Mental Health

Paul Burstow Excerpts

Thursday 16th May 2013 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

I beg to move,

That this House has considered the matter of mental health.

There can be no health without mental health, and, above all else, I hope that today’s debate communicates that clearly and powerfully in the country and in this House. I start by thanking the Backbench Business Committee for recommending this most important of subjects for a debate, and the Government for finding the time to make it possible. Undoubtedly, there is a lot to debate on mental health, and I am grateful to my two colleagues—one on either side of the House—who have joined me in seeking this debate. I refer to the hon. Members for Bridgend (Mrs Moon) and for Broxbourne (Mr Walker), who hope to catch your eye, Mr Speaker, and contribute as we proceed.

Last year the House had a remarkable, moving debate on mental health, which was very personal for some hon. Members. It demonstrated that mental health is not an issue of “them and us”, but affects all of us. One in four of us may experience a mental health problem at some point.

[Yasmin Qureshi (Bolton South East) (Lab)]

I congratulate the right hon. Gentleman on securing the debate. Recent World Health Organisation figures predict that by 2030, depression will be the leading cause of diseases around the world, physical and mental. People can lose years of their life, as mental illness undermines their physical health too. Would the right hon. Gentleman agree, therefore, that mental health must be at the top of the Government’s agenda?

[Paul Burstow]

I certainly would. The fact that a large number of hon. Members are present, hoping to contribute to the debate, that the Backbench Business Committee advocated the debate, and that the Government have given the time suggests there is cross-party consensus that mental health has for far too long been hidden in the shadows and not awarded sufficient priority. The cost to our society of mental ill health across England, Scotland and Wales amounts to over £116 billion a year, but that does not adequately capture the human cost—the misery—that arises from it. Given that the burden of mental ill health is about 23% of the burden of all disease in our country, it is surprising that for so many years it has not been tackled with the necessary vigour. So I agree absolutely with the hon. Lady.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

Does the right hon. Gentleman accept that, in addition to the need for continued investment in the so-called medical facilities and services that are part of treating mental health, there is a need for continued investment in the so-called talking therapies, and the opportunity to invest and grow the social services’ response to mental health services as well?

[Paul Burstow]

I am grateful to the hon. Gentleman for that question. He is absolutely right that access to talking therapies—begun as a result of Lord Layard’s initiatives before the general election, which the coalition Government continued to support and which is being rolled out—is very important in enabling people to recover socially, get back into work and get on with their life. At the best performance rates, as many as half the people that go through talking therapy services recover, and that can make a huge difference to them, their families and the figures I was talking about earlier. I shall return to the subject of talking therapies in a moment.

Last year I took part in the debate from a slightly different position—I spoke from the Dispatch Box. I was able to report some important progress. We had a new mental health strategy. We had the continued roll-out of talking therapies, which the hon. Member for Harrow West (Mr Thomas) just asked about. Groundbreaking work was being done to reinvent child and adolescent mental health services from the inside out, to offer access to talking therapies for children and young people. We had the flowering of a new movement to establish social recovery as a goal for mental health, with the establishment of recovery colleges channelling the lived experience of mental illness into practical learning and skills, and resilience to enable people to get on with their lives.

There was the good news that the Government had backed financially the task of Time to Change, the charity sponsored by Rethink and Mind, really motoring to tackle issues of social stigma in our country. Reports since then show that the first phase of that programme has materially altered public views about mental health in this country, but the programme needs to be sustained.

[Jeremy Corbyn (Islington North) (Lab)]

The right hon. Gentleman makes a good case for supporting Mind and other mental health charities, which do a very good job in changing attitudes to mental health. Is he not concerned, however, that many health authorities throughout the country are cutting funding to non-governmental organisations—voluntary organisations that do very good mental health therapy work, often on a contract basis? They are being cut, and therefore the opportunities for support for people going through crisis are reducing, not increasing.

[Paul Burstow]

Yes, I am concerned. The picture is complex. The figures show that spending on adult mental health services over the past couple of years overall has reduced by about 1%, which is not good, but deeper analysis of those figures shows that about half of commissioners have increased their investment and the other half have reduced their investment, so the picture is more complex than it first appears. None the less, it is concerning that services are being withdrawn where they involve providing peer support or reaching into harder-to-reach communities, particularly black and minority ethnic communities, which often get left behind and often are most prone to being subject to the most coercive parts of our mental health system. So I agree with what the hon. Gentleman said.

In the debate last year I was delighted to be able to signal the Government’s support for the Mental Health (Discrimination) (No. 2) Bill, which was introduced by my hon. Friend the Member for Croydon Central (Gavin Barwell). It is a rare thing—as we heard earlier in the business statement, only about 10 Bills last year which were introduced as private Members’ Bills made it on to the statute book. It was great that that Bill made it on to the statute book, and I congratulate my hon. Friend and all those involved in taking it forward.

I have referred to the mental health strategy for which I had some responsibility. At its heart is the radical—I might even say revolutionary—idea that there should be parity of esteem between physical and mental health. That idea is gathering momentum. We have seen the Government place that notion in the mandate for NHS England as a driving force for the way the Commissioning Board takes its responsibilities forward. It is increasingly on the lips of policy makers and service commissioners. But the recognition that there are critical interdependencies between physical and mental health still has a long way to go.

There are more than 4.6 million people in this country living with long-term physical and mental health problems, and far too often their experience of the NHS is that they are broken down into their constituent diseases, rather than being treated as a whole person. As a result, their physical health needs are treated in one place—in many cases, in many places—and their mental health needs, if they are identified at all, are dealt with in another.

[Mr Robert Buckland (South Swindon) (Con)]

I pay tribute to my right hon. Friend for introducing this welcome debate, which I hope will become an annual debate. He is making a very important point about the experience of service users and the lack of integration in dealing with their needs. Does he agree that we should be aiming for a well-being-based approach with a single point of entry, which will allow people to be signposted to appropriate services? That means local authorities, the health service and the third sector genuinely coming together in an integrated way.

[Paul Burstow]

The hon. Gentleman makes an important point about the need for a greater focus on well-being. It is one of the reasons why I am so pleased that the Care Bill which was introduced in the House of Lords last week has as its first and clear mission for our social care system the promotion of well-being, and it goes on to stipulate what that means in practice. It is about control and people’s ability to lead ordinary lives—the lives they want to lead in their communities. That must be at the heart of an approach to mental health that sees the whole person, rather than trying to treat them in constituent parts of the presenting conditions.

The point about failure to join up services is key. All too often, long-term physical health problems overshadow mental health problems. The results of that are all too clear—slow, and in some cases no, recovery and people living with long-term physical health problems that could have been better treated in the first place. The cost in wasted resources in our national health service is about £10 billion a year and up to a further £3 billion on medically unexplained symptoms.

[Mike Crockart (Edinburgh West) (LD)]

My right hon. Friend talks about the need for all services to be involved, starting with social care and local authorities. Does he agree that the process needs to start even earlier and move into education and training, enabling teachers to recognise when illnesses start to show themselves? One in 10 children aged between five and 16 now suffer from mental health problems, including eating disorders and self-harm—the types of problems that will blight their lives for decades afterwards.

[Paul Burstow]

I entirely agree. That is one reason why the Government have committed to the talking therapies service for children and young people that has so far been rolled out. I am meeting head teachers in my constituency tomorrow to discuss how we can ensure that they commission the right mix of services to support children and young people, not least because conduct disorders, for example, cost society hugely and hold young people back from realising their potential, academic or otherwise. That is undoubtedly the case with integration, which is a key theme of tackling these issues more effectively. That is why I welcome the fulfilment of the commitments made in last year’s care and support White Paper, which my hon. Friend the Minister announced earlier this week, regarding integration pioneers and the new integration framework.

Work on mental health must be embedded in physical health services, which must be embedded in mental health services. When we consider that people with severe mental illness die, on average, 20 years younger than the rest of the population, and that that is due mostly to physical health problems, we begin to understand just how profound that diagnostic overshadowing of mortality can be. It is a scandal and it needs to be addressed. I am delighted that the Government are taking many steps to tackle it.

[Dame Anne Begg (Aberdeen South) (Lab)]

The right hon. Gentleman is rightly concentrating on health services and how they can help mental health and well-being, but does he share my concern that other parts of Government, such as the Department for Work and Pensions, are exacerbating many people’s mental health problems through the way work capability assessments are being carried out, and that those people are having new mental ill health episodes as a result of the trauma of having to go through an Atos assessment?

[Paul Burstow]

Yes, and that issue, which I know is of concern to Members on both sides of the House through their constituency casework, for example, was raised in last year’s debate. Although some steps have been taken to try to improve those processes, they still do not seem to me to capture fully the important differences in dealing with mental health and, as a result, can exacerbate mental health problems. There is more to do in that area and I look forward to the Minister picking up on that issue. Given that the Cabinet committee that had co-ordinating responsibility for the mental health strategy, which is a cross-government strategy, is no longer in place, I wonder how tackling those sorts of issues will be co-ordinated in future.

It is worth noting that there are a considerable number of working-age people with a history of schizophrenia, for example, who are able and—I stress this point—willing to work. Indeed, Rethink’s schizophrenia commission identified employment rates in that group as being about 8%, with a range of 5% to 15% across the country, compared with the obviously much higher rates for the general population. Individual placement and support schemes, which are some of the most effective forms of employment support for people using mental health services, really can achieve remarkable transformations in people’s ability to take up employment. I hope that the Minister can say something on how such issues are being addressed with DWP colleagues, because that is where a cross-government strategy really should be making a difference, rather than simply addressing direct NHS provision.

[Mr Thomas]

Will the right hon. Gentleman give way?

[Paul Burstow]

I will give way one last time, but then I really must conclude.

[Mr Thomas]

I am grateful to the right hon. Gentleman for giving way a second time. Will he underline the importance of mental health trusts such as Central and North West London NHS Foundation Trust, which serves my constituents, working with the local voluntary sector such as the Mind groups in Harrow and Brent? Will he therefore encourage his Front-Bench colleague to look with particular interest at the letter I am about to write to him, raising the concerns of Mind in Harrow and in Brent about the trust’s failure to work properly with the services it is providing?

[Paul Burstow]

I note that the Minister paid close attention to that intervention and I am sure the hon. Gentleman will enjoy the exchange of correspondence on the matter.

I want to discuss the health care aspects of parity of esteem. Curiously, not all general hospitals have 24/7 access to a mental health liaison service offering immediate support, yet we know that when that works well it can make a big difference to the quality of care, help to reduce the length of stay in hospital, especially for older people, and generate savings four times greater than the cost of running the service. There are good examples of where this has been done, particularly in Birmingham, and it is odd, given such obviously compelling evidence, that it has not yet been taken up more widely.

[The Minister of State, Department of Health (Norman Lamb)]

I completely agree with my right hon. Friend. There is some very good practice, including RAID—rapid assessment interface and discharge—at Heartlands hospital in Birmingham, but there are too many places where there is a complete absence of such services. The starkest aspect of the lack of parity of esteem is that there is a good emergency service—it may be under pressure but it is there—for people with physical health problems but not for those with mental health problems. That has to be addressed.

[Paul Burstow]

I am grateful to the Minister. Perhaps in his own speech he can say a little more about how we might better incentivise this change. Despite the compelling economic and medical benefits, these services are still not being provided widely enough.

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

The more fundamental point is that a significant proportion of the money that is spent on mental health services in the national health service—about £14 billion—is focused on acute services. If we were to shift, say, 4% of that budget into community-based solutions and early intervention, that might have a much more dramatic impact on our ability to tackle the underlying problem.

[Paul Burstow]

The hon. Gentleman makes a good point. Indeed, that has been part of the approach taken in the talking therapies strategy, which is about moving the resource to where it will make the most difference at an earlier stage, and helping to promote recovery in the first place.

The Minister said that the emergency service is a stark example of where parity of esteem has not been achieved, and I want to give another example. The Royal College of Psychiatrists and its president, Sue Bailey, have been looking, on behalf of the Department of Health, at the whole issue of parity of esteem and what practical steps could be taken to address it, and it has recently published work on that. How can it be right, for example, that a recommendation by the National Institute for Health and Clinical Excellence on the availability of a drug is a must-do for the NHS but a NICE recommendation on the availability of therapies is not? This means that evidence-based non-pharmacological treatments that are clinically effective and cost-effective are often left unimplemented. I hope that that bias will soon be brought to an end.

The same can be said for access standards. There has rightly been uproar when even small changes occur in the amount of time people wait to attend accident and emergency departments. NICE has said that a person experiencing a mental health crisis should be assessed within four hours, yet only one in three people is so assessed. I am puzzled by the decision not to set a 28-day access standard for therapy, because the NHS constitution should embody parity of esteem, and that is a tangible way it could do so. Having said that, I take heart from the revised NHS constitution handbook, which said albeit it in a footnote:

“The Mandate indicates that we will consider new access standards, including waiting times, for mental health, once we have a better understanding of the current position. We need to do this work and consider carefully the implications of introducing any new standards, before we can make any firm commitments in this area.”

Why on earth is this problem still not being understood? Why do we need yet more reviews? Will the Minister give an indication of the time scale?

[Norman Lamb]

We clearly need to understand the scale of the problem of access. It is a bit shocking that we do not know the figures across the country for the number of people waiting and how long they are waiting. The mandate of the commissioning board requires that it must establish that and then set access standards. That is really important work, because there is a legal obligation to seek to meet the requirements of the mandate.

[Paul Burstow]

rose—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Can I help the right hon. Gentleman? We said that he would have 15 minutes, but we are now on 20 minutes and other people are waiting to speak.

--- Later in debate ---

[Paul Burstow]

Thank you, Mr Deputy Speaker. I was looking at the time and at my notes and thinking that I should conclude so that other hon. Members can contribute fully to the debate.

My final point concerns the power of data and the difference they can make. Will the psychiatric morbidity survey, which is due to be repeated in 2014, be repeated? I draw attention to the value of the cancer intelligence network, which has demonstrated the power and effectiveness of nationally co-ordinated data. Given that, as I have said, mental health accounts for 23% of the total disease burden in this country, it really would make sense to have a mental health intelligence network to bring together all the relevant data. I hope the Minister will address how that might be achieved.

In conclusion, estimates put the cost of poor mental health in England, Scotland and Wales at £116 billion, but the right combination of public health, sustained effort to tackle stigma, easy access to psychological therapies for all ages, and good community and crisis care could make a huge difference to that figure. More importantly, it could deal with and reduce the suffering experienced by people with mental problems as a result of our past failures. I hope the Minister will respond positively to this debate, and I am grateful to the other Members who wish to take part in it.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

I thank the shadow Minister for her contribution. I feel that this subject brings out the best in this place—we have had a well-informed, civilised and rational debate. There has been no political point scoring, just thoughtful concentration on an important subject, and I am grateful to all hon. Members.

Before I come on to the contribution of my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), I will say that I completely agree with the hon. Member for Hackney North and Stoke Newington (Ms Abbott) that the arrival of public health in local authorities presents us with an opportunity. The establishment of Public Health England brings its expertise to bear on its relationships with local practitioners in public health, working alongside other services. The potential for public mental health, which has been largely disregarded or ignored in too many places in the past, is real. At the conference for the directors of children and adult services in Eastbourne last October, I attended a presentation by an academic from the London School of Economics on the economic case for interventions in public mental health. There is a powerful return on investment, which means that people are benefiting from it. We have a great opportunity, and I am grateful for the hon. Lady’s comments.

The hon. Lady made important comments about black and minority ethnic communities and the mental health system, and I will come back to that. I appreciated the comments made by the hon. Member for Croydon North (Mr Reed), and I will refer to them later.

The hon. Lady raised the issue of suicide and young people. There are too many cases in too many hospitals where people who have self-harmed turn up and do not get a psycho-social assessment. We know that having that assessment, with the therapy that can follow, massively reduces the risk of suicide, yet only about 50% of A and E departments ensure that that happens. That has to change, because lives are literally at stake. We have to take this issue very seriously.

I am tremendously grateful to the Backbench Business Committee for giving us another chance to talk about mental health. I again pay tribute to my right hon. Friend the Member for Sutton and Cheam for leading the debate and for the great work he did in office to lay the foundations for the progress we are now tangibly making. The previous Government invested heavily in mental health, as well as the rest of the health service, and it is right to acknowledge that progress was made in that period. The focus on parity of esteem, and making it a reality, is potentially exciting. I was struck by an interview with Angela McNab, the chief executive of the Kent and Medway mental health trust, which is one of the larger mental health trusts. She said that the Government were

“prioritising mental health like never before, making sure that it fits on a par with physical health”—

and that this had come as a welcome step change to mental health professionals. That is an encouraging view from the front line.

My right hon. Friend raised several important points, including about recovery colleges. I am very interested in the whole recovery model and the role of recovery colleges. He also talked about the importance of the inspiring Time to Change campaign, which is part- funded by the Government. I mentioned earlier that I am encouraging all Departments to sign up to that campaign, so that we can lead from the front. We cannot expect private sector and other public sector employers to act properly if the Government do not lead, so it is important to demonstrate parity of esteem in the way that the Government treat employees.

My right hon. Friend also referred to the adult psychiatric morbidity survey. I can confirm that discussions are taking place between the Department and the Health and Social Care Information Centre and that it should take place in 2014. He also referred to the intelligence network. NHS England and Public Health England are developing plans and using the cancer intelligence network as a model, not necessarily to replicate, but to learn from. I am grateful to him for raising those issues.

The impassioned words that we have heard today show that within these walls lies the ambition, across all parties, to make the necessary changes, and I thank all hon. Members who have spoken about their experiences, views and, yes, even their criticisms. This sort of open debate can help to challenge stigma, scrutinise services and scrutinise commissioning decisions, which are critical in terms of how much money is allocated to mental health as against physical health and to ensuring that mental health remains a core priority not just for the Government, the House and the NHS and care system, but for the whole of society.

We have heard many good contributions. I shall write to hon. Members to respond to the substantive challenges and questions they have raised, but let me touch now on several quick points made today. The hon. Member for Bridgend (Mrs Moon) mentioned the importance of recognising the link between alcohol abuse and mental health. She talked about people who have left the armed forces with problems of post-traumatic stress disorder, which has become prevalent with the conflicts in Iraq, Afghanistan and so forth. Simon Wessely and his colleagues are doing some fantastic work on that.

The hon. Lady also mentioned the role of the police, particularly the Metropolitan police, and made the valid point that they are not trained well enough or systematically enough. Lord Adebowale, whom I met this week to talk about his report, makes the point that the police will always have to deal with mental health. It is not a question of it being wrong that they are dealing with it; the critical point is that there should be close working between the police and mental health services so that there is an immediate referral, not an inappropriate placing of someone in a police cell. Just imagine suffering from a mental health crisis and ending up in a police cell. It is the worst possible thing that could happen. Even children sometimes end up in police stations. It is totally inappropriate and avoidable—that is the important point.

The hon. Members for Broxbourne (Mr Walker) and for North Durham (Mr Jones), who have done so much to challenge stigma, have performed a valuable service in speaking out about their own experiences of mental illness. They have demonstrated, very visibly, that someone can be successful and make an enormous contribution to society, yet also have mental health problems. That is an incredibly important point. The hon. Member for Broxbourne talked about the role of employers and mentioned some really good employers, such as BT. This is about enlightened self-interest, not just about being kind to people. It is in companies’ and employers’ interests, including the Government’s, to treat mental health issues seriously. The cost to employers when those suffering from mental health problems lose their jobs—the loss of all the training and experience or just the sickness absence—is enormous, but it can be significantly reduced with a smarter approach. The hon. Member for North Durham talked about a number of individuals who have had mental health issues, but also been very successful. He talked a lot about the importance of tackling stigma.

The hon. Member for Croydon North (Mr Reed) made an important contribution about the treatment of black people by mental health services—the shadow Minister talked about that as well. There is something wrong that has to be challenged. The hon. Gentleman raised the case of Seni Lewis, which I am happy to talk to him about—I have surgeries on Monday night and we can discuss this. I have agreed to attend the Black Mental Health conference on police and mental health in June, because I felt it was important that I should engage in this whole issue and take it as seriously as it deserves to be.

The hon. Member for Totnes (Dr Wollaston)—I apologise for missing her contribution and a number of others—raised a number of issues. I will ensure that she receives proper responses to them. She talked about liaison psychiatry. While we are talking about emergency services, one thing that has become more and more apparent to me is the complete disparity between what happens to people with mental health problems and what happens to those with physical health problems. I was utterly shocked—but sadly not surprised—by a letter that a Member of Parliament in the south-west wrote on behalf of a constituent. The constituent had rung the crisis number for mental health services in his area and had not got a reply. No one was answering the crisis helpline. On another occasion they rang and were asked to ring back in half an hour. In the meantime that person could have committed suicide.

Then we come to what happens in A and E and the fact that in too many hospitals there is no mental health specialism available. Last Saturday I met a constituent who had found her son at home with ligature marks round his neck. She took him to A and E, where there was a half-hour conversation with a junior doctor before he was discharged home. The next day she found him hanging in her home. She is determined to pursue the complete failure of the system when something so dreadful can happen.

Whether we are talking about what happens when someone is picked up in the middle of a mental health crisis by the police and taken to a police station inappropriately, what happens when someone tries to get in touch with crisis services or what happens at A and E, we have to have an effective emergency mental health response system in place. This is a matter of real urgency, so I have asked all the relevant organisations—the Home Office, the Association of Chief Police Officers, the Department of Health, the Royal College of Psychiatrists and so on—to come together and draw up an agreed plan to tackle the most stark differences between the treatment received by people with physical health needs and that received by those with mental health needs.

[Paul Burstow]

That is a welcome announcement from the Minister about achieving parity of esteem in emergency and crisis care. However, in the wake of the Francis inquiry, which rightly drew our attention to serious patient safety and dignity issues in our physical health care system, I suspect that we will need to ensure that we are not distracted or led into not addressing the same issues—which clearly exist—in our mental health systems.

[Norman Lamb]

My right hon. Friend makes a very good point and I completely agree.

The hon. Member for Romsey and Southampton North (Caroline Nokes) spoke again about eating disorders—I took part in a debate that she secured in Westminster Hall. She talked about the role of parents, the nightmare of a child—I will call them a child—over the age of 16 deciding to refuse treatment and the horror that parents sometimes go through when they are not listened to sufficiently by clinicians dealing with their loved one’s condition. She also mentioned type 1 diabetes sufferers, and I would be interested to hear more about that.

My hon. Friend the Member for Harrogate and Knaresborough (Andrew Jones) is no longer here. Oh, yes he is! He has moved to a different place, just to confuse me. He talked about the low diagnosis rate for Alzheimer’s and dementia in his area. He also stressed the importance of the recognition of mental health by the Government, which I think he welcomed.

The hon. Member for Bolton South East (Yasmin Qureshi) talked about the importance of accessing appropriate and culturally sensitive care and treatment. That is incredibly important, as is getting the approach right for each individual and giving them the power to determine their priorities. She made those points well. She also stressed that the picture round the country was very variable. That is more the case in mental health than in physical health. Some areas have great services, some of which I have witnessed, but in others they are simply not good enough.

--- Later in debate ---

[Paul Burstow]

I thank the Backbench Business Committee again for enabling us to have the debate. I also thank those on both Front Benches, my hon. Friend the Member for Broxbourne (Mr Walker) and the hon. Member for Bridgend (Mrs Moon), and every other Member who has either intervened in the debate or contributed directly.

Today’s debate on mental health, like last year’s, has created and elevated a sense of hope. It has made it clear that there is a real commitment across parties in the House to do better and to do more: to enable people to gain access to the right care, at the right time, in the right place. That means starting early. It means starting in our schools. It means ensuring that when there is a crisis, we have an emergency service that is as good as our physical emergency services. I welcome what the Minister has said about that today.

A number of Members have suggested that this should become an annual debate. Clearly Parliament needs to hold the Government and the NHS Commissioning Board to account on these issues, and it would be good if we could find time every year to see just how much progress has been made.

It has been very interesting for those of us who follow Twitter to see just how many people have been tweeting about the debate. It has already extended well beyond the confines of this place, and that is to the good. I am pleased that so many Members have taken part, and I am very grateful to them. I hope we will eventually reach a place where there is no health without good mental health.

Question put and agreed to.

Resolved,

That this House has considered the matter of mental health.