Mental Health Units (Use of Force) Bill

Oliver Dowden Excerpts

2nd reading: House of Commons
Friday 3rd November 2017 Commons Chamber

[Oliver Dowden (Hertsmere) (Con)]

Thank you very much for calling me to speak so early in the debate, Mr Speaker. I should like to begin by paying tribute to the hon. Member for Croydon North (Mr Reed) for bringing forward this legislation, which I very much support. In common with most Members, I am sure, I find that mental health is a rising issue in my constituency. Many of my constituents frequently contact me about it and many have particularly asked me to speak in this debate. I want to talk about two provisions in the Bill that I think are important. First, it is important to have transparency. As someone once said, sunlight is the best form of disinfectant. If people can see what is going on, they are much less likely to behave in an inappropriate fashion. The use of body cameras in many other areas of police work has done a great deal of good, so their introduction in this area, through the Bill, is to be welcomed.

Secondly, I welcome the provisions in the Bill on effective recording. One of the frustrations of my constituents who have mental health problems or whose family members have mental health problems is that the information on their interactions with public bodies—whether the police, local authorities or schools—is not properly collated or shared. Patients and their families therefore feel that they are constantly going round in circles repeating information. The more we can do to retain that information effectively, the better treatment those affected will receive. The root of all this lies in the need for a change in attitudes towards mental health; my constituency is emblematic of the changes that have taken place over the past 30 or 40 years.

[Ms Karen Lee (Lincoln) (Lab)]

Does the hon. Gentleman agree that, no matter what equipment we have, the root of the problem is not having enough staff to deal with these situations? I am a nurse, and I know that we do not have enough nurses. It is as easy as that, and we need to address the problem.

[Oliver Dowden]

I quite agree that we need to have the right levels of staff, and that is why I am so pleased that the Government have protected police funding. I was going to come on to this point, but I will raise it now. In the health service, we are moving towards achieving parity between mental and physical health. Some of the stats on this are very welcome. We are now spending £11.6 billion a year on mental health, for example. I believe that that is more than we have ever spent before. Also, the Health and Social Care Act 2012 is giving parity of esteem.

[Victoria Atkins]

Does my hon. Friend agree that this is not just about the numbers of staff but about how well they are trained to work in the particularly difficult circumstances of a mental health unit? The pressure on members of staff is particularly acute in such an environment. Clause 5 requires training in the appropriate use of force, which will provide positive benefits for members of staff.

[Oliver Dowden]

My hon. Friend is absolutely right. I do not think anyone is suggesting that police officers are actively seeking to treat mental health patients in an incorrect fashion, but there is a need for training so that they understand the correct way to behave.

[Clive Lewis]

We on the Opposition Benches do not think that this is only about the money that is going in now. If we look at the figures, we can see that there has been an increase in recent years, but the fact is that the years of cuts that went before have had an impact on staffing levels. In my trust, the Norfolk and Suffolk mental health trust, we have seen a 20% drop in the number of doctors and nurses on the payroll in the past five years. We can train up a lower number of doctors and nurses in restraint techniques, but the fewer there are, the more risk there will be of a need to restrain. We cannot get away from that fact.

[Oliver Dowden]

I am not sure that I entirely agree with the hon. Gentleman. Of course there have been historical problems with the funding of mental health. I hope that Opposition Members will recognise, as we do on the Government Benches, that over the decades there has not been enough funding going into that area. On the question of the NHS, however, despite this Government inheriting the largest budget deficit in our peacetime history and an appalling fiscal situation in which we were spending £4 for every £3 we earned, we made a decision to prioritise health. Health spending has risen every year under this Government and we are committed to implementing Simon Stevens’ recommendations. He, after all, was a Labour special adviser who advised this Government, and he recommended £8 billion of additional funding. I am very pleased that we have been able to do that.

[Ms Marie Rimmer (St Helens South and Whiston) (Lab)]

rose—

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[Oliver Dowden]

I would be delighted to give way to my hon. Friend on the other side of the House, if I may call her that.

[Ms Rimmer]

When public services are stretched and under-resourced, and with rising demands, it is more important than ever that we have the correct processes in place. Our public services do an exemplary job, and the Bill is not about criticising them. It is about having a regulated, transparent process so that we can minimise harm to staff and the people they care for. I have been contacted by many of my constituents on this matter. Indeed, there is widespread public concern about it. Does the hon. Gentleman agree that we should not turn this into a debate on another issue? Please let us stick to what we are here to talk about today.

[Oliver Dowden]

I was responding—

[Mr Speaker]

Order. I am immensely grateful to the hon. Member for St Helens South and Whiston (Ms Rimmer), but may I gently point out that interventions must be brief? I recognise the sincerity and seriousness of what she said, but there is huge pressure on time in respect of this Bill and of what might follow, so a certain self-denying ordinance is needed.

[Oliver Dowden]

I thank the hon. Lady for her intervention. I know that she, like me, greatly values the work of our public sector workers. With respect, I was seeking to respond to interventions from other Opposition Members, and if they will refrain from making political interventions, I will happily refrain from rebutting them.

The root of this can be traced back to my constituency of Hertsmere, which I proudly represent and in which I was born and grew up. I remember the way in which mental health was treated during my childhood. We are on the edge of London, and London was historically surrounded by very large mental health institutions. In my own constituency, we had facilities such as the very large hospitals at Harperbury and Shenley. In many ways, those institutions had a positive ethos. I am fortunate to represent many mental health nurses who worked in those institutions and who still live in the constituency, and there was certainly a positive ethos of rehabilitation and providing a safe, calm space for people. However, the flipside of that was a tendency to put people in those institutions, shut them away and never think about the problem again. It is absolutely right that, under successive Governments, we have sought to change that approach. We now mainstream mental health problems, certainly in my own constituency and I am sure in many others.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I believe it is important for the hon. Gentleman to acknowledge that there are still far too many young people with autism and learning disability living for the long term in hospitals. Does he acknowledge that that problem is related to the resources available for their care and how those resources are spent? I believe that we need a shift towards properly resourced community settings for people with autism and learning disability, who really should not be in hospital for the long term.

[Oliver Dowden]

The hon. Lady makes an important point. The closer to the community the treatment can be given, the better the treatment will be. I see this with my own constituents. If they are having to travel long distances, particularly with younger children, to access mental health care facilities, that can only add to the disruption in their lives. However, I believe that a journey is taking place in all of this, and I am glad that the Government are addressing the need for that journey.

The experience of many of us is that mental health is now delivered at the primary care level. From speaking to GPs in my constituency, I know that they are now on the frontline of the process. What is the answer? The first thing is to ensure that we have parity of treatment between mental and physical health. A broken limb is a serious injury and the patient is patched up and treated properly—no one doubts that they have had an injury. However, it has been the case for too long that if people have a mental health condition, it is not immediately treated with the same seriousness, and there is a sense that the person concerned has to prove that they have a problem in the first place.

[Wendy Morton (Aldridge-Brownhills) (Con)]

My hon. Friend is making an important point. In addition to parity of esteem, we need greater understanding of what it really means to live with a mental health illness, and Bills such as this are important for raising awareness of what can be a sensitive issue.

[Oliver Dowden]

My hon. Friend is absolutely right. This is about not just understanding the experience of the person who is suffering from mental health, but the knock-on effect on the entire family. One thing that my constituents frequently raise is the impact on other siblings when one child in the family has mental health issues and ensuring that the others do not feel neglected or disadvantaged when one sibling necessarily gets more attention.

Not only do we need to change cultural attitudes towards mental health, we need to look at the legislative framework. Most of us would agree that 1983 was the last time we had a serious, large-scale piece of legislation and, in 1983, the old model that I was discussing earlier was the prevalent model. There is a pressing need for a larger piece of legislation that can build upon on the measures in this Bill and ensure that we take a more comprehensive look at things.

[Kevin Foster (Torbay) (Con)]

I am enjoying listening to my hon. Friend’s speech. Does he agree that the use of police cells is a big area for review? While we have seen a welcome decline in the use of police cells as places of safety, it is unacceptable that someone can end up in a cell not because they are suspected of a crime, but because they have been unwell.

[Oliver Dowden]

My hon. Friend makes an important point and that is something that we are waking up to. As Home Secretary, my right hon. Friend the Prime Minister made great strides to seek to change the approach taken by the police so that people are not automatically put in a cell. If somebody is already suffering from a mental health condition, the worst possible thing for them is a night in the cells, the conditions of which we have all seen as constituency MPs.

[Kevin Foster]

Will my hon. Friend briefly give way again?

[Oliver Dowden]

I will, but I am conscious of the time.

[Kevin Foster]

My hon. Friend is being extremely generous. The situation is ironic, because we have strict time limits for detention without a magistrate’s warrant due to the mental health impact on criminal suspects, yet we do not have the same for mental health. That could be looked at in future legislation.

[Oliver Dowden]

Again, my hon. Friend makes an important and interesting intervention, which comes back to the wider question of how we achieve parity. Parity is about not just funding or treatment by GPs, but all these other forms of, for want of a better phrase, micro-discrimination.

[Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)]

I agree with the hon. Gentleman that parity is not necessarily achieved just through funding, but what does he think about the data collected by my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger)? Through FOI requests, she was able to demonstrate that half of all clinical commissioning groups are looking to reduce the amount of money they spend on mental health provision in their communities, so that they can put more money into acute pressures, with which they are struggling due to other funding arrangements.

[Oliver Dowden]

I thank the hon. Gentleman. That goes back to my earlier point that the funding is there. We are increasing funding for the NHS, and CCGs should not be seeking to cut mental health services in order to cross-subsidise acute services. That is certainly not the case with my local CCG.

Hon. Members on both sides of the House have made important points, and I hope that the mental health review that the Government announced in the Queen’s Speech will take all considerations into account. Mental health really encompasses every area of Government activity, and a holistic approach is important.

I am conscious that I have taken up a little too much time, so my final point is about co-ordination. When sufferers of mental health find themselves in contact with the police, it is often due to more severe mental health episodes, and there is sometimes a frustration about which agency will take responsibility. If the police recognise a mental health problem, they will often get in contact with mental health services in the NHS, which may then get in contact with mental health services at the local council, and the patient and their family can feel that they are being pushed from pillar to post with no individual seeking to take responsibility. Returning to the provisions in the Bill about the collection of data, it needs not only to be collected but shared effectively among institutions. I hope that the review, which will hopefully lead to fresh legislation, will look at how to provide some co-ordination, so that there is somebody who can be a champion for people with mental health conditions and bring together the experiences of all the different institutions. At a time when families and individuals feel under so much pressure, if they can see that there is one person to whom they can relate, instead of having to negotiate with different bodies, that could provide much better outcomes.

In conclusion, I again pay tribute to the hon. Member for Croydon North for bringing this important issue to the House. I hope that this private Member’s Bill will complete its stages and make its way on to the statute book, but I also hope that it will mark the beginning of a wider process that will feed into fresh legislation covering all the different areas where we need to ensure genuine parity between mental and physical health. I hope that all hon. Members agree that that is the ultimate goal.

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[Mrs Trevelyan]

I thank my hon. Friend for that intervention. She is right: so often the circumstances of patients in the units has meant that people have been able to develop more sophisticated techniques and de-escalation programmes, and this best practice needs to be shared. That is the great challenge, as it so often is in education and in other parts of our public services. We need to find an effective way to share these best practices, so that we can help people who are doing their best in units across our constituencies but who are not necessarily using the most effective tools to help patients recover and restore their stability.

These two key policy areas, transparency and accountability, will protect patients, and promote dignity and respect. Everyone who passes through our mental health system should receive dignity in their care and respect for them as an individual in our society. I had a lovely chat with a gentleman on the street last night, not far from here. He was asking for money because he needed £35 for his bed and breakfast last night—this was going to be his night of luxury—and he had with him a sign saying, “This can happen to anyone.” That always makes me stop to chat. His life story was just unfortunate, with a series of unfortunate events, and there he was on the streets. Mental ill health can strike everyone, so to suggest that not everyone is entitled to that dignity would be wrong.

[Oliver Dowden]

My hon. Friend raises an important point. Does she agree that we must be careful not to judge people in that situation? There is always a temptation to think that there could be other reasons for it, but often they come from terrible circumstances, for example, having been the victims of child abuse and so on. There still needs to be a change in society’s attitudes, as we see when we look at some of these appalling cases of these people being abused by other members of the public.

[Mrs Trevelyan]

My hon. Friend is exactly right. It is incumbent on us as we go forward with this Bill to set these new markers to ensure that we get a cultural change; we need that understanding that mental ill health is part of our life experience and most of us may well suffer from it in one form or another. For those who are the most vulnerable we absolutely need to ensure that the practices are the best they can be, so that dignity and respect is afforded to every person who needs that support.

Transparency and accountability will also allow health professionals and emergency staff to manage the risks, protecting not only the patient, but our public servants. This can protect them from false allegations and allow us to have that evidence should things go wrong. Body-worn cameras are so important in this regard. The prison in my constituency, HMP Northumberland, was one of the prisons where body-worn cameras were trialled. This has been running for nearly two years now and there has been a dramatic drop not only in the reported cases of argy-bargy between prison officers and inmates, but in poor behaviour, because inmates who might have decided to have a go cannot be bothered anymore because they know it is going to be filmed; the relationship has improved so much as a result. This has created the same thing as we see where a teacher has good discipline in the classroom, understanding that if we provide a framework everyone within it works in a more conciliatory and more constructive fashion.

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[Rishi Sunak]

My hon. Friend makes an excellent point—and one he has spoken about before. My hon. Friend the Member for North West Hampshire (Kit Malthouse) has also spoken passionately in the House about what more we need to do to protect children online and ensure they have a safe space to play and learn about the world around them.

[Oliver Dowden]

My hon. Friend rightly pays tribute to the work of our hon. Friend the Member for North West Hampshire and makes an important point, which pertains to mental health, about children needing a safe architecture in which to grow up. Just as we, as parents, give them safety and security in the physical world, so they must have safety and security in the online world, where they spend increasingly more of their time.

[Rishi Sunak]

My hon. Friend is absolutely right and puts it better than I could myself, so I will move back to the physical world, if I may.

Sadly, the evidence is that self-harm among young people is on the rise. It is right, therefore, that the Government have responded by improving mental health training in schools. Many colleagues have already mentioned the importance of appropriate training for those dealing with children—or adults—with mental health issues. This vital training will help teachers and staff at schools not just to identify but to assist at-risk children.