Health: Mental Health Strategy

Lord Patel of Bradford Excerpts

Monday 14th February 2011 Lords Chamber

[Lord Patel of Bradford]

My Lords, I, too, add my thanks to the noble Baroness, Lady Murphy, for calling this timely and important debate. As some of your Lordships will be aware, I have a keen interest in the subject of mental health, having been chairman of the Mental Health Act Commission for a number of years prior to its transfer to the Care Quality Commission. Also, as a researcher and service manager, I have a long history of working to improve experiences and outcomes for mental health service users, carers and families, especially those from black and minority-ethnic communities. I therefore welcome the Government’s strategy, which places experience and outcomes at its heart.

However, despite the excellent approach this strategy represents, there remain some areas that I feel should receive greater attention, especially with respect to the mental health experiences and outcomes of black and minority-ethnic service users. For example, I was disappointed to see that the proposed outcomes and the action plan appear to contain little on tackling inequalities with respect to ethnicity, especially given the emphasis placed on reducing stigma and discrimination, which is often compounded by issues such as racism, the high levels of fear and the lack of understanding among so many black and minority-ethnic communities. I shall raise two issues in this respect: first, how the funding for mental health services will be protected as a whole; and, secondly, how the new mental health strategy will ensure that the full range of data and information on ethnicity and mental health is used to the best effect.

I start with protecting the financial investment that I believe is vital, in light of the sweeping reforms to the NHS and the cutbacks across the public sector services. The Government have acknowledged that making cuts to mental health is a false economy, storing up problems in the long run with costly consequences. These consequences can be even more devastating for those communities that already face the burden of inequality and discrimination. While I am pleased to see the commitment to £400 million of investment for early intervention services, I, like the noble Baroness, Lady Murphy, and the noble Lord, Lord Newton, would like to see more on ensuring that that money is actually spent on the intended services and does not become a casualty of the severe and increasing pressures that we know local health and social care authorities currently face.

This is, however, not just an issue of money, as the proposed changes in the Health and Social Care Bill over commissioning are a source of particular concern, especially among many of those who work in mental health. There is enough evidence, as the noble Baroness, Lady Murphy, already said, from the experience of PCT-based commissioning to give serious pause for thought over whether GPs—whether in consortia or through commissioning agencies—will have the appropriate knowledge, experience and planning skills to ensure adequate mental health provision, particularly in specialist in-patient services. The increased focus on contestability could also mean the end of some of the more specialist services that we now have.

What assurances can the Minister give that mental health funding will be protected at local levels and what specific actions will be taken in the strategy to ensure that commissioning is appropriate and expert in relation to mental health? For example, can the Minister assure me that GP consortia will be subject under the Equality Act 2010 to the public sector equality duty?

Secondly, although the strategy highlights the importance of collecting and monitoring information on ethnicity and culture at local levels and how it can be better used to inform commissioning and service delivery, there is no reference to the importance of existing data sources, such as the Count Me In census. I must declare an interest as the original architect of the Delivering Race Equality in Mental Health programme, including designing the Count Me In census. Therefore, having been involved in the set-up of the Count Me In census, I am very concerned by this omission and by the continuing delays in publishing these vital data. They are almost 10 months overdue. This is at a time when we know from the most recent findings of the mental health minimum data set that:

“The proportion of inpatients who were detained during the year rose across all ethnic groups, but this was particularly noticeable for the Black group, of whom 66.3 per cent were detained in 2009/10 (compared with 53.8 per cent in 2008/09)”.

We also know that black and minority-ethnic patients are even more disproportionately represented, albeit by a small margin, in community treatment orders, something I warned could occur when these new orders were introduced if they were not accompanied by action to address the existing levels of discrimination and imbalances in representation in the mental health system. Against these disproportionate rises in numbers of black people subject to the powers of the Mental Health Act, the evidence and information provided by the Count Me In census is more important than ever. What specific actions will be taken under the strategy to ensure that the full amount of information on ethnicity and other equality strands is published and used to inform local planning and service delivery?

In summary, while there is much in this strategy to be recommended, and the overall approach is one I strongly endorse, the devil, as they say, is always in the detail, and it is the detail that we currently lack. I hope that the Minister will be able to provide some of that detail in answering my questions, and I also hope that we will see this strategy develop in a way that truly improves mental health services and well-being for all communities.