was most concerned about its own reputation. At the time, its main concern appeared to be whether any controlled drugs were missing from the pharmacy where she worked. It would appear that the drugs that Alison took to end her life came from the unused drugs that were returned to the pharmacy by patients. Although there is a register of these drugs, I wonder whether there should be tighter regulation because it is up to individual pharmacies whether the drugs are recorded. There should be a process of monitoring how the drugs are collected, registered and ultimately destroyed.

While doing the research for this debate I tried to find statistics on mental health problems and suicide among pharmacists. I am not aware of any statistics being held centrally that show this information. We might look into collating such figures to inform this debate, which is clearly ongoing.

Alison Stamps’ death is a tragedy, not only for her family but for us all as citizens, as we have lost a bright, conscientious young lady with much to offer. Her life was, sadly, cut short by circumstances she thought she could not face. It is quite clear that lessons need to be learned and that changes need to be made, not just in the way we regulate pharmacists but in the way we employ them and treat them in the workplace. Alison’s employer, Boots, should take stock not only of how it is dealing with her case but of how it employs other people within its organisation. It would be right to finish with something that Mr and Mrs Stamps said in a letter to me when they first raised the case with me. They said:

“It is clear that Alison was a victim of corporate greed and collateral damage by an uncaring company intent only on its own agenda.”

Autism Diagnosis

Liz Twist Excerpts

Wednesday 13th September 2017 Westminster Hall

[Bambos Charalambous]

My hon. Friend makes an excellent point. Sometimes the private assessment is not recognised by the local CCG, so referral does not take place as planned, leading to more stress on families and children. I have enormous sympathy with her constituent who has faced that situation.

We all know that the early years of a child’s life are so vital for their long-term development. If a child does not get a good start, it is always hard to catch up. Research conducted by the charity Autistica has found that a programme of parent-led video therapy delivered during the early years of an autistic child’s life could significantly improve their communication and social interaction skills. People who are not diagnosed until adulthood can experience depression and have suicidal thoughts.

[Liz Twist (Blaydon) (Lab)]

Does my hon. Friend agree that Autistica’s research also indicates that people with an autism diagnosis, once they get it, can have an increased risk of mental health conditions? In fact, such young people are 28 times more likely to consider suicide than other young people, and that affects adults who do not receive a diagnosis, too. People who have autism have an increased risk of suicide.

[Bambos Charalambous]

My hon. Friend makes an excellent point. Other additional conditions can develop, and suicidal tendencies are one of them. Other mental health conditions can similarly manifest themselves in young people in particular. I congratulate her on looking at that research.

Oral Answers to Questions

Liz Twist Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

I am more than happy to meet my hon. Friend, but he should be confident that we have put in place a substantial support package, including a buddy relationship with another trust and special teams from NHS Improvement, to turn the situation around.

[Liz Twist (Blaydon) (Lab)]

T10. What action does the Secretary of State intend to take to address the link between suicide and socioeconomic deprivation highlighted in the Samaritans’ “Dying from inequality” report as he seeks to reduce the suicide rate by 10% by 2020?

[Mr Hunt]

We will look carefully at the Samaritans’ report, as we always do with what the Samaritans say. I think the signs are that our policies are having an impact and reducing suicide rates significantly, but suicide remains the biggest cause of death among men under 50.