Depersonalisation Disorder: NHS Treatment

Debate between Lyn Brown and Jackie Doyle-Price

Tuesday 12th March 2019 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Mr Gray. It is also a great pleasure to respond to the debate brought by the hon. Member for West Ham (Lyn Brown).

As the hon. Lady says, we have met to discuss this before, and I too extend my thanks to her constituent Jane, who has been incredibly courageous, despite living with a condition that is profoundly distressing for her to manage, in none the less using that in such a positive way. Frankly, the most important thing we can all do is to raise awareness of this disorder, and she is doing that beautifully and is incredibly articulate in how she does it. I pay absolute tribute to her; she has certainly put the disorder on my radar, so I am delighted to have the opportunity to discuss it in the House and do our bit to raise awareness, because, as the hon. Lady has mentioned, eight to 12 years before getting a diagnosis is not good enough.

The reason people wait so long is that this is a disorder that is not understood, but it is also fair to say that many personality disorders are misunderstood. We tend to lump mental ill health and disorders together, but they require to be treated in very different ways. Often, when it comes to disorders, medication is not the best solution, so it is important that we get diagnosis right and the way we will do that is by raising awareness of what is, as the hon. Member for Strangford (Jim Shannon) said, a very common condition. Many of us may have had out-of-body experiences when we are going through something unpleasant, because that is how the body naturally copes with trauma, but when people are going through sustained trauma, as many sufferers of DPD have, it becomes a way of dealing with life.

The worst thing, as the hon. Member for West Ham highlighted, is that that can often be brought on by drug use. I do not think we should be squeamish about mentioning that. We have a debate going on about drugs at the moment that is all about, “We have lost the war against drugs; it is all done through the lens of crime and disorder.” The reality is that the extent of cannabis use in this country is contributing to our mental health crisis—of that I have no doubt—and I do not think we should be squeamish about saying it, so I am grateful to the hon. Lady for giving me the opportunity to do exactly that.

We must ensure we do better. Last year, I had the great privilege of chairing the women’s mental health taskforce, and I saw that we are seeing a greater scale of mental ill health being experienced by women between the ages of 16 and 24. We put trauma at the root of much of that, and we have a strategy to roll out much more trauma-informed care across the NHS, which I hope will also extend to raising greater awareness of this disorder.

The hon. Lady’s point about making GPs and practitioners more aware of this disorder during their training is very good. We—collectively, as a system—need to think what more we can do to educate the whole NHS about the difference between severe mental ill health brought on by other conditions, things that are brought on by, for example, trauma, and the whole issue of disorders. We should not just medicalise treatment through prescribing drugs but should put together wraparound support and care, giving people the tools to manage what are often debilitating conditions.

As I said, I greatly enjoyed meeting Jane and the clinicians from the South London and Maudsley NHS Foundation Trust last year, where I was given a compelling presentation. We need to explore this condition more, so that we get this right. Its triggers are poorly understood but may be related to previous trauma, as we have heard.

The hon. Lady asked for more support through CAMHS. A lot of this trauma starts and is sustained in childhood. An important tool in spreading awareness of this disorder will be the new children’s mental health teams that will go out into schools. We are looking for mental health leads within schools to refer children that they sense are having difficulties, so that we can intervene early to support them. We know that the longer people live with this ongoing trauma, the harder it is for them to manage. Without going into individual cases, because it is very distressing for the people involved, I am certainly aware of cases of adults now living with this disorder having gone through sustained trauma in childhood. We clearly need to find a way of dealing with that.

We have come a long way in breaking down mental health stigma and raising awareness of different conditions, but I repeat that there is a real lack of awareness about disorders. We now talk broadly about bipolar disorder or borderline personality disorder, but do people really know what they mean? I do not think so. We need to spin our education around that. As the hon. Lady mentioned, at the moment only one clinic specialises in this disorder. Partly because of the lack of awareness, it is fair to say that the research evidence on what works to treat this disorder is still at a very early stage. Obviously, the NHS will support further investment in those treatments based on evidence. We lack National Institute for Health and Care Excellence guidelines for the treatment of DPD. That must be on the do-to list.

Essential to that support will be finding out more about this disorder. This is a learning process for everyone, and people like Jane obviously contribute massively, but it is for clinicians and researchers to do their best and really get to grips with what will be required. I acknowledge the world-class work being undertaken at the Maudsley clinic, which is one of the leading research and clinical treatment units in the world for this condition. It has pioneered an incredible service, which Jane praised to the hilt for what it has done for her health. It really works to improve health outcomes for patients and is dedicated to expanding the understanding and treatment of depersonalisation through its research, which I encourage, because further research is vital to improving our understanding of the prevalence of this condition and its treatment.

The Maudsley clinic has successfully assessed more than 500 people since the inception of its service, which is amazing, but as 2% of people suffer from it, there is more to do. It also works closely with the research unit at King’s College London, which adds to that understanding. Clearly, waiting nine to 12 months for therapy after diagnosis is not good enough, so I am pleased to say that the Department held an initial roundtable meeting at the end of last year to hear about the work of the service provided by the trust and to discuss current research into those treatments and suggestions on NHS management of the condition. We look forward to taking that work forward. We also discussed options for next steps with the Maudsley clinic, including its applying for a development grant from the mental health policy research unit of the National Institute for Health Research.

I understand that the team at the specialised unit at the Maudsley clinic has faced challenges in acquiring such funding in the past. It is tricky: we need evidence to get the money for research, but money for research is needed to feed the evidence. I completely understand that. However, I say to the hon. Lady that the Department’s research team will discuss with the unit the most appropriate type of research funding for it to bid for. Clearly, we want to make sure that we make the most of its expertise and expand our understanding of this condition. I hope that that brings some reassurance. I look forward to seeing further developments in this space.

[Lyn Brown]

As always, I am delighted by what the Minister has offered us, especially on research, which is fantastic. I thank her for that. However, I would not be me if I did not press her on the three things on my list that she has not mentioned—writing to the presidents of the Royal College of General Practitioners and the Royal College of Psychiatrists, introducing a programme of training for mental health trusts and improving access to treatment for under-18s. I am happy for the Minister to write to me on those.

[Jackie Doyle-Price]

I would like to take that away and discuss with the NHS clinical lead how best to do those. I agree with the hon. Lady, but I will look at this in the broader context of disorders and really getting that understanding of severe mental health conditions and ongoing disorders, which need different tools. However, I will write to the hon. Lady, and I know that we will continue to have dialogue on this issue.

In conclusion, I readily acknowledge that there is still a lot of work to be done to support people with this disorder and to help them to make a full recovery with treatment and support. I assure the House that that is very much on my to-do list. I look forward to having further dialogue with the hon. Lady and Jane, who I wish every success in managing her condition. I hope I have provided sufficient reassurance that we are committed to doing what we can for these people.

Question put and agreed to.

NHS: Hysteroscopies

Debate between Lyn Brown and Jackie Doyle-Price

Tuesday 11th December 2018 Westminster Hall

[Jackie Doyle-Price]

I give way to the hon. Member for West Ham.

[Lyn Brown]

I am really grateful to the Minister for her response thus far. I have found her, to be honest, to be the only Minister I have been able to have proper conversations with about such issues who has understood them. I am grateful. However, I honestly believe that we need to do something about the fourth ask. I am a fairly strong woman, but even I was in such a position: I had requested a hysteroscopy with general anaesthetic, but the hospital spent an hour of its time trying to talk me into having one without anaesthetic. I am in a high-risk category of being an older woman and of not having had a child, but I had to beat off the medic who was trying to use every piece of emotional blackmail that she could to get me to agree—the cost to the NHS, taking up resources, the possibility that I had cancer or of a long wait, and so on. It was an uncomfortable conversation. If we do not get rid of the perverse financial incentives, even women as strong as me will be browbeaten.

[Jackie Doyle-Price]

I thank you, Mr Howarth, and the hon. Lady for the generosity of allowing me to recover myself. We can tell it is December, because we all have colds—thank you very much.

In the short time I have left, I will address the specific issue of the tariff and the possible incentives, which I know the hon. Lady is particularly concerned about. She is right that there is a best practice tariff that incentivises care in a day-case setting with no anaesthetic, just pain relief. That tariff is agreed with the Royal College of Obstetricians and Gynaecologists, but it is revising its guidance. I want to engage the hon. Lady and the campaign group in that process through the women’s health taskforce, so that we can all satisfy ourselves that the guidance is appropriate. She is absolutely right: if someone such as her or me—women Members of Parliament—cannot look after ourselves, neither can anyone else, and I have heard many tales of people often feeling diminished at the hands of the NHS. She and I have the opportunity to use our voices to ensure that women get a better deal.

I again thank the hon. Lady for all her work. I look forward to continuing to work with her to ensure that all women who face that procedure can do so with sensitive treatment and appropriate pain relief.

Question put and agreed to.