Mental Health and Well-being of Londoners

Luciana Berger Excerpts

Thursday 12th February 2015 Commons Chamber

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I thank my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) and the other sponsors of this debate for ensuring that the House can discuss such an important issue. I also thank hon. Members on both sides of the House for their contributions, which are testament to how much mental health is a vital challenge, not just in London but across the country.

In recent years we have seen a growing appreciation that mental health is just as important as physical health in ensuring the well-being of the population. Almost three years ago my colleagues in the House of Lords tabled amendments to the Health and Social Care Bill on parity of esteem between mental and physical health. As this debate has shown, however, there are challenges in how that measure is put into practice.

Since then, mental health has risen up the agenda as more evidence emerges not only of the scale of mental health illness, which affects one in six of us at any one time, but of the huge costs involved. In London, meeting the mental health needs of the large and diverse population poses a challenge, and it is welcome that tackling the cost of mental illness has been identified as a priority by the London Health Board. Of course the challenges are significant. In London almost £7.5 billion is spent each year addressing mental illness, while the wider health, social and economic impacts of mental illness cost the capital an estimated £26 billion.

As we heard from my hon. Friend, the pressures that mental health services face across the country are being acutely felt in London. Last week the Care Quality Commission published a report that found that last year the mental health in-patient system was again running over capacity. By the last quarter of 2013-14, the number of available mental health NHS beds had decreased by almost 8% since the first quarter of 2010-11. That is putting mental health professionals under extreme pressure, and more vulnerable people have to travel hundreds of miles to get the treatment they need, or they are getting no treatment at all.

I have had the privilege of visiting many fantastic services across the country and in London, such as the Channi Kumar perinatal unit at Bethlem Royal hospital, the Camden psychotherapy unit, and most recently the mental health service users group, the Lancaster Centre in Enfield. In response to the right hon. Member for Uxbridge and South Ruislip (Sir John Randall), I should say that I have also visited Dagenham council, which is training 1,000 front-line workers in mental health first aid. That is an example we can all learn from.

I have seen at first hand the pressures our mental health professionals are experiencing. They are working extremely hard in very challenging circumstances. I would be very interested to hear the Minister’s immediate plans to ease the pressure on in-patient mental health services in London. I think the key question we should be asking is why so many people in London need in-patient mental health care in the first place. Could it have anything to do with the fact that mental health spending has been cut in real terms for the first time in a decade? There are thousands fewer mental health nurses and hundreds fewer mental health doctors now working in the NHS. Is it because of the fragmentation of commissioning across our health service since the introduction of the Health and Social Care Act 2012?

My hon. Friend rightly talked about the pressures on child and adolescent mental health services in London. The right hon. Member for Uxbridge and South Ruislip said that we do not talk about this issue, but I challenge that. In recent weeks, we have seen front pages of newspapers covering this specific issue. I echo the concerns raised by my hon. Friend that the CAMHS budget has been cut in real terms by £50 million a year since 2010. We have seen other false economies, such as: cuts to early intervention and psychosis services; a reduction in the number of social workers; and the decimation of the early intervention grant, which we know is putting so much pressure on in-patient services.

Just today, I received a letter from the Danshell Group, an organisation that provides 20% of CAMHS provision across the country, including in London. It wrote to me because it is very concerned about the state of CAMHS, particularly in London. The contract they have been offered by NHS London for the next financial year will see a 40% reduction in the number of CAMHS beds it can offer, down from 26 to 16. NHS London has said this is because of its “financial envelope”. This reduction will have a very real impact on many young people. The provider is already forced to reject more than 30 patients every month. Its concern, which I share, is that these young people will end up in A and E, have to go to medium secure facilities if no low secure facilities are available, or be sent home because there is nothing or nowhere that can help them. This is simply unacceptable and cannot carry on.

In addition to the 50 extra beds NHS England has commissioned across the country for CAMHS, I am keen to know what steps the Minister is taking to address the bed shortage in London and across the country. The letter I received said that NHS London is going to reduce the number of beds even further. This is a very particular and significant concern. At least one in 10 children is thought to have a clinically significant mental health illness, which equates to 111,000 young people in London. The impacts of childhood psychiatric disorders cost London’s education system approximately £200 million a year. For people to be presenting at hospital, particularly to specialist mental health services, means their mental illness has usually become much more serious. Waiting until that point to address problems is not only worse but more expensive too, as it requires more specialist health care from other services.

We need more focus on prevention and promoting good mental health. The principle of prevention has long been the driving force behind public health policy for physical health, but there is no comparable body for public policy interventions for mental health. Will the Minister share with the House what actions she and her Department are taking to ensure we are doing everything we can to prevent mental illness in the first place?

My hon. Friend referred to the distinct challenges London faces, particularly in relation to mental health. I note that she uses “well-being” in the title of today’s debate. This is not all about mental illness. London has the UK’s highest proportion of the population with high levels of anxiety. Nearly half of Londoners are anxious, and almost a third report low levels of happiness. Life satisfaction and feelings of worth in London are lower than the national average.

Mental health is shaped by the environment in which we live our lives and for most people that is not in the NHS, but in our homes, communities, schools, colleges and workplaces. These institutions can help or harm mental health, sometimes quite profoundly, and this is particularly true for Londoners, who experience stark and unacceptable differences in well-being and length of life. If we can begin to address these basic and too-often-ignored problems in the capital, we can begin to unburden ourselves of both the moral and economic costs of mental ill health.

I want to deal with the issues raised by hon. Members. On poverty, insecurity and disadvantage, there is a social gradient for many types of mental health, such as depression, with those in lower income groups more likely to experience them than those in higher income groups. The incidence of mental illness varies sharply between boroughs in London, with some mental illnesses twice as common in deprived parts of London as in the least deprived. We have heard today how Government policy can be a major factor, and the National Housing Federation estimates that one in seven households affected by the bedroom tax is now at risk of eviction. Given the cross-cutting nature of these challenges, I am keen to hear what steps the Minister is taking to ensure that all Departments take mental health into account when developing policy. We are concerned that the Cabinet Sub-Committee on Public Health, which brought together all those cross-cutting Departments, no longer exists.

We are keenly aware that we are in the midst of a housing crisis, but this is particularly acute in London. In all but two of London’s 33 boroughs, at least one in 20 people are on council waiting lists, and across London as a whole more than one in 10 are on waiting lists. Behind these shocking statistics, however, are thousands of families living in overcrowded, temporary and often poor-quality private rented accommodation. The impact on family life, and the life opportunities particularly of children, is huge. My hon. Friend also referred to the spiralling costs of housing. The average rent in London is well over £1,000, which has a significant impact on many families. Poor housing, overcrowding, insecurity and lack of access to community facilities can have a harmful impact on mental health as well. Will the Minister tell us what actions she is taking nationally to ensure that health and housing needs are considered together by both service commissioners and providers?

My hon. Friend rightly raised the particular experience of the black, Asian and minority ethnic communities in London. People from BAME communities in the UK are more likely to be diagnosed with a mental illness. For example, they have a threefold increased risk of psychosis, and for black African and black Caribbean groups, this rises to a sevenfold increase. It is completely unacceptable that people from BAME groups living with mental illness are more likely to experience poor outcomes from treatment. There is so much work to be done to tackle these inequalities, particularly in a city as culturally diverse as London. What steps is the Minister taking to ensure that mental health services are culturally relevant to service users?

The previous Government’s action plan on BAME mental health, “Delivering Race Equality in Mental Health Care”, ended in 2010 and has not been renewed or replaced. We believe we need a renewed focus and leadership on tackling race inequality in our mental health services. Does the Minister have a plan for a new national strategy to tackle race inequality in our mental health services and to ensure improved outcomes for BAME communities? My hon. Friend also rightly raised the particular challenges of the lesbian, gay, bisexual, and transgender community in accessing mental health services, and I hope the Minister will address that too.

My hon. Friend the Member for Islington North (Jeremy Corbyn) raised the serious issue of the recent INQUEST report into the deaths of people in treatment or in-patient care. Anyone who saw the “Newsnight” report this week will have been very concerned, and again I would be interested to hear from the Minister about that.

[Jeremy Corbyn]

Would my hon. Friend support an investigation, on the basis of the INQUEST report, with a view to changing the regime of inspection, inquiry and appeal where there are tragic deaths in custody? She must be aware, as must the rest of the House, that many people in mental health institutions are completely alone, never get any visitors or support and are at the mercy of what we, the state, are prepared to provide and do for them.

[Luciana Berger]

I thank my hon. Friend for his important intervention, and for raising the point earlier. It is right to look at this issue. It is very clear from the report that INQUEST has outlined and provided that many serious challenges have not been addressed. Part of the challenge is that people find themselves isolated because they are placed in care and treatment, which can be hundreds of miles away from their homes, families and support structures. This means they are less likely to have visitors. Seeing the footage of one family’s experience—of their child’s in-patient care and the quality of her surroundings—was frightening. I hope that the Minister will address this specific report and share with us what the Government intend to do to look at the issue a lot more closely.

We have heard today that mental health is one of the most unaddressed health challenges of our age. Mental health services across our country are increasingly facing significant challenges, and as we have heard today these pressures are being acutely felt in London. Meeting the mental health needs of London’s population is critical to ensuring the future health and economic sustainability of the capital. In order fully to tackle these pressures, we must end the false economies and the stripping back of preventive and early intervention services that we have seen under this Government, and achieve a new focus on prevention and early intervention. I look forward to the Minister’s response.