Autism Community: Mental Health and Suicide

Madeleine Moon Excerpts

Thursday 30th November 2017 Commons Chamber

[Dr Cameron]

I agree. Our police are on the frontline and they deserve the utmost respect for the work they do, but yes, it is correct to say that they require further training and also further support. There requires to be a clearer pathway when people exhibit challenging behaviours in the community, from the point at which the police are put into contact with them right through to the provision of adequate support in the health system, without their being caught up in the criminal justice system in between.

[Mrs Madeleine Moon (Bridgend) (Lab)]

The hon. Lady will be aware that the societal body that is most likely to come into contact with someone who is likely to take their own life is the police. The police, and particularly the British Transport police, are doing critical work in assessing how staff can be trained to identify potential suicides and to take action to take people back at a time of crisis in their life in order to prevent them from taking forward a suicide. We should not knock the police too much. They are doing fantastic work in this area.

[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.

--- Later in debate ---

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I add my thanks to my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron). I think I am the first person to pronounce the name of her constituency correctly. I am pleased once again to participate in a debate about autism, a condition that, as we all know, for too many years has not been sufficiently recognised or its challenges fully appreciated. That is starting to change, which is good news for all who are living with autism and who have been either not recognised or misunderstood for too long.

Autism is not a mental health condition, but autistic people are more likely to develop mental health problems such as anxiety disorders, OCD and depression. That is for a host of reasons, such as not being supported and experiencing social isolation. Research shows that a diagnosis of autism can lead to an increased risk of mental health conditions.

Support for those living with autism is very important, as has been widely recognised in the Chamber this afternoon. Anxiety disorders are very common among those on the autism spectrum. Roughly 40% have symptoms of at least one anxiety disorder at any one time, compared with around 15% of people in the general population, and such disorders in themselves can lead to depression.

It is very worrying that young people living with autism are 28 times more likely to consider suicide than other young people are, and it also affects adults who have not been diagnosed. There is no doubt that people with the condition have an increased risk of suicide, as my hon. Friend has pointed out. That could well be because 66% of autistic people and 67% of their families have reported feeling socially isolated.

[Mrs Moon]

Does the hon. Lady recognise that another major problem for families of autistic children is that should one of their children take their own life, the postvention support—the after-suicide support—is not there either, so the social isolation that they experienced in life continues after death and complicates families’ grief? That area must also be tackled.

[Patricia Gibson]

I absolutely agree with the hon. Lady’s excellent point. Should such a tragedy occur and a suicide take place, it is important that the family is supported through that as much as possible.

Some 70% of autistic people are reported to have mental health disorders, such as anxiety or depression. As we have heard, suicide is one of the leading causes of death in the autism community, and that alone tells us that this issue demands our attention. As the hon. Member for Blaydon (Liz Twist) pointed out, diagnosis is important because it should be the foundation on which effective support for autistic individuals and their families is built. Similarly, a delay in diagnosis can hinder effective support and prevent intervention strategies from being put in place.

The National Autistic Society Scotland reported in 2013 that 61% of those it had surveyed said they felt relieved when they received a diagnosis, because such a diagnosis can end years of feeling misunderstood and isolated. We have talked a lot about this as a UK issue, but as a Scottish MP, I want to mention the Scottish Government’s strategy for autism. The strategy, which is based on research, is working to improve waiting times for diagnosis and assessment to create consistent service standards across Scotland, and is providing training opportunities. The entire autism spectrum needs to be addressed, as well as the whole lifespan of people living with autism in Scotland. This is the logic behind this autism strategy, so it is a very positive step.

We have heard about initiatives such as autism hours in supermarkets and special autism-friendly cinematic screenings, and these are all very important and positive steps. There is a greater awareness and understanding of autism in this country but, as we have recognised today, we still have a long way to go. I will end by saying that we often think of those with autism as finding it difficult to see the world as we see it, but the truth is that we need to see the world as they see it, because if we do so we may then be able to start to make real progress.

--- Later in debate ---

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

I have greatly enjoyed listening to the debate, because I have heard so much good common sense and so much passion and care expressed about this important issue. It has been a pleasure. I am glad that we reached it in the end, although it was slightly truncated.

I congratulate the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) on securing the debate, and I congratulate all the other Members who have participated in it. Everyone was absolutely right to say that we need to understand more about mental health, autism and suicide, and to understand more about what constitutes appropriate mental health treatment and treatment for people with autism. The existence of the suicide statistics, unpleasant as they are, demonstrates that we really must do better in this regard.

As I have said, I enjoyed all the speeches today, but I pay particular tribute to the hon. Member for East Kilbride, Strathaven and Lesmahagow for the expertise and the personal passion that characterised her arguments. She has given me a lot to think about, but let me reaffirm to her that my door is always open so that I can hear more. I particularly want to hear what the strategy in Scotland has delivered, because she is absolutely right: when we see good practice, we should all share it and ensure that it becomes the norm for everyone.

We can never debate autism without considering the issue of waiting times, and, as Members have pointed out, in some areas they are very poor indeed. As we have confirmed, we will be publishing more data from April which will provide us with the tools with which to “give challenge”. However, it is clear that waiting times are not good enough, especially in the north-east, and we are failing people when we do not give them an early diagnosis.

The hon. Member for Cardiff West (Kevin Brennan) mentioned the criminal justice system, which is where people with autism and mental health issues often end up. As he said, we need to improve the sensitivity with which the criminal justice agencies deal with such conditions. I can tell him that the Ministry of Justice is working with the Home Office and the Crown Prosecution Service to develop new guidelines to help officers to support people. I think I need to do more with the MOJ to ensure that we do not put people in a setting that will damage them further, but I am pleased that there are now liaison and diversion services covering 80% of the country to achieve exactly that.

The hon. Member for East Kilbride, Strathaven and Lesmahagow also described very well, as did the hon. Member for Washington and Sunderland West (Mrs Hodgson), how for some people with autism accessing support from GPs can cause distress in itself. This is where debates such as this can be so useful, because sometimes the most simple, practical things can make the biggest impact. It surely cannot be beyond the wit of any of us to make sure that GPs receive appropriate advice about things like lighting, and even having a quiet area. We often now have multi-service GP and health centres, and there must be space in them to have a quiet area.

[Mrs Moon]

One of the risks is that, rather than going to their GP, people will look on the internet, where, sadly, they will find far too much information about how to take their own life and what methods to use. Also, if they go into chatrooms to share, they find encouragement to take their own life. This is an area that we must tackle.

[Jackie Doyle-Price]

I thank the hon. Lady for that intervention and the work she does in this area; I know she cares about it a great deal. She is absolutely right that there is a serious vulnerability among people who feel uncomfortable about accessing medical care. We must consider the proximity of the internet where it is possible to buy drugs and where nobody really understands what they are buying. We can do a lot more to enable people to protect themselves. The internet is a great source of information, but it can be less than benign when people want to use it for these purposes.

I have limited time and know I will not be able to do justice to all the contributions to the debate, but I will do my best. If I do not cover them all, it is not because I have ignored any of the points raised; rather, it is because there were too many good speeches to address in a short space of time.

The hon. Member for Bristol West (Thangam Debbonaire) made some extremely good points. She rightly highlighted the issue of unemployment, and I, too, am particularly concerned about that. We have just published the work and health strategy, and this is an area where we need to do better. The reality is that there is a great skillset here for particular disciplines, and enlightened employers recognise that. We can do a lot more to spread good practice here, as with GP surgeries, such as about what would be sympathetic interview styles for people with autism, so that we can enable them to become integrated. The hon. Lady is right that work is probably the best tool with which to protect our mental health, and we will look at that.

I was also intrigued by the hon. Lady’s autism surgeries, and wonder whether she might consider making that a toolkit that all of us with an interest in the issue could roll out in our own surgeries. Again, a lot of this is about raising awareness of the challenges people with autism face. We are in the public eye and have the ability to do that, so I ask the hon. Lady to tell me how she organised those surgeries.

My hon. Friend the Member for Bexhill and Battle (Huw Merriman) rightly mentioned schools. There is a problem with provision, and whether we always get it right—whether it should be mainstream or alternative provision, and whether we have enough places for alternative provision if that is the appropriate setting. That is particularly challenging in my local area, but it is not fair to fail individuals by excluding them because maintaining them in mainstream schools is either challenging or not appropriate for them. The state needs to ensure they get appropriate schooling.

My hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan) spoke at length about her own experience and set me a number of challenges. I will be happy to report to her on them. I can also give her every guarantee that the data she asked for will be made public next year.

I shall now turn to some of the things we are doing to develop the autism pathway and autism strategy. We have set an expectation in the NHS mandate that the NHS will reduce the health gap between people with mental health problems, learning disabilities and autism and the population as a whole, and support them to live full, healthy and independent lives. We acknowledge, however, that the complexity of autism and the multifaceted nature of the needs of those on the spectrum poses particular challenges to professionals and commissioners. I am keen that mental health should be considered by the new task and finish groups that are being established to implement the autism strategy, and I will ensure that progress is made in implementing the strategy in line with the Autism Act 2009.

It is important that the NHS accommodates the requirements of vulnerable groups such as autistic people through staff training, awareness raising and reasonable adjustments to services, as we have heard. Autistic people should be able to access mental health services like everyone else if they are supported to engage with services and helped to explain their problems so that they can receive treatment. They should not fall between two stools—between autism or learning disabilities services on the one hand and mental health services on the other. We need to ensure that we are giving bespoke treatment and care to people with both issues.

A lot of the treatments that we are developing in mental health will not be suitable for people with autism. We are therefore looking at what we can do to alter the psychological therapies that are available to make them more user-friendly and sympathetic to people with autism. I was horrified to hear what was said about group therapy. I am a lay person, but it is pretty obvious to me that group therapy is not appropriate for people with autism. Clearly, the fact that that is happening is an indication of how much more we have to do to ensure that society is more sensitive to the needs of those people.

I am running out of time, and I really want to hear from the hon. Member for East Kilbride, Strathaven and Lesmahagow, but I just want to emphasise that research will play an important role. We are looking at many projects at the moment. There is a research theme on neurodevelopmental disorders, and a project at Avon and Wiltshire Mental Health Partnership NHS Trust looking into guided self-help for depression in adults with autism, as well as work at Leeds and York Partnership NHS Foundation Trust. In the East of England, a project is being led by Professor Simon Baron Cohen focusing on suicide, autism and autistic traits, which will obviously be of interest to everyone who has participated in the debate today. I am grateful, too, for the research undertaken by Autistica, which has really highlighted this issue and brought us to where we are today. I am pleased to say that Autistica has met the national suicide prevention strategy advisory group, which advises the Government on the national suicide prevention strategy, to talk about its research. We will be reflecting on the advice that it has given us.

I thank everyone once again for participating in the debate. As I have said, I am always interested to hear about good practice and what more we can do. Rest assured, we still need to do much more to support people with autism, and particularly to ensure that they can access appropriate mental health services.