Mental Health

Robert Buckland Excerpts

Thursday 14th June 2012 Commons Chamber

[Nicky Morgan]

I am not sure that I entirely agree with the hon. Gentleman. I agree with him that people often enter the system at a time of crisis and experience a single episode, but others who experience episodes will get better. For years they may have no problems at all. The hon. Gentleman shakes his head, but I can tell him on the basis of the experience of constituents and family members that it is possible to go in and out of the system. One of the hardest things for people to accept when they are diagnosed with a mental health condition is that they will be on drugs for years and years. That is often difficult for people to admit, particularly when they are striking up a new relationship or working for a new employer. I think that that is why people want to have a voice in the way in which they are treated.

According to Mind, people are three times as likely to be satisfied with their treatment if they are presented with a choice of treatments, and failure to stay on medication is the main cause of relapses, when people often have to re-enter the system at a time of crisis. There is a need to work with and trust health professionals. According to a recent study by the university of Kent,

“Low levels of trust between mental health patients and professionals can lead to poor communication which generates negative outcomes for patients, including a further undermining of trust”,

and

“trust can play a significant role in facilitating service users’ initial and ongoing engagement with services, the openness of their communication, and the level of co-operation with, and outcomes from, treatment or medication.”

In 2009, a mental heath in-patient survey by the Care Quality Commission revealed that in some mental health trusts as few as 40% of people diagnosed with schizophrenia felt that they were involved as much as they wanted to be in decisions about their care and treatment. I am no health professional—I hope that some Members who are health professionals will speak later this afternoon—but what people have said to me suggests that medication is not always the answer, at least in the long term. Research by Platform 51 has found that a quarter of women have been on anti-depressants for 10 years or more, that half of women on anti-depressants were not offered alternatives at the time of prescription, and that a quarter of women on antidepressants have waited a year or more for a review of their medication

I welcome the Government’s investment of £400 million in treatments under the improving access to psychological therapies programme. I should add, to be fair, that that builds on announcements made by the last Government. I also commend the report by the Centre for Social Justice on talking therapies, which calls for a broadening of therapies. Every patient is different, and patients will respond differently to different medications and therapies. Mental health patients must have real choice, and I think that Any Qualified Provider and Payment by Results must be extended to them in the way in which they are being extended to patients with physical health conditions. We must also ensure that patients’ voices are heard within the management structures of both clinical commissioning groups and health and wellbeing boards, whose job it is to hold services to account for the care that they are giving.

I expect that Members will refer to integrated care: the need for all services to work together. Poor mental health has an impact on every area of Government policy: health care, benefits, housing and debt, social exclusion, business and employment, criminal justice and education, to name but a few. One person with a mental health condition may need help from many different agencies, but too often care is not joined up, and each agency deals with its own bit and passes the person on. Sometimes there is no follow-up, and the person is lost in the system.

In a 2011 survey, 45% of people contacted by Mind said that they had been given eight or more assessments by different agencies in a single year. YoungMinds, which campaigns on behalf of children and young people with mental health conditions, has called for one worker to be allotted to each child needing support for a mental health condition, so that children can avoid multiple assessments and need not re-tell their story each time they see a new person in the system. However, there must be a clear care pathway, whatever the point at which access is gained to the mental health system.

The other thing patients are calling for is the ability to self-refer. We need to do all we can to prevent people from reaching crisis point, and often it is patients themselves who are best able to tell when they are about to reach that point. My West Leicestershire clinical commissioning group is developing an acute care pathway in partnership with Leicestershire Partnership NHS Trust. It plans to replace the many and varied access routes to secondary care and mental health services with a single access point, in order to provide speedy access at times of greatest need. That move has come out of both patient and GP feedback.

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

I congratulate my hon. Friend on securing this debate, and I am particularly interested in the proposed single access point for services. That could be useful not only for acute services, but for non-acute services and well-being provision. Does my hon. Friend agree that well-being provision is an important part of mental health provision?

[Nicky Morgan]

My hon. Friend is absolutely right, and I shall talk about well-being shortly. We often talk about these subjects in very negative ways. If we all talk about our mental well-being, and are regularly asked about it when we see our GPs, that will help a lot to de-stigmatise mental health issues.

I want to touch briefly on secondary care. One of the Sunday Express campaign demands is that all hospitals should be therapeutic environments where people with mental health problems feel safe and are treated with respect and have someone to talk to. In a debate in this House last November, I mentioned patients who abscond from secondary care units, and in particular the tragic case of my constituent Kirsty Brookes, who was able to escape from a unit in Leicester and subsequently hanged herself. I am sure the Minister will remember that debate, and our discussion of the definition of absconding.

The Care Quality Commission has published its first report on absconding levels, and I welcome that, but the picture in respect of absconding and escape numbers is still unclear. The numbers provided in this first CQC report need to be broken down further, therefore, but the report showed that in the year in question—2009-10, I think—there were 4,321 incidents of absence without leave from secondary care. Some of them were, of course, far more serious than others; some will have involved a person missing a bus on the way back to the unit, while others might have ended in tragic circumstances. I make this point not to beat up on secondary care providers and health providers generally, but we must know the scale of a problem before we can begin to tackle it.

The impact of the voluntary and community sector on mental health must not be forgotten either, and I hope Members will talk about that. The sector offers vital support, and it must be part of the commissioning landscape.

--- Later in debate ---

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

I speak as somebody with not only constituency experience of mental health issues but nearly 20 years of professional experience of dealing with a number of cases involving clients with mental health problems committing serious crimes such as murder, and crimes right through the criminal spectrum, many of whom have required the input of consultant psychiatrists and the assistance of the provisions of the Mental Health Act 1983. For many years, it struck me that the question of why those people ended up in that situation was never adequately answered. Years after my first experience with a such a client, I am still struggling to answer that question; perhaps it never will be adequately answered.

Mental health conditions are an integral part of what being a human is all about; they are with us every day of our lives. We are all, parliamentarians or otherwise, a little more brittle than we sometimes care to admit. Some of the testimony that we have heard today has shone a welcome light on the realities of what it is to be a human. Remembering that rule will guide us much more effectively as a society when we deal with mental health and the sad stigma that still pervades mental health issues far too strongly. However, I will not reiterate what other hon. Members have said about stigma.

I repeat my congratulations to my hon. Friend the Member for Loughborough (Nicky Morgan) on securing this debate. It is not an overstatement to call it historic, because many of the comments that we have heard will be remembered long after it is over, and not only by interested people in the mental health community. That is an excellent example of how this place can really help to make a difference in our wider society.

As a constituency MP, I take a huge interest in mental health issues in my area. Swindon, like many other towns of its size, has its fair share of mental health challenges. We have excellent local voluntary organisations that are increasingly working together to improve provision. In response to the hon. Member for Islington North (Jeremy Corbyn), the way to deal with the challenges of commissioning is for local voluntary groups increasingly to come together to co-ordinate their activities and to make bids for tenders. That is what is happening in my constituency. Only last Friday, I was at a meeting of Swindon Charities Working Together, where those from the carers centre, Swindon Mind and other organisations were all talking to each other and co-operating, because they recognise that if they do not, the scenario envisaged by hon. Members whereby the big players secure every commissioning tender will become even more prevalent. We must avoid that if we are to develop genuinely local and properly tailored mental health services.

Much has been said about the importance of involving service users themselves, and I cannot place enough emphasis on that. We have a wonderful organisation in Swindon called SUNS—the Service User Network Swindon—which runs a listening line that is operated by service users, for service users. So, on those lonely Friday and Saturday nights, if those people with mental health conditions have nowhere else to turn, they can ring their friends, talk to them and work through their problems. That saves thousands of pounds that would otherwise be spent on the use of crisis teams in the acute services. That is diversion. That is the kind of therapy and approach that we need to encourage more.

There is also much that can be done in the workplace. The Mindful Employer organisation is one of the largest networks of employers in the country. It brings together local businesses, shares best practice and emphasises the fact that it makes good business sense to manage the stresses and strains of the work force more sensibly. I am proud to be what I regard as a mindful employer. One of my employees here in Parliament, Christopher van Roon, has suffered from a mild bipolar disorder—I have his permission to say this to the House—and he manages it with the help of his employers, my hon. Friend the Member for North Swindon (Justin Tomlinson) and me. He has worked here for two years while dealing with his mental health condition. He enjoys his work and being part of a healthy workplace.

That is an example of how people with mental health conditions can be brought back into the workplace and shown that there is a way forward. The idea that mental health conditions somehow mean a dead end for people’s lives has to be ended. That is far from the truth. As other hon. Members have said, such experiences can often make people all the stronger.

My thanks go to all the organisations in Swindon that do so much for mental health provision in my constituency, and also to the army of family members and carers who, in an unsung way, do so much to support those with mental health conditions. I am delighted to have taken part in the debate, and I commend the motion to the House.