Psychological Therapies

Debate between Luciana Berger and Seema Malhotra

Wednesday 16th October 2013 Westminster Hall

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

Sir Edward, it is a pleasure to serve under your chairmanship this morning.

This has been a thoughtful and important debate on a subject that is not talked about nearly enough. Every day in Britain, people of all ages and backgrounds, and from all communities, have their lives blighted by the spectre of mental illness. Theirs are some of the great untold stories of our society. As many hon. Members have already said, the issue of mental health has been swept under the carpet for too long. One in six people are afflicted by mental illness, but all too often they are scared into silence. That is why this discussion is so important.

I also congratulate the hon. Member for Halesowen and Rowley Regis (James Morris) on securing this debate and on the campaigning that he has done on this issue. In addition, I thank him for giving me the opportunity to talk about mental health in my first debate as Labour’s newly appointed shadow Minister with responsibility for public health.

This debate is even more timely because of the news that we have heard on the BBC this morning, to which a number of hon. Members have already referred. Dr Baggaley, the director of medicine at South London and Maudsley NHS Foundation Trust, has said that our mental health services are in “crisis”, following the news—after the BBC made freedom of information requests—that in a little more than two years we have seen the loss of 1,700 mental health beds. I note that the Minister of State, Department of Health, who is the Minister with responsibility for care, said this morning that the situation is “unacceptable” and that the provision must improve. I hope that the Minister who is here in Westminster Hall today will refer to that when he responds to the debate.

We have heard a number of valuable contributions this morning. In responding to the excellent points that have been made, I will cover three broad themes: first, I will reiterate the importance of early intervention; secondly, I will talk about the improving access to psychological therapies programme, including some specific issues about how IAPT needs to work better; and thirdly, I will talk about what we need to do beyond IAPT.

Let me begin with early intervention. As hon. Members have already said, the long-term consequences are clear if we do not tackle mental illness early; indeed, we can already see those consequences right across our society today. We can see them in the workplace, where mental illness is the largest single cause of long-term sick leave; we can see them in our criminal justice system, where 70% of those in our prisons have a mental illness; and we can see them in our economy, where mental ill health costs Britain’s businesses £26 billion every year, or £71 million every day. Also, in our health service, according to the London School of Economics the physical health care necessitated by mental illness costs the NHS an extra £10 billion each year. All those points show why the case for action could not be any clearer.

I am sure that, like myself, many hon. Members will have had experience of constituents coming to them for assistance; indeed, several hon. Members have referred to those experiences in their contributions to the debate. Constituents come to us in deep distress and dire circumstances. However, many of those situations could have been avoided if those people had received specialist treatment for mental illnesses at a much earlier stage. I echo the hon. Member for Halesowen and Rowley Regis, who said that it is absolutely crucial that we look at this issue of early intervention.

That was why in 2007 the last Labour Government launched the IAPT programme, which helped to make respected and evidence-based therapies available to more people than ever before. As we heard in the hon. Gentleman’s opening speech, thousands of people have been helped on that programme so far. Since then, the current Government have continued the programme and extended it to cover more people, which is a welcome step. However, as this debate has made clear, IAPT is still a developing scheme, with areas that are in need of much improvement. So, my second theme is to focus on those areas that require attention, and I would be grateful if the Minister could address them in his closing remarks.

There are three areas in particular that require attention. The first is funding. Spending on IAPT has increased from zero in 2008-09, when the programme was first launched, to £214 million in 2011-12. The Department of Health has also allocated £54 million to improve access to therapies for children and young people, which is a good step. However, it must be noted that Ministers always pledged that IAPT funding would be additional funding and would not replace existing psychotherapy services. Despite those assurances, non-IAPT therapy services have been cut by more than 5%. Funding has fallen from £185 million in 2009-09 to £172 million in 2011-12. What makes that even more worrying is that overall mental health spending has been cut in real terms for the second year in a row.

That real-terms cut has particular resonance when it comes to the second area that requires attention, which is waiting times; again, waiting times have already been mentioned by hon. Members during this debate. NICE’s aim is that patients receive access to evidence-based therapies within 28 days of referral. It is regrettable that this debate falls the day before the latest programme statistics are published. According to the latest figures, however, which are for 2012-13, more people are having to wait longer to start receiving treatment for anxiety or depression.

[Seema Malhotra]

My hon. Friend makes very important points about waiting times and how they have continued, and also about the cuts to services. Given that the number of university students seeking counselling has risen by a third in the last four years, does she agree that it is important to recognise the impact that the drop in funding could be having on vulnerable students, sometimes forcing them to leave university, which can affect the rest of their life? With the number of students in that situation increasing and without data for average waiting times, we must recognise the importance of early intervention and very fast response.

[Luciana Berger]

I thank my hon. Friend for that intervention, and she raises an important issue. There are lots of different groups of people who do not have access to these sorts of services or who have to wait a disproportionate amount of time to access them. We have already heard hon. Members talking about older people who might not be able to access the IAPT programme, and my hon. Friend refers to university students, who do not necessarily fall into the category of children and young people, but who, as young adults, are struggling with leaving home and with financial pressures.

I have not seen any direct research about what effect the current cost of living crisis is having on our population—I hope that there will be some research into that issue—but my experience from my case load as a constituency MP indicates that we have a problem in our society regarding the pressures of life. More people are having to access these services and therefore the services should be available, which makes the issues of waiting times even more relevant.

More than 115,000 people had to wait more than 28 days from referral until their first treatment or therapy session, which was a 19% increase from the previous year. The hon. Member for South West Bedfordshire (Andrew Selous) made the point that this issue is not only about the statistics but the people behind the statistics, who have to go through the trauma of waiting for treatment and suffering the uncertainty of not knowing when it will come.

On Monday, someone contacted me to say that they had been waiting for a year and a half for cognitive behavioural therapy in the Wirral, on Merseyside, and just this morning on BBC “Breakfast”: there was a woman who was interviewed who had had to wait 17 months for talking therapies treatment. Eventually, she had to be sectioned as her condition deteriorated while she waited for treatment. These cases are not unusual— there are too many cases like them—and it pains me to learn of them. According to a report produced by the We Need to Talk coalition of mental health charities and royal colleges, one in five people have been waiting for more than a year to receive treatment. However, the same report found that people who receive treatment within three months are almost five times more likely to be helped back into work by therapy than others who have to wait for one or two years. As another person wrote to me this week, even a six-week wait can seem a whole lot longer if someone is clinically depressed. Just as we focus on waiting times for cancer treatment and other examples of physical care, we must do the same for mental health therapies.

I will repeat the commitment, which my right hon. Friend the Leader of the Opposition made a year ago, that the next Labour Government will rewrite the NHS constitution; that we will strengthen the rights that it grants to patients; that we will create a genuine parity between mental and physical health care; and that we will set down a new right of access to the therapies that we have been talking about this morning. That will mean that mental health patients will be entitled not only to drugs and other medical treatments but to psychological therapies, and they will have the same guarantees on waiting times, professional advice and patient experience.

However, in addition to how long it takes to receive treatment, we need to examine the range of therapies that are available in the first place, which brings me to my third broad theme; again, it is a theme that has been already been referred to by other hon. Members, but it is important to reinforce it and to ask the Minister to respond to it. Different people are affected by different mental health conditions for all sorts of different reasons. That is why we need diverse mental health provision, with a range of therapies, to cater for people with different needs, preferences and personalities. As the hon. Member for Halesowen and Rowley Regis said, only five types of therapy are currently available via IAPT. Moreover, 90% of IAPT funding has gone towards cognitive behaviour therapies, with limited support for other modes of therapy. The United Kingdom Council for Psychotherapy has described this as an

“overwhelmingly manualised and brief approach to therapy that sits at odds with the professional practice of the majority of leading psychotherapists and counsellors.”

We need to look at going beyond basic therapies that help people go about their day-to-day lives more adequately. There needs to be appropriate room for more intense and longer term psychological treatments, so that the underlying causes do not go unaddressed.

The hon. Member for South West Bedfordshire mentioned the need for couples therapies. The hon. Member for Halesowen and Rowley Regis also talked about older peoples’ problems with accessing treatment.

There is a patient choice issue, too. According to a survey of 500 service users by Mind, only 8% of people had a full choice about which therapy they received and just 13% had a choice about where they received therapy. The 8% who had full choice of therapies—a very small number—were, on average, three times happier with their treatment and five times more likely to say that therapy had helped them back into work. As the programme develops, we need to do all we can to ensure that it caters to people’s individual needs.

What needs to be done beyond IAPT? As welcome as IAPT is, we have to remember that the programme currently only aspires to be available to 15% of the population. The programme’s three-year report, published last November, shows that it is currently delivering 45% recovery rates and aims to reach 50% by March 2015. The big question this raises is, what about the other 50% to 55%—the 50% who continue to suffer from conditions, having gone through the IAPT process, but are not eligible for more intensive psychotherapy services under the stepped care model? That question, and this debate, requires an answer that goes far beyond the IAPT programme. It requires ending the artificial dividing lines in our NHS and pursuing a whole person, fully integrated approach to mental, physical, social and care issues, as Labour has indicated, and it demands a complete revaluation of how we, as a country, think about and approach mental health. That is what Labour’s mental health taskforce is looking at, under the expert leadership of Stephen O’Brien, the chair of Barts Health NHS Trust.

General mental health support should not start in hospital or the treatment room. It needs to start in our workplaces, our schools and our communities, even across our kitchen tables and in the conversations we have with one another. There is no reason why we should not be able to talk about mental health and psychological therapies in the same way we do about access to sexual health services, vaccinations or cancer treatment, but we have a long way to go.

I look forward to the Minister’s response. I hope that he will respond to my questions and issues raised by other hon. Members. Returning to my opening comments on today’s news about the crisis in mental health provision and the reduction in the number of beds, the point of our debate is access to services that would prevent people from going into those beds in the first place. However, we hear today that bed capacity is at 100%. I hope that the Minister will mention those issues as well, because they are interlinked.