Mental Health

Matthew Offord Excerpts

Thursday 14th June 2012 Commons Chamber

[Mr Matthew Offord (Hendon) (Con)]

The Minister says that the Government wish to reduce the stigma surrounding mental illness, and I accept that. Does he agree that the decision of the Department of Health in 1994 to hold an independent inquiry into every death involving someone who has suffered mental illness or been part of the mental health system continues to perpetuate that stigma?

[Paul Burstow]

That is an important and challenging point, and I will want to go away and think about what we do. For patient safety, we still need to learn lessons when things go wrong in our system, acknowledge when things have not been done properly and put them right. In that sense, confidential inquiries are an important part of the learning mechanism. One point of frustration that I hear in debates in the House and see in correspondence from hon. Members is the sense that lessons are not learned. As part of our reforms, with the NHS Commissioning Board taking on responsibility for patient safety, we need to ensure that that is not the case in future.

We are investing £16 million in “Time to Change”, and we were delighted when Comic Relief decided to put in an additional £4 million, one of the biggest grants that it has ever made.

I wish to make another point that touches on the contributions of my hon. Friend the Member for Broxbourne and the hon. Member for North Durham. One in five people still think that anyone who has a history of mental health problems should not be allowed to hold public office. How many former Presidents, Prime Ministers or Ministers would have been excluded if that view had been applied? [Hon. Members: “Churchill.”] Precisely. Such a law is as outdated as asylums and as outdated as many of the attitudes that sit behind it. It has to be consigned to the history books just like asylums have been, and under the coalition Government’s watch, it will be. I congratulate the hon. Member for Croydon Central (Gavin Barwell) on securing a slot for a private Member’s Bill on the subject.

Looking ahead, although we have made progress there are still big challenges to tackle. Reference has been made to the implementation framework that will be published to support the roll-out of the “No health without mental health” strategy. That framework has been produced in conjunction with five national mental health organisations—Rethink Mental Illness, the NHS Confederation, the Centre for Mental Health, Turning Point and Mind—and many others have been involved.

We have previously had a very good debate about “Listening to Experience”, Mind’s excellent report on acute and crisis care, and Mind’s policy team have been directly involved in ensuring that the framework delivers on those issues. It will provide a route map for every organisation with contributions to make to improve the nation’s mental health. It will spell out how progress will be made, measured and reported.

What does success look like? To me, it means more people having access to evidence-based psychological therapists; services intervening earlier, particularly for children and young people; services focusing on recovery and people’s needs and aspirations above all; and service users and carers being at the heart of all aspects of planning and service delivery.

Today, economists tell us that mental ill health in this country costs £105 billion a year, and that is just in England. If we succeed and put in place the right combination of public health, anti-stigma policies, accessible psychological therapies and excellent community and acute services, we can dramatically reduce that figure. Put another way, if we can deliver the right evidence-based treatment to children and young people so that their conditions do not persist into adulthood, we can prevent as many as two in five of all adult mental health disorders. As a society, we have made huge progress in how we recognise people’s mental illness, but despite that we have not fully accepted that mental health is equal to physical health and that parity of esteem is needed between the problems of the body and the problems of the mind. That is the challenge—

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[Mr Matthew Offord (Hendon) (Con)]

I will keep my remarks short, as time is certainly against me. I want to focus on the stigma of mental illness and the reasons why I think it continues to exist. We often recoil in horror when we think of the old asylum system in which people were locked up for various reasons. I believe that the care in the community system has been welcomed by most people, and I say that with evidence from the 1994 Ritchie inquiry into the care and treatment of Christopher Clunis, which broadly endorsed the community care policy.

Even though the community care policy is widely accepted, the issue of mental health is not accepted by the majority of the British public. I say that with evidence from the 2010 public attitudes survey showing that, although people are broadly sympathetic towards those who suffer from mental illness, some of their attitudes are worse than when the Department of Health first commissioned the poll in 1994. I believe that it is fear that drives this county’s mental health system; not the fear of those who suffer from mental illness, but a fear that is perpetuated by the actions of vested interests and perpetuates the stigma. I believe that it occurs through three main areas: mental health lobby groups, politicians and the media.

First, fear of those who are mentally ill has been fuelled by lobby groups that use the rare cases of homicide to keep mentally ill people in the public’s consciousness. Although their motivations are honest, the reality is that their actions promote a fear that is not always conducive to their aims. I do not intend to criticise individuals who have suffered terrible personal tragedies, but highlighting mental health issues as aggravating causes in deaths will not reintroduce a policy of asylum hospitals for severely mentally ill people. That behaviour alienates other mental health charities, which consider it to be unproductive.

Secondly, we as politicians have to take responsibility for reducing stigma. As I have already said to the Minister, the political decision to hold an independent inquiry into every homicide involving a mentally ill person has exacerbated public fear. Following the Ritchie report in 1994, the Department of Health ordered that an inquiry should be held into every homicide involving mental health services, but mental health professionals describe the environment in which they now have to work as an inquiry culture, whereby staff are made aware that any variation from recommended perfect practice could lead to an unpleasant afternoon in front of a cynical committee and the humiliation of being named in one of their reports. Those inquiries are viewed by mental health professionals as a threat, rather than as a corrective mechanism to enforce a “safety first” culture that promotes a perception among the public that every death is preventable.

It is easy for politicians to fall into that trap of trying to face both ways; indeed, the previous Government did fall into it to some extent. They were described as “compassionate” when they embarked on what the Mental Health Commission called

“the quickest and most dynamic transformation of policy in the history of state intervention in mental health illness,”

but to the public they presented an authoritarian face, capitalising on the alarm caused by the random attack on Jill Dando and the assault on George Harrison.

The third influence on mental health policy is provided by the media. Comments have already been made about the front page of The Sun in 2003, when it faced a significant backlash for branding Frank Bruno “Bonkers” after he had been taken to a psychiatric hospital. But that was not an isolated story. There have been many others, such as “Doc freed psycho to kill” and “Psycho killer was a time bomb waiting to explode”. They all inflame public outrage and continue to promote among the public a perception that mental illness equates to dangerous murderers whom doctors allow out on to the street, free to roam and to kill at will, but that is simply not the case.

Figures show that there has been no increase in killings by people with a mental illness in the past 40 years, during which time many mental hospitals have been closed in favour of care in the community. Less than one in 10 murders is committed by someone with a mental disorder, and over the past 40 years that number has decreased as a proportion of all homicides, as the overall murder rate has increased over the same time.

On the representation of mental illness on television, the Scottish Recovery Network found that 45% of characters with mental health problems in soap operas were portrayed as violent or as posing a threat to other people. In real life, it was very concerning when in 2007 Nikki Grahame, someone who clearly has mental health issues, and Pete Bennett, who suffers from Tourette’s, were allowed on “Big Brother” simply to increase its viewing figures.

Kerry Katona has admitted that when she sought to go on the same programme on Channel 4 in 2010, she failed the psychological test, as she had just come off her bipolar medication and a doctor advised her that it would not be sensible to appear. In 2011, however, when the show went over to Channel Five, that broadcaster did not produce any psychological tests and she was allowed to go on, the consequences of which could be seen each day.

The biggest change over the past decade has been the increase in protests from people with mental health problems who use the services on offer. Their dissatisfaction is with treatment, its greater emphasis on risk reduction and containment and its narrow focus on medication. Those who suffer from mental health problems dislike the heavy use of antipsychotic and sedative drugs, given their side effects, with some even rejecting completely the biomedical approach, which defines mental health problems as illnesses to be medicated, rather than as social or psychological difficulties to be resolved with other treatments, including talk therapies, for example.

There were some good measures in the Mental Health Act 2007, but there were also some negative ones, so I ask the Minister to address them and, in particular, to outline the benefits that he thinks the 2007 Act has introduced or, if he does not think that it has introduced any, the coalition Government’s policies to address the need for legislation that is fit for the 21st century.

The public and politicians want to be assured that the services people receive from mental health organisations are safe and will protect people from such rare but catastrophic attacks as those that have occurred in the past. People with mental health problems, and their families, however, want to be assured that the services are responsive and supportive, not coercive. They want to be included as active partners in, not passive recipients of, their care. However, a coercive service whose priority is public safety is vote-catching, while concern with civil liberties for a minority group, and one with a dangerous image at that, is not.

Patients continue to be treated with drugs rather than therapy, yet the constant cry is for more talking treatments, which NICE now accepts work for conditions such as schizophrenia. Carers are still neglected; their views are ignored and they lack support. There is huge variability, with some places having great services while others, as has been described today, have appalling services.

Perhaps the biggest scandal in mental health provision is in physical health. Evidence shows that people with severe, enduring mental illness die 15 to 20 years younger than on average. That is partly due to high levels of smoking and the use of other drugs—in effect, self-medication. There is also evidence that people with mental illness suffer discrimination in relation to their physical health. They do not get seen as quickly and they do not get treated as well as those in other parts of the NHS dealing with patients who do not suffer from their conditions.

The prescription for Ministers appears to be this: more talking treatments; better physical care; concerted action to reduce stigma; and more direct payments for those who can cope with them, allowing those on benefits to buy their own care rather than relying on social services.

[Several hon. Members]

rose—