Health: Mental Health Strategy

Lord Alderdice Excerpts

Monday 14th February 2011 Lords Chamber

[Lord Alderdice]

My Lords, like other noble Lords, I am grateful to my colleague, the noble Baroness, Lady Murphy, for obtaining this debate, albeit, as the noble Lord, Lord Newton of Braintree, said, a brief debate in which it is not possible to deal with such a complex subject as mental well-being and a complex system for dealing with it.

I come to this debate with feelings very different from those of previous speakers. For the whole of my professional life, I spent half my time on Northern Ireland politics and the other half on developing mental health services, particularly psychological services, in Northern Ireland. As a young psychiatrist, I discovered that there were very limited services for alcoholism and drug dependence. There was no proper training for psychological treatments within psychiatry, so I devoted myself to working at that for the next 25 or more years. When I retired at the end of March last year, part of the reason for doing so was because I felt increasingly depressed about the way that mental health services were going. For the first 10 or 15 years, every year I could look at services, not just the one I was working in, but more generally, and see improvement and development, but for the past 10 or 15 years, everything seemed to get worse every year in a number of different ways. In devoting myself more to working in Parliament to try to make changes, this document is the first time in the past 10 or 15 years that I have felt seriously encouraged that people are beginning to address mental health and well-being problems in a proper and serious way.

I shall describe the document from two or three perspectives. First, it is the first document I have seen issuing from government that recognises that mental health and well-being go across all government departments. We talk about stigma. One of the key elements of stigma in mental health is that everybody in the community and right across government is very happy to deposit mental health in psychiatric departments and not recognise that education, maternity services and well-being in employment practices all contribute to mental health. We had a Government who demanded that people reconstruct the management of their businesses in such a way that bullying became good management to get the best out of things. It was neither good management nor good for people’s well-being. The point about this document is that it makes it clear that in business and management—which includes management within government—we have at our disposal the mental well-being of those who work in the services. We need to take that into account.

We can get into the details. I see that one Royal College of Psychiatrists document—No Health without Public Mental Health—is well represented but Self-Harm, Suicide and Risk, which I was involved in, is relatively little represented. In particular, there is not much recognition that self-harm is a different phenomenon from suicide; it is not just uncompleted suicide. In the details there are things that one could point out. At a high level this document seems to be an attempt to get recognition right across government and the healthcare services that not only in what people sometimes dismiss as the walking wounded but in serious, enduring mental illness—the schizophrenic disorders, manic depressive psychosis and the more organic disorders—there is a psychological component.

One of the difficulties in my own college is that for some years—it is not true more recently—there was such a focus on the biological side of things that the psycho-social became much less important. Many professionals, including some from my own profession, fell into the trap of thinking that the way to deal with things was to retreat into a biological approach. This document says, “No, I’m sorry, that’s not sufficient. We have to see the person as a whole”. Four hundred million pounds may not be a lot of money in terms of developing psychological services but at the moment it would not be easy to find all the trained therapists within the National Health Service who could go on to do the work. You cannot produce therapists at the drop of a hat, particularly in the psychological services. It will take some years to train them. One of my anxieties is that to spend the money quickly there will be a temptation to employ all sorts of people who might not necessarily be good therapists. The previous Government never got around to the statutory registration of psychological therapists, despite considerable pressure over the past 10 years from some of us.

As I look at this document, it is wholly possible to point out all the flaws and difficulties. We are starting from very difficult circumstances. However, it seems possible to understand from this that the Government are trying to point to a whole new direction in this document. I am not much enamoured of the term “big society”, which is used in this document and pretty much everywhere else. However, I do like the notion of active citizenship. When people come along with difficulties in their lives, it is not about what we do to them in healthcare services, but about how we engage with them and help them to engage with their lives.

I pick up on one comment in closing. The noble Baroness, Lady Murphy, whom I regard as my noble friend, talked about the danger that serious, enduring mental illness might not be dealt with because lots of other things might be espoused first, particularly in psychological therapies. It was not this Government who produced the notion of recovery models. However, the Government pointed out, albeit in a footnote, that recovery does not necessarily mean that you recover. It means, as it says in the footnote on page 16,

“living a satisfying, hopeful and contributing life even with the limitations caused by the illness”.

The noble Baroness is totally right. It would be Utopian to have the notion that mental illness can be done away with completely. It is part of the human condition for more of us, including some in this House, than we would like to believe. In the face of the enormity of that problem, we should not be dismayed by this report but encouraged by it.