Mental Health

Peter Bottomley Excerpts

Thursday 14th June 2012 Commons Chamber

[Mr Jones]

The hon. Lady makes an important point that should be considered. That is where we need to join up the two relevant Departments.

Mental Health North East has carried out a survey and I thank that organisation and Derwentside citizen’s advice bureau for the examples I am going to use. Like the hon. Member for Loughborough, I asked whether I could use names. One person said that I could, but late last night she rang me to say no. I am sure that people will understand why I use letters to refer to these individuals rather than their names.

The first case is that of Mr A, a 50-year-old man who lives alone and received ESA. He suffers from depression, anxiety, agoraphobia and anger issues. Despite the support he is getting and the drugs that he is taking, he was called by Atos to a work-related interview. He got no points at all even though he finds it very strange to go outside the house, let alone to interact with people. He decided to appeal and attended the appeal. There is a huge backlog in the appeals system that is adding to people’s anxiety as they are having to wait a long time, and the pressure on citizen’s advice bureaux and local welfare rights organisations to support those appeals is creating a crisis in some of them. When I give some of these examples, Mr Speaker, you will see that they should never have gone to appeal in the first place.

This case was very interesting. Mr A turned up at the appeal, which, as my hon. Friend the Member for Islington North mentioned earlier, caused him huge stress as he thought he was going to lose. He turned up in the afternoon, and his appeal had been heard that morning without his being present and his award had been granted on the basis of the medical evidence. If the appeal hearing could do that, why could Atos not do so? The reason is that Atos is not taking medical evidence into account at all.

The second individual is from Stanley in my constituency and I have known this young lady since she was in her early 20s.

[Sir Peter Bottomley (Worthing West) (Con)]

In the hon. Gentleman’s example, was Atos setting its own procedures or was it following the instructions under the contract?

[Mr Jones]

Having seen the form, I think it was according to the contract, and this is where things need tweaking. We need a special form for people with mental health issues, rather than using the generic form for people with other disabilities, too. That is the important point that needs to change.

Miss B, as I will call her, is 36 and a single parent who lives in Stanley in my constituency. She has a very supportive family and receives huge support from her local Sure Start and her local community mental health team. She has been unemployed, suffers from bipolar depression and is on a cocktail of medication. Although everyone has been told not to contact her directly but to contact her mother, Atos contacted her directly. She lives independently just down the street from her mother, which is good, but everyone has been told to contact the mother because she does not quite understand. When Atos contacted her with a telephone request for interview, according to her mother it sent her into an absolute panic. If her neighbour had not been there to help her, it would have caused huge problems.

Miss B went to the interview and failed it, getting no points. She is now having panic attacks, she has had episodes where she has felt suicidal, and without support her child would have been taken into care. She was nearly hospitalised because of the stress. She has now had to wait upwards of eight months for her appeal to be heard, but in the meantime, and not just because of the ESA, her housing benefit has been stopped so she is in debt. It is one thing after another, which is not what someone with severe mental health illness needs and that is why we must refine the system. That woman has been waiting for an appeal for eight months now and, knowing the case as I do, I have no doubt that she will win.

My final example is Mr J, a 52-year-old who suffers from mental health illness, partly as a result of his separation from his partner a few years ago. He suffers from very severe depression and is on antidepressants. He has tried to help himself by going to cognitive behavioural therapy sessions. In January 2012, the Department for Work and Pensions wrote to ask him to attend an Atos interview, which caused him to withdraw from his treatment programme. That was not good for him. Very insensitively, Atos then rang him on Christmas eve to organise the appointment. Again, despite the fact that a lot of medical evidence was presented, Atos did not take any of it into account.

There is another thing that Atos is getting completely wrong, or at least has an inconsistent approach to. Mr J took his son, who is one of his key supporters, along with him and asked whether he could make representations on his behalf. He was told no. In other cases, people have taken their community psychiatric nurses with them only for them to be told to sit outside the interview while the individual goes in. Atos is being inconsistent in its approach and is clearly not taking on board any of the medical evidence that is put forward. Mr J appealed and, as in the first case I cited, the appeal went through on the basis that the medical evidence presented was good enough. What is Atos doing? What concerns me about these cases is the cost not just to the individual but to the health service and the local NHS.

Let me highlight the findings of the survey I mentioned and read some quotes from it. In response to a question about whether medical evidence was taken into account, someone said that it was “not even looked at.” Another response was:

“Not at all and there was a great deal including an advocate (myself) attending the Medical. Nothing that I said”

seemed to make a difference. Yet another:

“Generally, clients feel that mental health is not taken into consideration”

and is not being focused in the way that physical disabilities are.

“Most clients believed that their own medical evidence had been completely disregarded”

at the interviews they attended. Another issue that was commonly raised was how little time it took—less than 15 minutes in most cases.

Question 6 asked about the impact on individuals. Let me quote some of the answers directly:

“Despair. Resignment to the cruelty dished out”

by the system.

“Very distressed, anxious, scared”.

“Very stressed, confused, angry and frightened as you can imagine, these people are already existing below the poverty line”

and this increases stress levels.

Judging by those examples, the system needs to be changed. It is inefficient, it is causing huge problems for individuals, and is also costing the system more. What we need to do, possibly through the Department for Work and Pensions and the Department of Health, is come up with a specific work test for people with mental health issues, and recognise that individuals have to be supported.

Now I am going to throw my notes away—I thought long and hard last night about whether to do this—and talk about my own mental health problems. 1n 1996, I suffered quite a deep depression related to work and other things going on in my life. This is the first time I have spoken about this. Indeed, some people in my family do not know about what I am going to talk about today. Like a lot of men, I tried to deal with it myself—you do not talk to people. I hope you realise, Mr Speaker, that what I am saying is very difficult for me.

I have thought very long and hard about this and did not actually decide to do this until I just put my notes down. It is hard, because you do not always recognise the symptoms. It creeps up very slowly. Also, we in politics tend to think that if we admit to fault or failure we will be looked on disparagingly by the electorate and our peers. Whether my having made this admission will mean that the possibility of any future ministerial career is blighted for ever for me, I do not know. I was a Minister in the previous Government and I think that most people on both sides of the House thought I did a reasonable job.

We have to talk about mental health issues in this place, including people in the House who have personal experience of it. As I have said, I thought long and hard last night about doing this and I did not come to a decision until I put my notes down just now. Whether it affects how people view me, I do not know; and frankly I do not care because if it helps other people who have depression or who have suffered from it in the past, then, good.

Politics is a rough old game, and I have no problem with that. Indeed, I am, perhaps, one of the roughest at times, but having to admit that you need help sometimes is not a sign of weakness. I also want to say to you, Mr Speaker, that we need to do more here to support Members with mental health issues. In terms of occupational health, we have an excellent individual in Dr Madan, who understands mental health issues very well. I know of only one other Member who has suffered from mental health problems because a colleague on the Labour Benches has spoken to me about her mental health issues and depression, but it is important to get the message across to individuals that if they are having problems they can go and see Dr Madan and her team.

May I also highlight to you, Mr Speaker, the problems that Dr Madan has with getting funding for treatment afterwards? The hon. Member for Loughborough mentioned drugs, and they are part of the answer, but they were not the solution for me. Things like cognitive behavioural therapy can be far more effective. As I learned over many years, it is about how you think. Dr Madan raised an issue with me regarding an individual for whom she was trying to get funding, but the House authorities were not prepared to do it. If she comes to you, Mr Speaker, regarding any Member who wishes to have mental health support you have to say yes because it is not easy for Members of Parliament to go to their own GP or local community to talk about these issues. Sometimes, it is perhaps better for them to have treatment and find solutions here rather than in their constituency. That is a plea to you, Mr Speaker, and I would be grateful if you took that on board.

As I have said, I do not know whether I have done the right thing. Perhaps I will go home tonight and think I have not, but I think I have. I hope that it does not change anyone’s view of me. Most people might think, “Christ, if it can happen to him, it might happen to anybody.” On that note, let me put on record my thanks for the opportunity to debate this issue. Let us go out and champion this issue.

Finally, let me say to every hon. Member present and to those who are not present that although being an MP is a great privilege—I have always thought that; it is a great thing that I love—it also has its stresses. Unless someone has done it, they do not know what those stresses can be personally, in terms of family, and in terms of what is expected of us in the modern technological age. A little more understanding from some parts of the media and some constituents about the pressures on the modern-day MP would be very valuable.

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[John Pugh]

I think that the expression used nowadays is “issue”.

[Sir Peter Bottomley]

The hon. Gentleman and I would probably agree that it is an experience.

[John Pugh]

We will settle for “experience”, then.

I congratulate the hon. Member for Loughborough (Nicky Morgan) on introducing the debate, although she omitted to mention the Mental Health Act 2007, over which the House laboured long and hard to, I hope, some good effect.

In the 18th century, it was possible to cross the river to Bedlam and gawp at people gesticulating, ranting, performing odd rituals, talking to no one in particular, exhibiting delusory beliefs in their own power, or expressing paranoid fears about their foes. The nearest 21st-century equivalent is probably Prime Minister’s Question Time. [Laughter.] That is not an entirely facetious point. The dividing line between robust mental health and mental illness is, in fact, a fine one. Statistics show that the bulk of people of working age who either report or are diagnosed with mental health problems are not, in general, those who suffer from the terrible scourge of schizophrenia. The hallucinations and delusions often associated with that disease currently affect less than 1% of the population, and are treated more benignly and more effectively than ever before. Moreover, numbers are not substantially on the increase.

Most mental health problems occur when the anxieties, the fears, the stresses and the dark moods to which we are all prone become insupportable, prolonged and disabling, and the individual is no longer able to cope in any ordinary sense but breaks down and loses control, social capacity and, sometimes, insight into his or her condition. That is on the increase: it is the major mental health challenge that we face.

Mental health is a genuine continuum. The mentally ill do not have viruses, germs, cellular patterns or physical impairments that the well do not have. They have the same gamut of emotions that we all have—often exaggerated, accentuated or uncontrollable, but in no way unique or uncommon. We all possess a shared vulnerability to mental health issues which could be described as a tendency to neurosis, managed with differing degrees of success at different times in our lives. That is why I took issue with some of the comments made by the hon. Member for Loughborough.

There is a nugget of truth in the American belief that we could all benefit from an element of psychiatry. As I have said, we share a common vulnerability, and for a variety of reasons—fairly complex in many cases—one in four, or one in six, citizens falls victim to that vulnerability. We have learned not to be too judgmental about those who do, and not to stigmatise them. We recognise that the vulnerability they display is often a product of circumstance, and that it is as frequently related to desirable traits—empathy and sensitivity, for instance—as to undesirable ones such as self-obsession or lack of self-control. However, although that recognition is now widespread, it does not eradicate stigma, nor does calling everybody “service users” as if they are some kind of consumer, and nor does saying mental illness is just the same as physical illness, because it is not.

The big problem for those with a record of mental health issues—particularly, perhaps, in respect of the workplace or getting off benefits and back into the workplace—is the bias of the wider world in favour of those who have not illustrated our common vulnerability. That bias is rather like having a—rational—preference for people with a stronger immune system. There are other vitiating factors at play, of course. People who suffer from mental illness often suffer from a lack of confidence, for example. There is also the fact, which has not so far been acknowledged, that a mental health diagnosis can sometimes be misused for employment and benefit reasons. The big problem is this bias and discrimination, however.

There are only two real remedies for that. One is better public education about what mental health actually is and what mental illness and frailty actually are. I would put more faith in the second remedy, however: having a public mental health campaign that is geared in positive directions, as described by the hon. Member for Loughborough. Having said that, we must acknowledge that the active pursuit of mental well-being is a bigger and more significant task than we currently recognise. Corporate Britain, business Britain and every public service in Britain needs to be seriously engaged with the Layard agenda and to accept that we need to promote well-being at work—including here in Parliament. We must create a wholesome workplace, and therefore bother about the happiness of the workplace and the individuals in it.

We may need to tackle a huge fallacy, however: the idea that we either have mental health or we do not, so we are either employable or we are not. That ignores the fact that many people in employment—in senior jobs, even—have mental health issues, some of which might not always be diagnosed. Sometimes they work them out in the office and the workplace in a wholly unsatisfactory way, and sometimes to the detriment of their colleagues—although not always, in certain professions, to the detriment of customers and profits. Sometimes people mask their symptoms and problems through alcoholic self-medication.

There was a time when employers would have walked away from considering issues such as personal safety at work, and there was a time when they would have walked away from issues of employment legislation and the rights of people at work. Nowadays, however, most employers are keen to stick “Investors in People” logos on their notepaper to show that they are a good employer in that respect. The next, and most obvious, stage is the pursuit of the wholesome workplace, in a move beyond the “Investors in People” initiative. That must be encouraged by public health bodies and by large public and corporate organisations. Indeed, to some extent it already is encouraged: 41% of large companies now have a mental health policy. That represents appreciable progress.

For most of us, work is where we spend most of our time, and it is where our feelings of self-worth are either confirmed or demolished—that is certainly true of this place. It is where people find meaning to their lives—although we do not always succeed in doing that here. Indeed, we in Parliament cannot honestly say our working environment is wholly conducive to good mental health.

Let me conclude by reiterating my key point: we cannot help people with mental health issues without making it manifestly clear that in everyday work and everyday life mental health is everybody’s issue.

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[Sir Peter Bottomley (Worthing West) (Con)]

It is a delight to congratulate the hon. Member for Vale of Clwyd (Chris Ruane) on his speech. We are having a debate of which the previous speakers and the Backbench Business Committee should be proud. I missed out on a lunch the other day and went with my hon. Friends the Members for Broxbourne (Mr Walker) and for Loughborough (Nicky Morgan) and others to appear in front of the Committee. They were tough and they were clear. We made our point that the subject needed a debate, and the issue then was whether it should be in Westminster Hall or in the Chamber. I think that if it had been in Westminster Hall, the impact would not have been so great.

When I was first elected to the House of Commons, if a Member of Parliament was thought to have gone mad, the Speaker would refer them to two people nominated by the Royal College of Surgeons. One of my early interventions was to suggest that psychiatrists might be rather more useful. If the Bill taken up by my hon. Friend the Member for Croydon Central (Gavin Barwell) gets through, perhaps that approach will be thrown away in turn.

Again when I was first elected, The Times and The Daily Telegraph would report debates and pick up a good point from everyone’s speech. If that happened after today’s debate, people’s understanding of the experiences of the lack of mental health, and of more extreme, occasionally disabling mental illness would become greater, deeper and wider. That would give comfort to the hundreds of thousands of people who care for people who are experiencing the lack of mental health.

[Andy Burnham]

I apologise for interrupting the hon. Gentleman so early on, but he is making such an important broader point about media coverage of mental health. Would he want to pay tribute to the Sunday Express, which has led a campaign that was mentioned by the hon. Member for Loughborough (Nicky Morgan)? One would not necessarily expect a newspaper to run a mental health campaign, yet it has. That is precisely the kind of media leadership that we need to see on this issue.

[Sir Peter Bottomley]

I join the right hon. Gentleman in saying that. I was trying to say things that had not been said already, and there has already been a tribute to the Sunday Express. I would add that several journalists have been prepared to speak about their own medical conditions that have challenged their ability to live or to work effectively. I am not saying that we should all have to spend our time saying what our physical or mental experiences have been, but it does help if it is regarded as being as normal to talk about having had an episode of depression as of having had a basal carcinoma removed or having recovered from a broken hip.

I pay tribute to the hundreds of thousands of people who care for those experiencing the lack of mental health. I also pay tribute to the professionals, particularly to Lisa Rodrigues, who is chief executive of the Sussex Partnership Trust. She has spoken of the services it provides across East Sussex, West Sussex, Brighton and Hove and Hampshire, and the 27,000 young people with whom she and her colleagues come into contact each year. They are not all experiencing real disability, but some will.

When I became roads Minister, one of my ambitions was to try to get the number of road deaths down below the suicide rate. Young people’s suicides number about 900 each year. The total number of road deaths among adults and young people is 1,800. The road deaths figure has come down from 5,600 a year to 1,850. Would it not be good if we could do the same thing for self-destruction and the penalties that that imposes—not only the shortened life but the damage to those around the person who has died?

My wife was a psychiatric social worker before she became a Member of Parliament, a Health Minister, and then Secretary of State for Health, when she took mental health issues very seriously. She worked with those at the Maudsley Institute of Psychiatry where, with one of her colleagues, Peter Wilson, she ran a support service for teachers. If we are to start being concerned with young people, we need to make sure that those who are in contact with them—parents, and teachers in primary and secondary schools—have an understanding of what is normally unhealthy, if I can put it that way.

One young person in four experiences some kind of mental health episode. We need to know how much of that involves a relatively normal experience from which they will recover. We also need to identify the one in 10 who will probably need help from someone with experience or specialist qualifications, and the 2% or 3% for whom the experience will be disabling.

YoungMinds is an association with which Peter Wilson was associated—I think he might have created it. It has a manifesto in which young people say that if they can get help when they are young, many more of them could be kept out of prison and psychiatric hospital, and kept in work and leading the kind of life that contributes to society.

I once met someone who had had experience of schizophrenia. There was a fine mental health project just outside my former constituency, and he told me that he was glad to have got to know about it. He became a client of the project. Six months later, he became a volunteer. A year later he wrote to tell me that it was the proudest moment of his life, as he was now a taxpayer with a paid job. He was given the opportunity to take those steps forward, in an environment in which everyone knew what was happening and could share in it and give support when appropriate. Those opportunities matter.

Had there been more time, I would have been tempted to talk about a range of issues, giving a sentence or two to each, but I do not think that that will be possible. I would say, however, to those who suffer at times, or constantly, from depression, anxiety, obsessive compulsive disorder, phobias, bipolar disorder, schizophrenia or personality disorders—I could go on—that information on most of those conditions is available on the websites of the organisations that provide help.

About 31 years ago, I was appointed to the council of Mind, formerly the National Association for Mental Health. The reason for that was that the then Conservative Government wanted to give the organisation their support, and its then general secretary was thought to be left-wing; I was there to provide balance. I am not sure how my Whips would regard that decision today.

The Mental Health Foundation does good work, and I also pay tribute to the Samaritans for the help that they give to people about whom they are concerned. Their website contains information on how we can help someone, even if we are untrained. It suggests avoiding the “Why?” question, as that can be regarded as challenging. Instead, it suggests asking:

“When—‘When did you realise?’ Where—‘Where did that happen?’ What—‘What else happened?’ How—‘How did that feel?’ In an ideal world what would you like to happen next? Would you like me to come with you?”

Standing beside people in that way can be a pretty effective approach.

I want to give the House one or two examples from the weekly newsletter from Lisa Rodrigues of the Sussex Partnership Trust. I try to send it on to two or three other people each week, to whom some of the points might be relevant. One week she talked about cancer, describing how, in the 1950s, Sir Richard Doll and others had started to examine the causes of lung cancer, and to realise that asbestos could also have a serious effect on breathing. She wrote:

“So why am I talking about cancer? It is because today dementia is where cancer was all those years ago…Why Sussex? Because we have the highest percentage of old people in the country living here. And why me? Because specialist mental health services hold the key to unlocking the potential in primary care, acute hospitals, local authorities, the voluntary and nursing home sector to provide better treatment and care to people with dementia, and support for their families.”

Lisa Rodrigues also recently attended a conference on how to get the various groups to work together more effectively, which is vital for people and their families and carers. If only they could find a one-stop shop to refer them to a place where they could be embraced as a person, a household or a family unit. She said that if we could get our mental health services working more effectively, our physical health services would have far less to cope with. That point has also been developed by other hon. Members this afternoon. She also wrote in her newsletter:

“We have a dream. In our dream, our psychiatrists, nurses, social workers, psychologists, therapists, care staff, receptionists and anyone else who comes into contact with the 100,000 people we serve each year will have the best possible tools to do their jobs. This will include a small, lightweight…portable device via which they can access patient records”

and the background of all the people they are in contact with. Up to now, that has not been possible.

Lisa Rodrigues talks every two or three weeks about employees who have done something special. In one example, she talks about the staff who have worked on a clinical reception and their helpfulness to patients and other visitors. She goes on to mention a person whom I have not met called Jackie Efford, a nurse in the health team at Lewes prison, who

“works flexibly so that, when prisoners arrive late into the night, she comes in to assess them and respond to any urgent physical or mental needs. Imagine being a prisoner and what a difference it would make to have a meeting when you first arrived with a compassionate and effective nurse.”

Lisa Rodrigues also talks about the child and adolescent mental health services. She says that the name is

“no longer fit for purpose. The word adolescent has negative connotations. And young people don’t respond positively to the term mental health.”

We must find the right language, not for political correctness, but to help people more effectively.

It would be easy to say more on this issue. However, I want to end by saying that if we have to wait another year to develop these themes, Parliament will not be doing its job properly. We should not have to rely on the pleading and cajoling that we provided at the Backbench Business Committee. Debates on this matter ought to be built in, rather than bolted on.

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

I, too, congratulate my hon. Friends the Members for Loughborough (Nicky Morgan) and for Broxbourne (Mr Walker) on securing this Backbench Business debate in the first place. Indeed, this is an historic moment, for the simple reason that it must be the first time that three former association officers of the Battersea Conservative association have found themselves speaking in the same debate.

[Sir Peter Bottomley]

It won’t happen again.

[Oliver Colvile]

I am sure my hon. Friend is quite right.

I have followed this issue very closely, because in my maiden speech I gave a pledge that I would try to raise the issue of mental health for our veterans during the course of my time in the House of Commons, however short or long that might end up being. I hope very much that I have been good to my word. Only too often when we have had debates on mental health or veterans issues in the House, we have found that it has been the Armed Forces Minister answering, and although he has always done a brilliantly good job of explaining what is going on, the debate has unfortunately never had a joined-up feel about it—for instance, by including Ministers from the Department of Health. That is why I very much welcome this debate.

I congratulate both the hon. Member for North Durham (Mr Jones) and my hon. Friend the Member for Broxbourne on their sheer candour in speaking about this issue. If we could capture my hon. Friend’s energy, we would sort out the national grid once and for all.

I recently had a Falklands veteran come to talk to me about how he feels he is being discriminated against in his benefits. That is something we most certainly need to look at as a House. My interest in this whole matter began in 2000, shortly after I was selected as the candidate in Plymouth, Sutton, when I went out with the people from one of the churches and saw them handing out soup and sandwiches to various people. Plymouth, being a major—indeed, principal—naval port, most certainly has a lot of veterans issues. There was a man on that occasion who had left the Army and was sleeping rough. He had come across real problems because he had taken to drink—he had obviously taken to drugs as well, which was also a very big issue.

Indeed, when my father served in the Navy—he went in as a boy sailor at the age of 14, serving in Dartmouth and subsequently in the second world war—he had the job of picking up the head of a man he was sharing a cabin with and throwing it over the side, into the sea. I think that would most certainly have given me the heebie-jeebies, I can tell you that, although it did not seem to affect him at all.

A number of Members have made a series of points in this debate which I fully agree with. I was going to talk a little bit about the position now, as we commemorate the Falklands war, 30 years on, but my hon. Friend the Member for Mole Valley (Sir Paul Beresford) has already dealt with that. However, we have to recognise that the families are the first people to get to know whether mental health issues are arising and how combat stress affects them. We need to remember that at the time when my father ended up having to deal with these issues, there were no mechanisms in place to look after his mental health or even try to take it forward. As others have said, my hon. Friend the Member for South West Wiltshire (Dr Murrison) has produced a very good report, which has very much formed the basis of Government policy in this area.

I ended up talking to Mind during the course of the last few days. The hon. Member for Plymouth, Moor View (Alison Seabeck) and I are speaking as one, as she made the point that the amount of money devoted to mental health in Plymouth is an issue. It seems that money has been taken away from mental health to be given to those who suffer from physical ailments. I think that we most certainly need to look at that.

Last week, during the jubilee recess, I visited the Glenbourne mental health unit at the Derriford hospital. I was told that it had seen a significant rise in the number of people with mental health issues, especially from the military, and I was told how important it was to ensure that something was done about it.

We must make sure that we adopt a proactive campaign so far as stress and mental illness are concerned, and that we give our support to those organisations that are in the business of delivering it, while also ensuring that we have trained GPs to look after people. The Jesuits have a saying, do they not—“Give me the child until the age of eight, and I will show you the man”. That was very much the issue that my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) raised in her contribution, for which I was grateful.

Let me finish on a small note. We need significantly more joined-up government between Departments. We should not be talking only about the Ministry of Defence, but about the Department of Health, the Ministry of Justice and the Department for Work and Pensions. If we can do that, we can make real progress.