Mental Health Taskforce Report

Debate between Oliver Colvile and James Morris

Wednesday 13th April 2016 Westminster Hall

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

I congratulate my hon. Friend on securing the debate. It is a pleasure to serve under your chairmanship, Mr Wilson.

Does my hon. Friend recognise that one of the key issues in constituencies such as mine, which is a low-wage, low-skill economy, is tackling depression? That is helping us get everybody into work. If we want growth, it is important that we deal with people who suffer from depression, which is, of course, another mental health problem.

[James Morris]

My hon. Friend is absolutely right. We need to support people with depression back into work. The report makes a number of recommendations, which he may be aware of, on the use of strategies such as individual placement and support to get people with mental health problems back into work.

The report also talks a lot about data, which underpin our decisions about where we should focus our efforts on mental health. It refers to a “black hole” of data and calls for a “transparency revolution” in mental health. As I said earlier, for a long time—probably 20 years or more—we have not been collecting sufficiently robust data about what is actually going on in mental health services. We need better data on what is going on to have a firm basis on which to understand what is working, what is not working and what is going on at local and national level. Recommendation 50 in the report—this pertains to what my hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) said about accountability—is at the heart of the implementation challenges that we face. It states:

“The Department of Health and NHS England should require CCGs to publish data on levels of mental health spend in their Annual Report and Accounts, by condition and per capita, including for children and Adolescent Mental Health Services, from 2017/18 onwards. They should require CCGs to report on investment in mental health to demonstrate the commitment that commissioners must continue to increase investment in mental health services each year at a level which at least matches their overall allocation”

of funding. That goes to the heart of our data challenge.

For too long, mental health services have not been properly resourced because we do not have an effective data set on what is actually happening in the NHS or, as the report highlights, an effective model in the NHS for paying for mental health services. They tend to be commissioned on what is called a block contract basis, which often has the effect of focusing on the delivery of a low-cost service, rather than on quality outcomes. We certainly do not have a model of care that focuses on an individual care pathway or a cure for an individual patient.

We need a different model of payment for mental health services in the NHS that focuses on quality and outcomes and reflects our aspiration, which is written into the NHS’s operating mandate, for parity of esteem—the integration of physical and mental health. How can we express that aspiration? To give an example, if I suffer from diabetes and a serious mental health problem, my treatment in the national health service is effectively split in two: there is a physical health pathway, which is paid for in one way, and a mental health pathway, which is paid for in another way. I believe that we need to move towards a payment-by-activity model in the NHS that does not discriminate between physical and mental health. That will certainly not happen overnight, but the report goes some way towards arguing for it in recommendation 47, which states:

“NHS England and NHS Improvement should together lead on costing, developing and introducing a revised payment system by 2017/18 to drive the whole system to improve outcomes”.

Mental Health (Police Procedures)

Debate between Oliver Colvile and James Morris

Thursday 28th November 2013 Westminster Hall

[James Morris (Halesowen and Rowley Regis) (Con)]

It is a great pleasure to speak in this important debate under your chairmanship, Mr Brady.

I thank the Backbench Business Committee, the hon. Member for Bridgend (Mrs Moon) and my right hon. Friend the Member for Sutton and Cheam (Paul Burstow). The three of us came together to secure this debate. I also speak in my capacity as chairman of the all-party group on mental health.

As the hon. Member for Bridgend said, the police are often on the front line in dealing with people who are suffering a mental health crisis. As she mentioned, it is estimated that up to 40% of police activity is related to mental health issues. In my region of the west midlands, West Midlands police estimates that 20% of all incidents that it deals with involve individuals with mental health problems.

Police officers are often asked to deal with complex and challenging situations on the ground. As the hon. Lady pointed out, they have specific powers under section 136 of the Mental Health Act 1983, and it might be worth dwelling on that section’s specific wording:

“If a constable finds in a place to which the public have access a person who appears to him to be suffering from mental disorder and to be in immediate need of care or control, the constable may, if he thinks it necessary to do so in the interests of that person or for the protection of other persons, remove that person to a place of safety within the meaning of section 135 above.”

The latest figures show that some 21,814 people were detained using section 136 powers last year. As the Royal College of Psychiatrists has pointed out—the hon. Lady mentioned this—far too many of those individuals are still detained in police custody suites. The Royal College of Psychiatrists talks about 36% of those people being detained in police cells, which are essentially a proxy for a health care place of safety.

There were 15 deaths in police custody last year, of which seven could be attributed to, or were related to, specific mental health concerns. A number of the deaths followed the use of the police’s section 136 powers. A number of the deaths are currently being investigated.

Section 136 is part of the 1983 Act, which built on the Mental Health Act 1959. In 1959, there were still a considerable number of asylums in Britain; the whole complexion of our approach to mental health care was completely different from today’s. Thankfully, we do not have asylums and we are making huge efforts to treat people in appropriate settings and in the community.

The reason for section 136 is essentially to give the police powers when someone has absconded from an asylum-based setting. There is a strong argument, which I put to the Minister, that we should consider reviewing the section 136 power in the context of how we approach the treatment of crisis care in mental-health settings in the 21st century. I am not saying that the police should not have the power, in certain circumstances, to detain people, but we should have a full review of how that power is used.

The relationship raises a number of important issues, not just about how the police are using the power but about how they interact with the health service when dealing with people detained under section 136. As the hon. Lady said, we should work towards ensuring that places of safety are located in appropriate health care settings.

As the hon. Lady also said, we must ensure that the police have adequate training to deal with the often difficult and challenging situations that they face. However we reform the system, there will always be circumstances in which the police have to deal with people suffering from severe mental anguish and difficulty. The police need the appropriate intensive training necessary to deal with such difficult and challenging circumstances, but it is also true that other agencies and public bodies, such as the national health service and the ambulance service, have a responsibility to work with the police. We must ensure that all those agencies are working in alignment.

In the west midlands, for example, West Midlands police has developed a good working relationship with the West Midlands ambulance service such that, when West Midlands police is dealing with people suffering from severe mental issues under section 136, an ambulance, rather than a police car, should take that person to a place of safety, thereby not creating the context of criminalisation. There is a good working relationship in my area, but I know there are many examples across the country of where that is not the case and of where there are barriers that prevent such important co-ordinated working, which supports people who are suffering from severe mental health crisis.

Michael Brown is a particularly interesting police inspector in the west midlands; he tweets under the name MentalHealthCop. He has been writing on his award-winning blog about some of the police’s difficulties when interacting with the national health service and about some of the blockages in the system. As the hon. Lady pointed out, one of those difficulties is often the reluctance of local NHS staff, particularly in A and E, to play a role in the section 136 pathway, if I may use that phrase. Staff are reluctant to take responsibility, and there are often confused lines of responsibility between the police and the NHS about who will take responsibility for the care of an individual.

The hon. Lady alluded to the assumption in certain parts of the NHS that the most clinically complex patients, who are often suffering from a mental health problem related to the overuse of drugs and alcohol, should somehow be left in a police cell until they sober up or recover. That situation is not acceptable in any circumstances—no one suffering from a complex mental health condition should normally be placed in police cells.

Police cells are simply not the right environment for such people to end up in. I am not saying that there are no circumstances in which such a person should be held in police cells—there may be particular circumstances in which they should—but we should move to a situation in which we do not, in a civilised and compassionate society, house people in police cells when they are suffering some of the most desperate moments in their life.

Like the hon. Lady, I welcome the street triage pilots that the Government have been running across the country. Police and community psychiatric nurses are working together to resolve issues on the ground, and I look forward to the Minister’s view on how those pilots have been working and when we can expect a coherent evaluation of their success. We need to move quickly to roll out those pilots across the country.

There is a broader point on our approach to mental health crisis care in general. This is ongoing work about which many Members are concerned, but we must ensure that there is better integration between the health service, the police and local crisis care teams, often with the involvement of social services. I understand that the Government are working on a crisis care concordat, which will outline the roles and responsibilities of all agencies in relation to crisis care. One way of reducing the police’s use of section 136 is to ensure that we have a coherent and integrated approach to dealing with mental health crisis care in Britain. We need to tackle the problem head on. The Royal College of Psychiatrists has said that we

“need to focus on reducing the need for section 136 by ensuring that patients, their families have ready access to appropriate and timely crisis care.”

I want to dwell for a moment on the role of police and crime commissioners. Although they have come in for some criticism, some incredibly good work has been done on this issue by PCCs over the past few months. In Staffordshire, the PCC has been able to take a strategic view of the relationship between the police and local health services and has put in place processes to start tackling the problems.

We need suitably staffed hospital-based places of safety. That is an absolutely critical and crucial part of the picture. A police station should be used in exceptional circumstances only. I ask the Minister to consider reviewing the section 136 powers and updating the definition of an appropriate place of safety, which is set out in the 1983 Act.

I want to mention a particular case that is tangentially related to today’s debate and illustrates the importance of all agencies—police, probation, social services and prisons—in dealing with mental health. Members may remember the tragic case of Christina Edkins, who was brutally killed on her way to school from Birmingham to Halesowen earlier this year. It was a particularly tragic and brutal killing, which shocked the whole community in my constituency.

It turns out that the killer, Phillip Simelane, who had been in prison several times and had a history of disturbed and violent behaviour, had been given a psychiatric assessment in prison. That assessment had raised some serious issues about his mental condition, but, following a breakdown in the process, when Simelane was released from prison he somehow got lost in the system. The relationship between mental health services—I think it was the Birmingham and Solihull Mental Health NHS Foundation Trust—police, probation and social services was not close enough and Simelane was lost to the system. That loss resulted in an absolute tragedy for a totally innocent young girl on her way to school.

I raise that case in the context of this debate only because the importance of all those who deal with people with severe mental heath issues can be seen in the story. The consequences of failure can be devastating for individuals and families. Each agency has an absolute responsibility to ensure that we avoid such tragedies, which can have a devastating impact on communities.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

Does my hon. Friend recognise that this is about not only the police and the national health service, but the courts? Better training must be available to the courts, so that they are better able to deal with such issues.

[James Morris]

My hon. Friend makes a good point. Mental health training and awareness need to exist throughout the criminal justice system, because, although I am not going to discuss this in my speech, I think that victims of crime have disproportionate levels of mental health problems and other issues.

In a compassionate and civilised society, we owe it to the most vulnerable and those suffering from acute mental distress, anguish and confusion, who get picked up by the police and are subject to section 136, to treat them with the dignity they deserve at a time when they may be experiencing some of the most difficult situations of their lives. It is incumbent on the police, mental health services, social workers and the Government to be responsible for ensuring that we achieve that goal of health-based places of safety where people can be treated in a compassionate and civilised way and can get back on a path to recovery. It is incumbent on us all to work together, both in government and in local communities, to ensure that that happens.