Mental Health

Lord Farmer Excerpts

Thursday 15th January 2015 Lords Chamber

[Lord Farmer (Con)]

My Lords, once again the noble Baroness, Lady Tyler, has secured a debate of vital national importance, for which I thank her. I take this opportunity also to congratulate my noble friend Lord Suri on a very fine contribution to this debate. I am aware of the considerable expertise that lies within your Lordships’ House on the issue of mental health, so it is with some humility that I approach the subject—but also with a conviction that there are neglected issues, and it is at these that I will pitch my comments.

My overriding concern is with the drivers of our high levels of mental disease—I use that term deliberately. When a nation as great as ours has prevalence rates of one in six adults at any one time suffering profound mental distress, as well as one in 10 children and young people, this surely reveals an underlying and widespread societal dis-ease. Mental illness does not just happen: very often there are preventable causes, and this is where a new wave of public health effort needs to focus.

We have just heard from the noble Lord, Lord Patel, that mental health is the single largest cause of disability in the UK. It is responsible for a quarter of the disease burden and 13% of the NHS budget. Although that disparity will, I am sure, be the concern of others here today, I would ask us simply to pause for a moment and consider how much is already being spent, and how much human misery it represents, rather than simply asking for more money. Moreover, it is a fraction of the overall cost to society, estimated by the Centre for Mental Health at £105 billion every year. We simply cannot afford these eye-watering costs and loss of human potential, so I emphasise the importance not just of treating mental illness but of preventing it from occurring—or recurring.

It is now widely accepted that we need to adopt a bio-psychosocial model to understand the causes of poor mental health. To put it more simply, it is not just about genetic predisposition, it is also about the kinds of families and communities people grow up and live in, the character of schools and workplaces, and societal attitudes. If we are serious about preventing mental dis-ease, we have to step back and ask some fundamental and searching questions about the kind of society we want our children and grandchildren to be born into, grow up in and grow old in. First and foremost, it should be one where the unique human worth of every individual is appreciated and which places a very high premium on relationships. With this as a backdrop, I will now unpack what is meant by a bio-psychosocial model, highlight key issues in these three areas where we need to see profound cultural change and recommend how this might be achieved.

First, in terms of biological drivers, drug misuse can be both a cause and effect of mental illness. The British Journal of Psychiatry reports that 80% of first-episode psychiatric disorders, schizophrenia or schizophrenia-like illnesses occur in either heavy or dependent cannabis users. Individuals using cannabis are doubling their risk of developing schizophrenia. This undeniable risk to mental health is why I am so strongly opposed to legalising cannabis. We need to send a clear and unambiguous signal to our young people that drug use, which many of them think is somewhat cool, is strongly implicated in the development of mental health problems—which everyone would agree are deeply uncool.

Similarly, I consider it highly appropriate for the Government to fund information campaigns such as Time to Change, which the noble Lord, Lord Patel, just referred to, which address the stigma of mental ill health. This deters many people from coming forward for treatment when problems are at an earlier and possibly more manageable stage. Stigma has to be seen alongside the second area of social factors, which include isolation and loneliness, unsupportive and hostile communities, poor housing, inadequate healthcare, financial poverty and sexual or racial discrimination.

The risk of psychosis among Black African-Caribbean groups is seven times higher than among the general population. They are more than twice as likely to commit suicide and three times more likely to be admitted to hospital. They are more than 40% more likely to be sectioned—in other words, detained without their consent under mental health legislation.

Prevention of hospitalisation is a worthy goal for financial as well as therapeutic reasons. I will describe how voluntary sector organisations can do just that. Recent polling found that, of those with experience of hospitalisation, more than half did not feel the settings and facilities aided recovery; 44% felt that the treatment they received was fairly or very ineffective; and 14% felt very unsafe. People who feel unsafe in hospitals are not necessarily simply nervous types. I have heard how returning soldiers with post-traumatic stress disorder consider UK hospital settings more dangerous than the Iraq or Afghanistan front line. It should not be possible to spend one’s days in a mental health ward, hunched up on the floor against the wall, alone with one’s troubling thoughts, while nurses busy themselves with bureaucratic tasks. One study found that only 16% of patients’ time was passed in what is loosely termed “therapeutic interaction”. The remaining 84% was characterised by a distinct lack of purpose.

I understand how much pressure mental health professionals are under. The Mental Health Act Commission found that nurses were unhappy about being too busy to develop therapeutic rapport with patients. The commission concluded that all hospital wards caring for detained patients should ensure that they have “protected engagement time” with nursing staff. I endorse that recommendation. Everyone needs to feel that they are significant, that they are worth spending time over and that they belong.

This leads me to a third category of psychological factors. These include insecure attachment to parents in infancy, sexual or physical abuse in childhood, inadequate, neglectful or abusive parenting and being bullied or harassed—in other words, continually feeling unsafe. This is possible even in the workplace, because of one’s own line manager. Bereavement, lack of any close confiding relationships and family breakdown are also factors. I keep promising myself that I shall give a speech in your Lordships’ House in which I do not mention family breakdown. It is getting very difficult to do that because of its myriad, knock-on effects.

There is a strong evidence base about the impact on a child of losing one parent, which sadly goes beyond the financial or emotional and reaches into the heart of this debate. According to Professor Richard Whitfield, for a child to surface, somebody needs to be crazy about them. Morgan and Fearon, researchers at the Institute of Psychiatry, found that family breakdown and early separation from a parent had a clear effect on rates of psychosis in the African-Caribbean population, where there is a higher likelihood of growing up without both birth parents. Insights such as these make it even more imperative that we address family instability, which affects poor communities of whatever ethnicity particularly badly.

Honesty requires us to admit that one’s birth family can be at the root of mental health problems. The first onset of mental health problems is commonly in childhood or adolescence. Half of all lifetime cases have started by the age of 14. A prevention agenda has to make parenting support a major priority. There is a great prize in helping families repair and its members become a resource to each other. Families can also be at the heart of the solution. Recent polling found that more than half the people with mental health difficulties received “a lot” of help and support from their families. This was more than those who cited their GPs and three times as many as those citing psychiatrists. We urgently need better family functioning to be included in the national Public Health Outcomes Framework. This would mean that local authorities had to ensure that couple support and family therapy were offered as standard—for example, in the family hubs for which I am pleased to hear there is growing cross-party support.

There must also be greater recognition of the role that supportive communities can play because not everyone lives in a family. The black-led churches are on the front line of preventing mental ill health. Organisations such as the African Caribbean Community Initiative in Wolverhampton are helping to keep many black people out of hospital by inspiring confidence in mental health professionals that their patients are safe in their hands.

That is what we all need for well-being and good mental health—reliable relationships, whether in families, the workplace, healthcare settings, faith communities or during our retirement years. The Government have a clear role to play by pursuing policies that will strengthen rather than undermine these relationships and the innate desire and ability that people have to look out for one another. I am my brother’s keeper.