Mental Health and Long-term Conditions

Peter Dowd Excerpts

Thursday 16th May 2024 Westminster Hall

[Peter Dowd (Bootle) (Lab)]

I beg to move,

That this House has considered mental health and long-term conditions.

It is a pleasure to see you in the Chair, Sir Robert. I thank all the organisations that wrote to me to provide information, statistics, views, observations and asks on this important matter of mental health and long-term conditions. I want to set out the list of organisations that wrote in, because the fact that so many did so is testimony to the importance and depth of this issue to so many of our constituents. They are: Parkinson’s UK, which requested the debate in collaboration with others, Impact on Urban Health, the British Psychological Society, the Cystic Fibrosis Trust, the Royal College of Psychiatrists, Marie Curie, Versus Arthritis, Genetic Alliance UK, the Juvenile Diabetes Research Foundation —a type 1 diabetes charity—Kidney Care UK, Kidney Research, the MS Society, Scope, Dementia UK, the Centre for Mental Health, the Royal College of Nursing, the King’s Fund, the Local Government Association and, of course, the excellent House of Commons research team, who produced a paper for this debate.

I hope I have caught all the organisations that wrote to me. If I have not, I sincerely apologise to them. The information they provided was very wide-ranging, fascinating, informative, comprehensive and, of course, at times very worrying. Rather than hear from me, I want hon. Members to hear from those organisations. I will quote pretty extensively from what they told me, and I will have asks for the Minister in due course.

People with long-term physical health conditions are more likely than the general population to experience mental ill health. That combination leads to poorer quality health outcomes and a reduced quality of life. The key to improving mental health outcomes in people with long-term conditions is integration between physical and mental healthcare to provide holistic support. As the Minister knows, the Government’s forthcoming major conditions plan contains a commitment to

“much closer alignment and integration between physical and mental health services” .

This debate is a timely opportunity for the Government to tell us more about what that looks like and how the NHS workforce plan will actually support that ambition.

We know that at any one time, up to 40% of people with Parkinson’s will have depression, and up to 30% will experience anxiety—considerably higher than the 17% of the general population who will experience a common mental health problem. The majority of people living with the condition told Parkinson’s UK that their mental health symptoms were the most distressing aspect of it.

Recent research commissioned by Parkinson’s UK found that from an audit of unplanned admissions at University College London Hospitals NHS Foundation Trust, the length of stay for people with Parkinson’s experiencing mental ill health was 29 days, compared with three days for those not experiencing mental ill health. More than two thirds of people affected by neurological conditions reported that their mental health wellbeing needs were not being fully met, and 67% of all respondents—children, young people and adults—to a Neurological Alliance survey said that their mental wellbeing needs were being met to a small extent, or most often not at all.

Diabetes is one of the fastest-growing health crises in the UK. Diagnoses of type 2 have almost doubled in 15 years, and there are now more than 5 million people living with that condition. Evidence shows that people with diabetes are twice as likely to experience depression, and that they experience it more frequently and for longer than the general population. Research suggests that about half of all people with multiple sclerosis will experience depression at some point in their life, and almost half of people with arthritis say that the pain often or always makes them feel down or depressed.

A 2022 survey by Kidney Research UK showed that of the more than 1,000 people who responded, 67% had experienced symptoms of depression, 27% had considered self-harm, and so on. It is not only quality of life that is hugely affected; the economic impact of this issue is vast in reducing people’s ability to work and in increasing health and social care costs.

That puts the issue in context. I want to quote a number of the organisations concerned. As I said at the beginning, I want hon. Members to listen to what people are telling us, rather than what I think they are telling us. That is important. It is the case that 153,000 people are living with Parkinson’s disease in the UK. That is often thought of as predominantly a movement disorder. However, between 50% and 60% of sufferers experience psychosis and 40% have depression. That is according to Parkinson’s UK. It says that those

“who experience anxiety and depression found communication barriers between”

health

“departments, difficulties accessing patient notes, and a shortage of mental health professionals with the knowledge and skills”

to meet their specific needs.

Impact on Urban Health talks about 15 million people in the UK having one long-term condition and about 3 million living with three or more. It says:

“Poor physical health is inextricably linked with poor mental health, and both can be exacerbated by social context, or in other words where and how we live.”

The British Psychological Society says:

“There is a growing evidence base demonstrating the benefits of developing the psychological workforce within physical health care service provision to support earlier intervention, interdisciplinary programmes of care, and a focus on health distress and psychological adjustment as part of rehabilitation and recovery.”

The Cystic Fibrosis Trust says that, in regard to out- patient care,

“the paediatric CF service specifications say ‘there should be access to psycho-social support’ and the adult CF service specifications say ‘there will be access to psycho-social support.’”

Its ask is this:

“Everyone with CF must have access to a CF social worker and clinical psychologist, as and when needed, and not just at their annual review, as NHS service specifications state.”

The Cystic Fibrosis Trust indicates that this is not something that just comes and goes; it is there all the time for many people.

The Royal College of Psychiatrists talks about how having a physical illness can also have a negative effect on how someone thinks and feels. There are impacts in relation to stress, the sense of self, relationships, and understanding of the world. It says:

“Research has shown a link between mental illnesses and certain physical illnesses”

such as cancer, diabetes, asthma, high blood pressure and epilepsy.

Marie Curie says:

“While parity of esteem between mental and physical health is enshrined in law it is not yet being realised. There is limited access to mental health support, insufficient training for health and social care professionals and poor integration of palliative care and mental health care. The Government must centre integrated mental and physical health care within their plans for improving health care.”

The Versus Arthritis organisation says that depression is four times more common among those with chronic pain than those without pain—I do not think that is surprising—20% of people living with osteoarthritis experience symptoms of depression and anxiety, and 33% of people living with rheumatoid arthritis have mental health problems such as depression or anxiety. It says:

“Stress is also a significant factor for people living with arthritis.”

One of its service users, Richard, said:

“I didn’t appreciate just how big an impact my arthritis had on my mental health until I became pain-free. The pain took up so much of my headspace without me realising it. Living in constant pain is incredibly draining because it’s always there, which makes it difficult to enjoy everyday moments.”

Genetic Alliance UK, which colleagues have an interest in, talks about rare conditions that are

“individually rare but collectively common”,

with more than 3.5 million people in the UK living with a rare condition. It says:

“Rare conditions can be life-limiting and life-threatening. Due to their rarity, services are significantly underdeveloped to support people affected by them.”

It also says:

“Almost half of people living with rare conditions and their carers have never been asked about their mental health…and families report being denied access to mental health services due to the complexity of their needs associated with having a rare genetic condition.”

Its solution is:

“It is necessary to urgently improve awareness of rare conditions among healthcare professionals and social care services.”

The diabetes charity Juvenile Diabetes Research Foundation talks about coping strategies:

“Seeking support from healthcare professionals, including doctors, nurses, diabetes educators, psychologists, and social workers, is crucial in developing effective coping mechanisms tailored to individual needs.”

Kidney Care states:

“Addressing the mental health and social needs of kidney patients requires a multi-layered approach combining clinical, community, and policy initiatives. Implementing our recommended strategies will lead to improvements in the overall wellbeing and quality of life for people living with kidney disease while reducing the burden on the NHS.”

I have often heard the word “burden”, but I do not think it is a question of being a burden; it is a question of people’s right to have care, as and when they need it—I never see that as a burden. Kidney Care went on:

“We cannot let the repeated absence of appropriate mental health and social support continue. Now is the time for us to act to ensure that people living with kidney disease get the help they need.”

Kidney Research UK states:

“Having a long-term condition dramatically increases a person’s risk of mental ill health…Having poor mental health as well as a long-term condition leads to worse outcomes for a person’s physical health.”

A thread runs through every single one of these narratives.

According to Dementia UK:

“70,800 people in the UK are estimated to have young onset dementia, when symptoms develop before the age of 65. Yet people affected by young onset dementia remain a hidden population with unmet health care needs.”

It recommends:

“The Government must mandate every”

integrated care system

“to develop a young onset dementia pathway—putting those of working age with dementia at its heart. This includes providing a timely and accurate diagnosis, immediate post-diagnostic support and a co-ordinated care plan”,

because the impact on people’s and families’ mental health also has to be taken into account.

Moving on, Scope wrote that

“we have been extremely concerned about the recent proposals from the DWP following the Prime Minister’s ‘sicknote culture’ which heavily focused on people with mental health conditions. These proposals look to make the benefit system even more hostile, with it becoming more difficult for disabled people to claim the amount they need”.

Basically, that puts more and more stress on people. Scope describes a benefits system that is “dehumanising, stressful and complex”, which impacts on people’s mental health.

Crohn’s and Colitis UK talks about people with inflammatory bowel disease, who are

“twice as likely to experience mental health problems.”

Mental health can be affected in different ways, but the organisation adds:

“Despite the clear impact, most people with Crohn’s or Colitis don’t have access to psychological support…as part of the IBD specialist team.”

Again, that theme runs right through.

The MS Society briefed on mental health and multiple sclerosis:

“People with MS are likely to experience mental ill-health. A survey of the MS community carried out in MS Awareness Week in April 2024 found that nearly half…of respondents experienced mental health difficulties as a symptom of their MS.”

It recommends that the Government

“develop and implement a neurological conditions Talking Therapies pathway”

and

“a training package for the neurological workforce on mental health awareness.”

Kidney Research UK says:

“There are an estimated 7.2 million people living with kidney disease”

in the United Kingdom. It wants the adoption of

“a tailored approach to mental health care through a stepped model that becomes more specialised as needs increase”.

It also wants increased Government funding

“for research into the relationship between kidney disease and mental health to enable the ongoing development of essential services.”

The Royal College of Nursing also wrote to me. It talked about parity of esteem:

“Our members have previously suggested that there is risk in over-emphasising the need for ‘more counselling and brief talking therapy’ without parallel and sufficient investment in services that can help ensure parity”.

I am coming to a conclusion. The King’s Fund talked about a “360-degree review” that looks at prevalence, access, workforce, funding, costs, quality of patient experience, acute mental healthcare for adults, services for children and young people, inequalities, and data. I understand that the Local Government Association has already put its submission on the major conditions strategy in to the Government, but it is sure to talk about taking a whole-systems, assets-based approach.

I have done a Cook’s tour of what organisations have said. There is much more, and I am more than happy to send the documents I have to the Minister so that she or her staff can read them to get a feel for what organisations are saying.

Finally, I thank the House of Commons Library for its briefing, which basically says that people with serious mental illness

“in England die on average 15 to 20 years earlier than the general population. Major causes of death in people with SMI include long-term physical health conditions including diabetes, hypertension, respiratory and cardiovascular disease.”

The thread I talked about runs through every one of the submissions I have read out, and I am sure the Minister has listened to all that I have said. More importantly, I have repeated and put out to hon. Members what all those organisations have said—it is not what I say, but what they say—and I hope she will listen carefully to it.

--- Later in debate ---

[Peter Dowd]

First, thank you for your excellent stewardship of today’s event, Sir Robert. I thank my hon. Friend the Member for Blaydon (Liz Twist) and salute her commitment to the rare diseases field, which I know she works very hard on. I also thank my hon. Friend the Member for Birmingham, Perry Barr (Mr Mahmood) for his compelling articulation of his personal experience. I think that we would all like to thank him for that. I also thank my hon. Friend the Member for Erith and Thamesmead (Abena Oppong-Asare) for her response. And, of course, I thank the Minister for listening and responding. Finally, a big thanks to all of the organisations that I mentioned earlier.

Question put and agreed to.

Resolved,

That this House has considered mental health and long-term conditions.