Mental and Physical Health: Parity of Esteem

Lord Carlile of Berriew Excerpts

Thursday 10th October 2013 Lords Chamber

[Lord Carlile of Berriew (LD)]

My Lords, the noble Lord, Lord Layard, has taken a long and influential interest in mental health; not least as a leading economist, he has made a powerful economic case for parity of esteem. We are very grateful to him for securing this debate.

I notice that the noble Lord is sitting alongside the noble Lord, Lord Bragg, on what I suppose one could describe as the polymath Bench this afternoon. This morning, the noble Lord, Lord Bragg, presented a most interesting Radio 4 programme featuring the life of Galen, the extraordinary second century Roman doctor. Galen discovered many things about medicine. One was that he realised that much of the variation in physical health and in human behaviour can be explained by temperament and stress, as he put it. He identified the inseparable links between physical pathology and psychopathology 1,900 years ago. To some people suffering from mental illness in this country and in particular to those who live with them, it can sometimes appear as though little more has been learnt in the past 2,000 years.

Of course, that is unfair. Generally speaking, huge advances have been made in the treatment of mental illness. Drugs are available which, for example, have vastly improved the quality of life for patients suffering from bipolar disorder and, more recently, for patients suffering from acute schizophrenia and other conditions. Therapies, not always involving drugs, have had a remarkable and beneficial impact on many individuals—albeit, I am afraid, with patchy availability in this country. I had the privilege of serving as Member of Parliament for a constituency in rural mid-Wales for some years. This is a bit historic, but even today I understand that the availability of therapies is very uneven in an area like that. You can get a therapy, but not necessarily the right therapy. Providing the correct therapy is extremely important.

The stigma of mental illness remains an obstacle to progress. The fear of telling an employer of a psychiatric diagnosis remains much greater than revealing a physical illness, however serious. In my own legal profession, I have seen careers destroyed by a psychiatric illness of limited duration, whereas a physical illness of similar duration has been received with sympathy and patience and people have been able to return to practice.

There has been some progress. The media have taken a commendable lead. I do not only listen to the noble Lord, Lord Bragg, on the radio; sometimes I watch television drama. Storylines in recent crime noir series, in “Homeland” and elsewhere, have highlighted that anyone, including the at least apparently heroic, can suffer from a mental illness and still lead a perfectly normal life and provide service to society.

Recently, I enjoyed the privilege of co-chairing with Professor Dinesh Bhugra an investigation for the Mental Health Foundation into the future of mental health services. Our report, Starting Today, was produced last month. There is not enough time in a debate such as this to go into the detail of the report, but one of its foundations was pleasure at the 2011 English mental health strategy, which rightly committed this country to parity of esteem. However, the declaration, welcome as it is, has not been matched by progress, which has been variable and not yet quick.

The Mental Health Foundation report has headlined a number of issues which could develop parity of esteem in the coming years. I will refer to a few of them. We certainly took the view that we need to look at fresh ways of implementing known best practice alongside developing technology. Above all, I would like to highlight mental health in primary care. GPs should become—but in only a few cases have become—leaders in mental health care, providing quickly accessible services in their surgeries.

I referred earlier to rural mid-Wales. I know of one practice which years ago introduced a psychotherapist into the health centre in a small Welsh market town. It had a remarkable effect. It meant that the doctor could say to the patient, “I think you need to go down the corridor and talk to my colleague”. An intervention was made which beneficially affected the life of the patient concerned. We need to see more of that. By the way, a two-week wait for an appointment with a doctor just will not do for someone suffering from a growing mental condition. GPs need to know as much about mental illness as about physical illness. So far as possible, primary and secondary mental health services should merge to produce early treatment and the value for money that the noble Lord, Lord Layard, has identified in some of the work he has done over the years on mental health.

The Mental Health Foundation report also found that there is value in self-management. So far as possible, patients in a personalised service should be encouraged to take training in the management of their own care in partnership with therapists and clinicians. A stake in your own recovery is a real incentive for a person who is suffering from mental health problems, but it needs some formal help.

Turning to crisis care and community support, every accident and emergency facility should be equipped to deal with emergency mental health issues, to be followed up by community support. They are not. All over the country, they are not equipped. That is not acceptable.

On collaborative working, I emphasise something that I have encountered in other areas, such as child safeguarding, which is the sharing of information. When somebody with a mental illness goes into an accident and emergency department, a solicitor’s office, a police station or a school, they go into a silo. That is not acceptable. Data protection is used as an excuse for not sharing information. Actually, it is near criminal not to share information for people who have needs that are demonstrated by mental illness. We must ensure that those who have information to share do not sit in silos and that the ability to pool funds from different funding streams into a single integrated care budget, shared protocols and partnership agreements, co-location of services, multi-disciplinary teams and liaison services becomes a reality.

The Mental Health Foundation report also emphasised the beginning and the end of life as key areas where mental health interventions should be made available quickly and fully. Early interventions in schools can identify mental health issues that affect not only the child but the child’s parents and carers. Many cases have been highlighted in some terrible reports that have been produced after fatal events that show that to be the case.

The final issue that I want to raise in the time available concerns the elderly. Perhaps this is an issue that we can raise comfortably in your Lordships’ House because so many of us are OAPs these days. There is a growing issue, as we all know, about elderly care. Many of us have enjoyed having parents who lived into their late 90s and indeed, happily, there are Members of this House in their late 90s, but we know that this issue needs a great deal more work than it has received. It will enable elderly people to lead a full life albeit while suffering from some incipient dementia.

There are many challenges and this debate highlights them. It allows us to show Parliament’s determination that parity of esteem should be a must and not merely a phrase.