Health: Mental Health Strategy

Lord De Mauley Excerpts

Monday 14th February 2011 Lords Chamber

[Baroness Murphy]

My Lords, 10 days ago, the first ever cross-government mental health strategy was launched, laying out plans for the future of mental health care in England. I congratulate the Government on recognising the crucial fact that mental health affects every area of a person’s life and impacts upon their ability to play an active role in society and I welcome the Cabinet-level commitment expressed so far. The strategy also makes plain that mental health has a parity of esteem with physical health—a lovely phrase—finally giving the issue the equal footing it deserves.

Sticking with the good things for the moment, I am delighted with the commitment to repeal the outdated law which forces MPs to stand down if they have been sectioned under the Mental Health Act for more than six months. This is an important anti-stigma signal by the Government.

However, I turn now to my—what shall I call them?—not exactly anxieties or worries but a sense of unease about the messages. I had niggles about the New Horizons strategy from the previous Government, so I am not blaming the coalition; rather I am blaming all of us in government, professional organisations and the voluntary sector for letting the ball slip through our fingers. I declare a personal interest¸ having spent most of my career working in specialist psychiatric services with people with serious, life-changing mental health disorders such as dementia, schizophrenia and other major psychoses and serious disabling developmental disorders of personality.

For me, the overarching theme of the strategy represents a misguided, somewhat soft-headed, utopianism focused on well-being and mental good health, as though there were a direct connection between a happy society and reduction in serious mental illness. But there is not. Events and circumstances, often unavoidable, play a significant part in the origins of serious disorders—but only a part, and often a very small part.

Let me make it clear that the broader public health issue of mental well-being and the aim to intervene to prevent the experience of distress are legitimate national strategic objectives. The toll of emotional human misery and minor psychiatric morbidity costs England an estimated £105 billion every year. This burden spreads beyond health services to education, employers, the social security benefits system, housing, the criminal justice system, families and communities. National well-being should influence our approach to economics and it is entirely legitimate to try to intervene to promote good mental well-being. However, I have doubts as to whether this should be the target of a mental health document which will largely be read by health and social care providers.

Many in the Chamber today have campaigned for the wider availability of psychological therapies, but again I have doubts about what Marjorie Wallace at SANE has recently referred to as the “therapy for the nation” strategy, which comes across as a panacea for the whole spectrum of mental health conditions and is being launched against a background of active planning for cost improvements of about £20 billion in the NHS, with local authorities shamelessly slashing and burning community services.

The experience of many local voluntary organisations which work with people with serious mental disorders is that people are being turned away from help, especially from in-patient care, when they feel desperate or they and their families have reached crisis point. Mental health services are still not getting it right for people with serious mental ill health and I want a strategy that does. Only today I received a deeply moving letter from the mother of a young man with a chronic enduring psychotic illness whose life circumstances were extraordinarily tragic and who was receiving inadequate support from the community services.

I am particularly critical of the public health outcomes framework in the strategy document, which seems to me to be mostly aspirational wishful thinking. It includes everything from reducing reoffending and self harm, all the way through to access to green spaces and “improving social connectedness”—a Facebook account for all? It is all lovely stuff but nothing to do with mental ill-health realities.

We know from studies in the US and our own research that social interventions that make a difference—for example, to the mental well-being of children and young people—have to be comprehensive, very focused, usually costly and require major changes in the way services are organised. Successful pilot schemes have been exceptionally difficult to replicate on a larger scale and to translate from experience in the United States. It is a waste of time, as we have known from so many social interventions, to intervene with individuals and families on a small scale, yet there is a real danger that that is what we will do.

Let us take maternal depression as an example. I am not denying that there is some evidence for the efficacy of preventive interventions, such as home visiting, parenting programmes, peer support, the refocused Sure Start children’s centres, parent support advisers working with school staff, and other family support workers, such as health visitors and early years outreach workers. Your Lordships may have noticed that I have already mentioned an army of helpers and workers of one sort or another. Then there is the family-nurse partnership programme, which works with the most disadvantaged young families with complex, interlinked problems and is aimed at interrupting the transgenerational cycle of poor health. The evidence is poor that this will work unless it is properly replicated on a very wide and expensive scale. The Government have pledged to increase the health visitor workforce by a further 4,200 posts, refocusing health visitors on maternal and infant mental health. However, the overall evidence for the efficacy of health visitors has been slight in the past. The NICE report currently on its website is based on an earlier Health Development Agency review of the evidence, which did not give much comfort in this area. Research has been small scale; much of it is interesting and encouraging, but its findings have so far been modest. Yet we are about to embark on vast investment.

To support these and other programmes, the Department for Education has introduced a new early intervention grant, which will bring together funding for a number of intervention and preventive services. These will replace the current targeted grant. I have no quarrel at all with the idea of a general grant that local authorities can use for the priorities in their area, but altogether the early intervention grant will be 11 per cent lower than the aggregated funding for this year, with a further major drop for next year. What of the £400 million extra for psychological therapies, which can and should, in my view, be targeted on those with the greatest need? It is in the baseline funding of the NHS, but do we really expect that it will be spent in the suggested fashion in the context of the £20 billion reduction? Some of it will be retained by a few areas, but I have grave doubts that it will find its way through to where it is really needed.

I suggest that a mental health strategy should focus primarily on those with the most severe disorders, whose lives are so often wrecked by the misery of mental illness. It has to be fit to be translated into measurable outcomes for the commissioning board and turned easily into commissioning intentions by GP consortia. We know that GPs lack confidence in commissioning mental health services. A survey last year by the charity Rethink found that, although three-quarters of GPs are happy to take on responsibility for commissioning diabetes and asthma services, fewer than a third feel the same for mental health services. They know that they do not like what they get at the moment for their patients with severe mental illness. Only half of GPs are confident about the quality of specialist care for depression and only a third are confident about the quality of care offered to people with psychosis. Many GPs doubt that patients with mental ill health will get the treatment that NICE recommends. In a way, that should encourage us, because GPs will want change for the better. I know that the Mental Health Network of the NHS Confederation is doing some very good work in collaboration with the pathfinder consortia.

The well-being of the nation is an important thing, but it is perhaps something other than a mental health strategy, so does the Minister not have doubts about whether we know enough to intervene cost-effectively or whether we have the public wealth to intervene on a wide enough scale to make a real difference? Will he accept that the well-being of a nation does not have a great deal to do with the sorts of services that will be delivered to people with serious and enduring mental health problems? I should like to see a strategy that really gets it right for the seriously ill.

Finally, I look forward very much to hearing other noble Lords on this topic. I firmly expect them all to disagree with me profoundly and I hope by the end of this debate to be converted back to my usual optimistic self.

[Lord De Mauley]

I have been informed that at least one noble Lord has withdrawn his name from the list of speakers for this debate, which means that all speeches, except for that of the Minister, will be limited to six minutes.