Health and Social Care Committee and Education Committee

Debate between Luciana Berger and Lisa Cameron

Thursday 10th May 2018 Commons Chamber

[Luciana Berger]

I thank my hon. Friend for his comments. While we did not talk about that explicitly in our report, we were able to have an informal discussion with young people from across the country, including young people being cared for by Place2Be, a mental health organisation that supports young people in schools. Young people said they were turning to illegal medication or prescription medication that they were getting through illegal means to make themselves feel better. That is clearly an issue for our young people. I know that my hon. Friend has raised that in the House, and I hope the Government will look specifically at it.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I would like to thank members of both Select Committees for this very forthright report. I was pleased to be part of the inquiry, and I would particularly like to thank the hon. Lady for bringing the report to the House. It is one of the most important reports for the next generation.

I want to raise two particular points. The first relates to workforce planning. As chair of the all-party parliamentary group on psychology and as a psychologist, I was very concerned by the evidence that educational psychology training places are being reduced and clinical psychology training places are currently inadequate, despite the fact that the Government’s delivery of the strategy relies very much on supervision from those key professionals. Secondly, we need to be targeting complex groups where more than one difficulty is present, such as the many children with autistic spectrum disorder who also suffer mental health problems comorbidly. Much more must be done on access to autism diagnosis alongside treatment and early intervention for mental health issues.

[Luciana Berger]

I thank the hon. Lady for her important contribution, which emphasised the need to focus on the workforce that the Government are expecting to deliver their Green Paper plans. We know that Health Education England is due to publish in July this year its workforce strategy, and I sincerely hope that it has listened to the points we heard in the Committee and those that she just made about the massive gap that exists in terms of psychologists and child psychiatrists in the community. That is a critical issue.

On the hon. Lady’s point about comorbidities, there is a gaping hole in the Government’s Green Paper on the children who are the most vulnerable and need the most support. There are references to children from the most vulnerable backgrounds, but nothing in practice about how that might be addressed. I hope that, in the Government’s response, they will reflect on our recommendations and seek to bring forward proposals that target children who most need support.

Autism Community: Mental Health and Suicide

Debate between Luciana Berger and Lisa Cameron

Thursday 30th November 2017 Commons Chamber

[Dr Cameron]

I wholeheartedly agree. As I said, the police are on the frontline. They face the crux of the matter when it comes to matters of life or death. They are doing their very best with the training and resources that they have, but there requires to be a clearer pathway so that people who are at that crisis stage can access health services—and probably crisis health services—and so that the police have somewhere to ensure that the clinical needs of those people are met. It is unfair for our police to have to take care of people’s clinical needs when that is not what their training provides for.

In 2016, an academic study in Sweden, which was published in the British Journal of Psychiatry, found that people with autistic spectrum disorder were nine times more likely to die by suicide than the rest of the population. The latest research indicates that people with autistic spectrum disorder account for a harrowing proportion of suicides in the UK. There is a 16-year gap in life expectancy between people with autistic spectrum disorder and the general population. To put it all very bluntly, people with autistic spectrum disorder are 28 times more likely to consider suicide than the average population —28 times. The statistics make one thing abundantly clear: what we are doing now to support people with autistic spectrum disorder is not working and is not enough. Research shows that almost seven in 10 people with autistic spectrum disorder experience mental health issues, including anxiety and depression. Services must be in place to ensure that people are cared for holistically. We have to meet all their clinical needs, which may mean their autism or their learning difficulties, but they will almost certainly have mental health issues. Quite frankly, we do not have services in place today that take account of the complexity of such needs.

What types of things are going wrong for people at the frontline? It is difficult for people with autistic spectrum disorder to access mental health support through the usual routes. For most of us, that might mean going to our GP as a first point of contact for primary care for mental health problems, but a GP practice is a daunting, unfamiliar place for people with autistic spectrum disorder. One young man wrote to me and described a recent trip, saying that it was

“quite hard for me to access the GP anyway. The whole environment is difficult. It’s noisy, there’s often children, it’s very hot. There’s also a loud beep when they call the next person that I find really quite painful. When you’re feeling emotionally poorly that becomes almost impossible.”

GP surgeries make reasonable adjustments for wheelchair users every day—simple changes that make the life of the patient easier—so the same policies should be implemented for people with autistic spectrum disorder. We need training to raise GP awareness. Access needs to be easier. We need to ensure that GPs know who on their register has a diagnosis of autistic spectrum disorder.

If an autistic person bypasses the GP and goes straight to mental health services, they may face unprecedented waiting times or they may simply be refused treatment. When individuals do attend services, they may find that they are discharged without any follow-up. At the Health Committee last week, we heard how a young autistic boy was turned away by child and adolescent mental health services four times, despite feeling suicidal, because he had not yet attempted to take his own life. Things have hit crisis point, and we need to ensure that we engage in prevention. Someone attempting to take their own life should not be the point at which they receive treatment. We need early intervention to pinpoint the symptoms of difficulty and where we should be aiming the treatment.

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

I thank the hon. Lady for securing this very important debate. We both sit on the Health Committee, and during the inquiry into suicide prevention we heard that the point at which someone is most likely to take their own life is, tragically, when they are discharged from in-patient care. The Committee’s recommendation was that everyone should be contacted within at least three days, and we are waiting for the Government to respond that. Does she agree that everything should be done to ensure that the most vulnerable, including people with autistic spectrum disorder, should be supported in that period when they are extremely vulnerable to ensure that they do not take their own life?

[Dr Cameron]

I agree. That is an extremely valid point. If people arrive at A&E for crisis intervention and are admitted for a period of time, it is important that they are discharged with some follow-up. People often return to the same circumstances that led to the difficulties in the first place, and if they do not have some support to deal with those difficult circumstances, they may be in a vulnerable situation and may try to self-harm or take their own life once again.

If a person with autistic spectrum disorder feels unable to go to the GP or to reach out to services in their local community, they might try to ring a suicide helpline. However, that can be extremely difficult in itself for a person with autistic spectrum disorder who finds communication and social interaction difficult. They might be able to verbalise only some of their difficulties, and they may then find there is no follow up from that service, either. Early access points and early intervention are crucial to preventing suicide and preventing mental health problems being exacerbated. Much more has to be done at that critical early intervention stage to ensure access to services.

If a person with autistic spectrum disorder reaches a health professional, they often find that their mental health problems are overlooked or misdiagnosed, which might be because they present an extremely complex case. They might also have concomitant learning difficulties, and they might not present the symptomatology that would usually be expected for anxiety or depression per se because their symptoms are complicated by their autistic spectrum disorder. It is extremely important that mental health practitioners have training in autistic spectrum disorder, in the types of presentation that they might need to identify and, particularly, in risk issues.

Diagnosis is still a postcode lottery. I hope to continue working with the Minister on that issue, because we need an understanding of who is appropriately trained in diagnosis of autistic spectrum disorder and what level of specialty we have in different professions. What is the workforce plan to ensure that this very great need is addressed across our society? This is so important. People with autistic spectrum disorder say they do not know where to go locally. As a member of the Select Committee on Health, I have asked services about that, and they say, “We don’t really have a map of who can diagnose and who can provide specialist intervention in a given area of NHS England.” Streamlined services would make it so much easier for people to gain that initial access.

I do not want to take up the whole debate, so I will provide a brief overview before letting others speak. Many Members want to contribute to this important debate, but I wish to touch on a few other important issues.

I request that the Minister look at what mental health therapies work specifically for people with autistic spectrum disorder who have concomitant mental health difficulties. There is no adequate research base yet, but we know it is critical—it is lifesaving—so we need to prioritise funding. Traditional mental health therapies might not work in the same way for people with autistic spectrum disorder. If one of us presented at a GP surgery, we might be offered cognitive behavioural therapy, but we do not know whether that is the best option for a person with autistic spectrum disorder, or whether some kind of adapted therapy would be more appropriate. That important work should be undertaken, and undertaken quickly, to engage people in appropriate therapies and save lives.

I have been contacted by a couple of individuals whose poignant accounts have struck me. One is an individual from my constituency who says that she has continually tried to access CAMHS for her daughter, who has been repeatedly self-harming. It has placed the family in such a stressful situation over a lengthy period that the family, including the mother and carers, now feel that their own mental health is under stress.

It is extremely important that we ensure not just that individuals can access the system but that we preserve family life, that we support carers and families, and that we do not place an additional burden on the NHS and other services. Families and parents may go on to develop their own depression and anxiety when dealing with an intractable situation because they do not know how to cope. If we do not address the problem at its root, we will multiply the problem for services across the UK.