Mental Health Treatment and Support

Neil O'Brien Excerpts

Wednesday 7th June 2023 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

I beg to move an amendment, to leave out from “House” to the end of the Question and add:

“notes the increased burden on mental health following the pandemic, including on young people and those with severe mental illness; recognises the historic levels of investment being delivered by this Government into services, with an increase of £2.3 billion per year in front-line mental health funding over the past four years; notes that current NHS targets around access to talking therapies and intervention in psychosis are being met due to the efforts of NHS staff; and acknowledges the investment in mental health teams in schools, as well as the ongoing investment into open access mental health helplines in the 111 service and into the estate, including three new mental health hospitals to be opened in the next two years accompanied by a further £150 million in investment in new mental health ambulances and the development of better alternatives to accident and emergency services, including crisis houses, safe havens and step-down services.”

Improving mental health is a top priority for this Government. We can all agree that in the past it was not given the priority it deserves, and was seen as something to be ashamed of and not spoken about. Thankfully, we are changing that. We are working to achieve parity of esteem between physical health and mental health, with record amounts of investment going into NHS mental health services in England, and the stigma surrounding mental health is being reduced.

“The Five Year Forward View for Mental Health”, which was published in 2016, was a major step forward and secured an additional £1 billion in funding for mental health, so that an additional 1 million people could access high-quality services by 2020-21. It was followed by the NHS long-term plan in 2019, which committed an additional £2.3 billion a year for the expansion and transformation of mental health services in England by 2024, so that an additional 2 million people could get the NHS-funded mental health support that they need. It is also funding the increase in the frontline mental health workforce to meet the plan’s ambition for 27,000 additional mental health staff by 2023-24. There were 138,610 full-time equivalent mental health staff at the end of 2022, an increase of 8,900 on the previous year and of 20,700 on December 2010, so the mental health workforce in the NHS is radically bigger. In total, we spent around £3 billion more on mental health last year compared with four years ago. That is an increase of a quarter.

Backed by this huge investment, we are expanding access to NHS talking therapies for adults to meet the long-term plan’s ambition for an additional 1.9 million people to access National Institute for Health and Care Excellence-approved treatments for conditions such as anxiety and depression. From starting small in 2008, around 1.2 million people are now accessing NHS talking therapies every year, with 98% waiting less than 18 weeks for their treatment and 90% waiting less than six weeks. This means that we are delivering well over our national waiting time targets of 95% and 75% respectively.

Local mental health services are transforming community mental health care to give 370,000 adults and older adults with severe mental illnesses greater choice and control over their care and to support them to live well in their communities. We recognise that poor mental health is a major cause of sickness absence in the workplace and we are providing support to employees and employers on mental health in the workplace. We have announced additional measures to support workplace mental health, including a package to support the long-term sick and disabled to remain in or return to work. This includes £200 million for digital mental health to modernise NHS talking therapies, to provide free access to wellness and clinical mental health apps for the population, and to pilot cutting-edge digital therapeutics. There will be around £75 million to expand individual placement and support services to help more people with severe mental health illnesses into employment.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

Will the Minister give way?

[Neil O’Brien]

I will make a little progress first.

We know that the number of children and young people experiencing mental ill health is rising, and that many of them will continue to experience mental health problems later in life. Spending on children and young people’s mental health continues to grow, from £841 million in 2019-20 to £995 million a year later, and now to £1.1 billion in 2022-23. This means that we are helping more children and young people than ever before. In 2021-22, there were over 743,000 new referrals to children’s and young people’s mental health services, which is 41% higher than the year before.

[Several hon. Members rose—]

[Neil O’Brien]

I will make a bit of progress before I give way.

The long-term plan will ensure that 345,000 more children and young people can get the mental health support they need when they need it.

We are committed to ensuring that children and young people can access mental health support in school, so that they can access help with anxiety and depression and other common mental health services before problems become more serious. In that way, we can prevent—in exactly the way we all agree on—the problems from becoming more serious. That includes continuing to roll out mental health support teams to schools and colleges in England.

[Fleur Anderson (Putney) (Lab)]

The picture that the Minister is painting does not quite tally with the experience that I am seeing in families, many of whom are watching with a feeling of helplessness as their children’s mental health deteriorates while they are on long waiting lists. In the NHS South West London ICB area, there are over 10,000 young people on waiting lists, and many have their cases closed without even getting the support they need. That leaves them with deteriorating mental health and it leaves their families in despair. How is it that the money the Minister is talking about does not seem to get through to the young people who need help?

[Neil O’Brien]

I will come to the point about waiting lists in a moment.

Let me complete my thoughts on prevention, which I think we all agree is important. There are 3.4 million pupils covered by mental health support teams in 2022-23, which equates to about 35% coverage of pupils in schools and learners in further education in England. We expect around 500 teams to be up and running by 2024, covering around 44% of pupils and learners, so it will be up from 35% to 44%. Over 10,000 schools and colleges now have a trained senior mental health lead, including more than six in 10 state-funded secondary schools in England. On prevention, the Government are also providing £150 million of capital investment in NHS mental health urgent and emergency care infrastructure over the next two years.

[Andy McDonald (Middlesbrough) (Lab)]

While the Minister is addressing the issue of young people, can I say that I have yet to hear any news from the Department as to whether there will be a public inquiry into the deaths of the three young women who died under the care of the Tees, Esk and Wear Valleys Foundation NHS Trust. Can he enlighten me on that?

[Neil O’Brien]

This is an extremely important issue that the hon. Gentleman is quite right to raise. We will be producing the results of the rapid review in the coming weeks, so he will not have to wait very long.

[Munira Wilson]

Like other colleagues, I see many children in my constituency waiting well over a year, sometimes two years, to access child and adolescent mental health services, so I was alarmed when NHS England recently told me that, on the latest modelling, the number of NHS-commissioned training posts in London for child and adolescent psychiatry will halve by 2031. I have no idea what is driving this modelling, but given that one in six seven to 16-year-olds have a probable mental health disorder, will the Minister at least look into these figures and undertake to write to me to explain why we are seeing such a drop in the number of training places?

--- Later in debate ---

[Neil O’Brien]

Those are not figures that I am familiar with or recognise, but I will certainly take this up with the London commissioners because it sounds like an important issue. I have talked about the dramatic increase we have already seen in the mental health workforce, and we are setting out further steps in our long-term workforce plan, but I will take that away and look at it closely with other Ministers.

[Mr Toby Perkins]

One of the issues here is that the demand for mental health services has gone through the roof, from 3.6 million in 2020-21 to 4.5 million in 2021-22. My hon. Friend the Member for Tooting (Dr Allin-Khan) was clear in her view, which I share, that the policies of this Government have been a factor in driving up the mental health demand. Does the Minister accept that? If not, what does he put it down to?

[Neil O’Brien]

I was just coming to that, but on the point about prevention and the social origins of these things, we are in agreement about tackling the origins of these things. In terms of financial security, that is why we are providing financial help worth £3,300 per household, one of the most dramatically generous packages anywhere in Europe. The question of good housing was raised earlier. We have the Social Housing (Regulation) Bill and we are taking action to extend the decent homes standard to the private rented sector.

[Dr Luke Evans (Bosworth) (Con)]

Is it not the case that we have to be really careful about what we are talking about? There is a difference between mental wellbeing and mental health. We all suffer with our mental wellbeing but we do not all suffer with our mental health, and we therefore need to have the support that is appropriate. Social prescribing, for example, has a fundamental ability to help people who suffer with their mental wellbeing. Are the Government doing anything more to drive up social prescribing, so that GPs and allied professions can get the support from the third sector and other voluntary organisations that people so desperately need for their mental wellbeing?

[Neil O’Brien]

My hon. Friend, as an experienced clinician, makes an important and thoughtful point. This is exactly why we have so dramatically increased the number of social prescribers in primary care. An example in Britain is the parkrun practices initiative, which is connecting people to sporting and cultural activities that can improve mental wellbeing as well as mental health. My hon. Friend is completely right, and that is why this is a priority for us.

[Andrew Bridgen]

The suicide rate in North West Leicestershire increased by more than 300% during the lockdown. Does the Minister know what the increase was in his constituency?

[Neil O’Brien]

It is just not true there was an increase in suicides because of the lockdowns. There have been a whole series of careful studies of this and that is just not the case. I am afraid that my hon. Friend is not correct about this.

[Wera Hobhouse (Bath) (LD)]

Eating disorders are a national scandal and have reached epidemic proportions. Anorexia nervosa has the highest mortality rate of any mental health disorder and a third of people with binge eating disorders are at suicide risk. With at least 125 million people suffering from eating disorders and with soaring waiting lists, is it not time that the Government appointed something like an eating disorder prevention champion to tackle this incredibly difficult but rising crisis?

[Neil O’Brien]

I completely agree about its tremendous importance, and I take this opportunity to mention the incredible work on this hugely important issue by brilliant charities such as Beat. I will outline some of the general things we are doing to increase capacity further.

[Janet Daby]

Only a few weeks ago, I met a constituent who endured an awful kidnapping and rape. She had some initial counselling and therapy from specialist services, but she has now been on the waiting list for more than a year and a half. What would the Minister say to my constituent, who desperately needs therapy?

[Neil O’Brien]

I am terribly sorry to hear about the hon. Lady’s constituent’s case, which I will look at extremely closely. This is why we are putting in extra investment and tackling waiting lists.

[Several hon. Members rose—]

[Neil O’Brien]

I should make a little progress before taking further interventions.

The Government are providing £150 million of capital investment in the NHS’s urgent and emergency care infrastructure for mental health over the next two years. Those interventions include £7 million for 90 new mental health ambulances, with the remaining £143 million going to more than 160 capital projects with a preventive focus. These include new urgent assessment and care centres, crisis cafés and crisis houses, health-based places of safety for people detained by the police and improvements to the NHS 111 and urgent mental health helplines. The hon. Member for Tooting talked about creating such facilities in the community, and we are already doing that. We are also investing £400 million between 2020-21 and 2023-24 to eradicate mental health dormitory accommodation, improving safety and dignity for patients. Twenty-nine projects have already been completed since the programme commenced in 2020-21, eradicating over 500 dormitory beds.

[Dr Ben Spencer]

Will the Minister join me in welcoming the construction of the new Abraham Cowley unit, which will eradicate the dormitories that were in my constituency?

[Neil O’Brien]

I join my hon. Friend in celebrating that unit and his advocacy for people affected by mental health.

[Florence Eshalomi (Vauxhall) (Lab/Co-op)]

I thank the Minister for giving way, as I appreciate that he is trying to make progress. On the capital programme, one of the issues that my hon. Friend the Member for Tooting (Dr Allin-Khan) highlighted is Seni’s law, which will look at the treatment that patients receive in mental health units, where, sadly, restraint has led to deaths. The Minister talks about prevention, and we need to make sure that Seni’s law, which was enacted in November 2018, comes forward now. Does he agree?

--- Later in debate ---

[Neil O’Brien]

The remaining provisions will be commenced as soon as possible.

We are working with the NHS towards implementing new waiting time standards for people requiring urgent and emergency mental healthcare, in both A&E and the community, to ensure timely access to the most appropriate high-quality support. We also recognise that there is much more to be done to improve people’s experience in in-patient mental health facilities. The Minister with responsibility for mental health, my hon. Friend the Member for Lewes (Maria Caulfield), has spoken to many Members following reports of abuse and care failings at a number of NHS and independent providers. We have been clear that anyone receiving treatment in an in-patient mental health facility deserves to receive safe, high-quality care and to be looked after with dignity and respect.

It is vital that, where care falls short, we learn from any mistakes to improve care across the NHS and to protect patients. That is why we have conducted a rapid review of mental health in-patient settings, with a specific focus on how we use data and evidence, including from complaints, feedback and whistleblowing reports, to identify risks to safety.

[Marsha De Cordova (Battersea) (Lab)]

The Minister wants to talk about data and evidence. We know that, within the mental health crisis, there are huge, long-established racial disparities, with young black men disproportionately being sectioned under the Mental Health Act 1983. The draft mental health Bill is still in train, and I would like to know exactly when the Government will table the Bill, which might stop these racial disparities and stop young black men dispro-portionately being sectioned.

[Neil O’Brien]

We are currently responding to pre-legislative scrutiny, so we are on the case. We are not just waiting, of course, and we are already doing things on these points, including through the culturally appropriate advocacy pilots for those at risk of detention and on the patient and carer race equality framework to avoid and prevent detention in the first place.

The rapid review’s report will be published very shortly. NHS England has also established a three-year quality transformation programme that seeks to tackle the root causes of unsafe, poor-quality in-patient care, including sexual safety, in mental health, learning disability and autism settings.

Our draft mental health Bill, which has been mentioned a few times in this debate, is intended to modernise the Mental Health Act so that it is fit for the 21st century and works better for people with serious mental illness. The draft Bill has completed its pre-legislative scrutiny, and we will respond to the Joint Committee’s recommendations very shortly.

In a world of increasing rates of multiple morbidity and diseases of increasing complexity, it is crucial that we continue our progress towards more person-centred, holistic care that considers a patient’s physical and mental health needs together. That is why we announced in January that we will be producing a major conditions strategy to tackle the conditions that contribute most to morbidity and mortality across the population of England, including mental health. The call for evidence is now open, and I encourage everyone to make their views known before it closes.

[Liz Twist (Blaydon) (Lab)]

The Minister is talking about the mental health strategy now being part of the major conditions strategy. Is he aware that many mental health organisations see it as a retrograde step that, having conducted an extensive consultation and invited views, the strategy will now be put back even further?

[Neil O’Brien]

I assure the hon. Lady that all contributions were fed into the major conditions strategy process. The reason why we are making the mental health strategy part of the major conditions strategy, and why we are looking at co-morbidities, is because, as the hon. Member for Tooting mentioned, people with mental health conditions have a shorter lifespan and, in general, the cause is typically a physical co-morbidity. It is essential that we look at these things together if we are to make progress on tackling disparities.

We have committed to publishing a new national suicide prevention strategy later this year, and we are engaging widely across the sector to understand what further action we can take to reduce cases of suicide. The new strategy will reflect new evidence and the national priority for preventing suicide across England, including action to tackle known risk factors and targeted action for groups of concern. We are also providing an extra £10 million over the next two years for a suicide prevention voluntary, community and social enterprise grant fund. This competitive grant fund will help to support the sector to deliver activity that can help to sustain services to help meet increased demand for support and to embed preventive activity that can help to prevent suicide and stem the flow into crisis services.

[Liz Twist]

Of course it is good that we will have a refreshed national suicide prevention strategy, and of course £10 million is welcome, but it is not out there yet. In the meantime, the £57 million that was earmarked for local work on suicide prevention has run out. Will the Minister consider making urgent interim arrangements to ensure that this vital work can continue until the strategy is published?

[Neil O’Brien]

I am conscious that we need to help the sector to maintain and grow its levels of service.

I finish by paying tribute to all those who do so much to support people’s mental health: frontline NHS staff, those working in the voluntary community and social enterprises, and all those who are quietly supporting a family member or loved one.