Mental Health Act 1983

Robert Buckland Excerpts

Monday 29th October 2012 Commons Chamber

[Mr Hunt]

I can reassure my hon. Friend that if any issues have arisen from the technical irregularity involving the authorisation of doctors under section 12, they will be dealt by the retrospective legislation.

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

I welcome my right hon. Friend’s approach, which is responsible and right. May I urge him to ensure that the review being undertaken by Dr Harris will include the effect of the changes in NHS structures on all relevant provisions of the Mental Health Act—for example, the provision of information about bed availability to courts under section 39?

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.

Adult Social Care

Robert Buckland Excerpts

Thursday 8th March 2012 Commons Chamber

[Sir Alan Meale (Mansfield) (Lab)]

I congratulate the hon. Member for Truro and Falmouth (Sarah Newton) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on their tenacity in securing this debate. Hon. Members from all parts of this House should give them credit for their hard work and effort.

In this important debate, I wish briefly to raise the issue of people suffering from autism and Asperger’s syndrome. As hon. Members will be fully aware, those conditions are extremely serious. Both are lifelong disabilities and they affect sufferers in a number of different ways. I fully accept that some people who have either of those conditions are able to live semi-independent lives, with only partial support, but others—indeed most—need a range of specialist support throughout their lives. Although they do not represent everybody who needs adult social care, I am not talking about a small number of people. Approximately 1% of people in the UK have autism, and they and their families account for at least 2 million involved citizens in the UK, which represents, on average, approximately 3,000 people in every constituency in Britain.

Yet, even given those numbers, the National Autistic Society says that sufferers routinely struggle to access the services they need and that when they do access them the outcomes are largely poor. NAS research also shows: two thirds of all adults with autism say that they do not have enough support to meet their needs; more than 60% of these adults rely absolutely on their families for financial support, with approximately 40% of them having to live at home with their parents; and only 15% of people with autism are able to find full-time work.

Failures to provide such support are also very expensive to the ordinary taxpayer. According to the National Audit Office, if local services supported only 4% of adults with high-functioning autism, that would be cost-neutral, and if they supported only 8%, that would save the Government at least £67 million a year. As a number of hon. Members have said, the Dilnot commission on funding of care and support stated a number of good things, in particular that the present system was both unfair and underfunded. It called on the Government to increase spending on social care and to limit the cost and charges for those who need it.

The report’s key recommendations included the need for national eligibility criteria, with all those who enter adulthood with health and social need being eligible for free state support immediately rather than being expected to pay themselves. This is where I have a slight difference with the Minister, who said that it is not only about money. For many people who come to my surgery at their wits’ end, it is about money. Indeed, even those who had money do not have very much left in their late adulthood to spend either on themselves or on their loved ones, so money is very important.

In conclusion, I believe that the adoption of the Dilnot recommendations would lead to an entirely fresh approach that would deliver greater awareness of autism, and in particular of the sufferers’ needs, care and, of course, support. It would also put in place measures to relieve the short-term crisis in funding in social care.

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

The hon. Gentleman is quite right to raise important statistics about people with autism, but may I urge him, when he speaks passionately about it, not to refer to people as suffering from the condition but rather to acknowledge that they have the condition and have great potential and that what we should all be doing through the care system is ensuring that they realise that potential? Does he accept that?

[Sir Alan Meale]

I fully understand the direction that the hon. Gentleman is coming from, but let me just say that I am the son of a permanently and seriously disabled person and he was that way all of my life. I also served as a board member of the Portland training college for the disabled in Nottinghamshire and have been deeply engaged in matters connected with the seriously disabled for years. Believe me, when I use the terms “suffering” and “sufferers”, I mean them not in a derogatory sense but to highlight the plight of the people who I am talking about.

In conclusion, I believe that adopting Dilnot would put in place measures to relieve the short-term crisis in social care funding and, most importantly, establish sustainability for care and support in the longer term.

--- Later in debate ---

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

I do not know whether I should thank my hon. Friend the Member for Hexham (Guy Opperman) for that warm-up act. I know my place, and I am more than happy to take part in this interesting and varied debate.

There is no doubt that the facts that face us all as parliamentarians are pretty stark. We know that 11 million people alive today will live to be 100 and that the population who are over 65 is projected to grow by 50% over the next 20 years. The expected number of working age adults with a learning disability will rise by about 30% over the same period. My hon. Friend the Member for Totnes (Dr Wollaston) reminded us that we should celebrate the fact that we are all living longer rather than being a permanent Jeremiah figure when it comes to these statistics. However, they do pose us quite a stark challenge.

Much has rightly been said today about the army of carers. I add my voice to that chorus of opinion about the invaluable work they do. My hon. Friend the Member for Congleton (Fiona Bruce) estimated that their work saves our economy £119 billion a year. I support the arguments made by my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) in respect of carer’s allowance for people post retirement. It is a sensible and thoroughly appropriate point to make in this debate, bearing in mind the need to create an incentive to care for people at home.

Many hon. Members have mentioned local carers centres. I pray in aid my local centre, the Swindon carers centre, which provides an excellent support service for carers, many of whom are young people still at school caring for an adult relative. It provides a focus and brings people together in the way that has been described and organises carers days in my constituency in which I and others take part. The messages we get from those events are messages not just of emotion, but of hard facts about the reality of life for carers on the ground. Frankly, they are the greatest experts on the people they care for, which is why they must be involved as service users in developing the services on which they rely. Carers are a huge resource, as we have heard, and must be an important part of the service.

Two key principles underlie the reform of social care: first, transparency—I have already mentioned the need for carers to have knowledge of and access to local services—and the way we track national funding and how it is spent locally; and secondly, predictability and reliability for those who need care and their families. They need to know that they can work within the system and rely upon it in the long term.

We have heard a lot today about care for the elderly, and I support the observations made by hon. Friends and Opposition Members. Rather like the hon. Member for Mansfield (Sir Alan Meale), I want to focus on those with learning disabilities. I am grateful to him for raising the issue of autism, which is rather close to my heart, as I think most Members will know, as I chair the all-party group on autism. Before dealing with the issue, it is right that I emphasise the importance of advocacy for people with learning disabilities.

There are many independent charities and voluntary organisations across the country that provide a voice for adults with learning disabilities. In my constituency the Swindon Advocacy Movement, which receives sustainable funding from the local authority, works hard on that philosophy. It draws in people in with learning disabilities so that they can be part of the planning for the service, which enables them to speak for themselves, because advocacy is not just about people like us talking for people like them; it is about enabling those people to do it themselves. I know that the hon. Member for Mansfield and I agree on that point, because I raised it when I intervened on him earlier. What we want to see is a service that enables people with learning disabilities to stand on their own two feet as much as possible and to play a full and active part in our society. That is why I believe passionately in local advocacy, which will help us see an end to the Winterbourne Views of our society and the betrayal of all the principles we believe in become very much a thing of the past.

We also heard about overarching frameworks within which care services should be developed, and I want to thank my hon. Friend the Minister publicly for following my advice, and that of many others, by referring the quality standard for care of adults with autism to the National Institute for Health and Clinical Excellence. He knows that I and others have been working on that issue for some time. It was the subject of a 10-minute rule Bill I introduced last year. As an aside, I urge him to look at a quality standard for care for children with autism, because I strongly believe that it is the transition from childhood to adulthood that we are still getting so badly wrong in this country.

I will pause for a moment and deal with the threshold into adult social care and how we need to plan adequately for that while the person is still young so that adult social services are working hand in glove with children’s services. In particular, when we develop our policy on special educational needs—I know that this is not the responsibility of the Minister’s Department, but it is a point that should be made—we must ensure that the new care, health and education plans go up to the age of 25. It is absolutely vital that we stick to that proposal, which was set out so helpfully in the special educational needs Green Paper, so that the threshold issue can be dealt with properly and there can be proper and adequate further education provision for young adults. There is a dearth of provision for young adults between the ages of 18 and 25, particularly those with autism and related conditions. It is in those seven key years of life that adult social care often fails and when we do not address issues of education for young adults with autism. Ambitious about Autism’s “Finished at School” campaign, which I had the privilege of launching in Parliament a few months ago, calls for that extension of provision.

I have referred to the key principles that underlie the Law Commission’s report on adult social care that was published last year, which we all know about. There needs to be a single duty on authorities to meet eligible needs, a duty for carers assessments to be undertaken and—something that we have perhaps not touched on in this debate—a duty for adult protection cases to be investigated by local authorities or other agencies. We are getting child protection largely right, but let us not forget vulnerable adults, whether they be elderly people or people with learning disabilities. To return to the Winterbourne View scenario, there needs to be a proper mechanism by which we investigate cases in which the welfare and safety of vulnerable adults has been called into question.

It has been a pleasure to take part in this debate. It was particularly reassuring to receive a clean bill of health from my hon. Friend the Member for Totnes. Dare I say that I am in the same age group as her? I will leave the Chamber thoroughly reassured. Finally, if we do not address these issues, we will fail not only current generations, but the generations to come.

NHS Risk Register

Robert Buckland Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Chris Skidmore]

I am, as I have the parliamentary Labour party brief—I can see that that is on the back of it.

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

My hon. Friend’s point about the Information Commissioner’s decision is vital, because the public interest test is the test applied at the time of the request. That makes the decision interesting but, frankly, historical rather than relevant to the issues raised by Members today.

[Chris Skidmore]

Absolutely. We are debating whether we should release a register that is no longer relevant and that was written in autumn 2010, at the time of the request on 29 November. The topic is completely irrelevant, as the debate has moved on. We ought to be talking about reform and why we need it. We have wasted six hours of parliamentary time today discussing an out-of-date risk register.

Southern Cross Care Homes

Robert Buckland Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

I do not know the particulars of the homes to which the hon. Lady refers, but if she would like to write to me with more details, I will certainly look at that matter. Many of the homes that Southern Cross owns have been specifically built and designed to provide residential care for older people, and there is therefore no other purpose for which they could usefully be converted—[Interruption.] Opposition Members might chunter about that, but that is why a consensual, solvent restructuring is now the best and most likely outcome of the process.

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

The residents, staff and families of the King’s Court home in my constituency will be encouraged by what they have heard today, but will my hon. Friend write to me with all the relevant information about the key issues of continuity and quality of care provision at King’s Court?

[Paul Burstow]

My hon. Friend is right to bring to my attention, and that of the House, the concerns of his constituents. I certainly hope that the statement I was able to make today is of some reassurance, along with the commitment I made to continue to keep both the House and individual hon. Members informed as this matter goes forward.

Winterbourne View Care Home

Robert Buckland Excerpts

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

Let me start by addressing the whistleblowing issue. Terry Bryan, the whistleblower in this case, is to be applauded for his tenacity in pursuing it. The Government have been clear about the need to strengthen the arrangements and safeguards for whistleblowers, because that is an essential first way in which we can make sure that the system protects those who are vulnerable. The right hon. Gentleman suggests that the Government have in some way cut the number of inspections, but he should reflect back to 2008 when his Government introduced the current mandate for the CQC and changed the basis on which it would inspect. That is what led to the changed inspection system. Perhaps he should ask some questions about that as well.

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

Does my hon. Friend agree that the model of large-scale institutionalised provision for people with learning difficulties is now broken and that we should support even more moves towards personalised and supported care close to the families and loved ones of people with learning difficulties?

[Paul Burstow]

My hon. Friend makes a very good point. The move towards personalisation and greater supported living is undoubtedly the direction that we wish to move in. That was started by the previous Government and we have been continuing it. We have made a massive transfer of resources from the NHS to local authorities to support that very transfer of responsibility, which is undoubtedly the way to deliver better results for individuals.

Health

Robert Buckland Excerpts

Tuesday 21st December 2010 Commons Chamber

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

May I convey my compliments of the season to all Members, and indeed to the staff of the House, who work so hard for all of us?

The reason for my contribution today is my long-standing commitment to the cause of raising the profile and interests of all children and adults who suffer from the lifelong conditions of autism, autism spectrum disorders and Asperger’s syndrome. I speak as a parent of a child on the spectrum, and as treasurer of the all-party group on autism.

I wish to urge the Government to refer autism to the National Institute for Health and Clinical Excellence as a key topic for a NICE quality standard, which would cover diagnosis, post-diagnostic support and support for those with co-occurring mental health problems. It is vital that at the stage when commissioning is handed over to GP consortiums, a national quality standard applies to help local commissioners act appropriately.

The National Autistic Society’s recent “You need to know” campaign revealed some startling statistics about children with autism and about child and adolescent mental health services, which are known as CAMHS. Some 71% of children with autism have a co-occurring mental health problem, and last year one in 10 children who used CAMHS had autism—that is more than 10,000 children. However, only one in three parents of children with autism who were surveyed thought that CAMHS had helped them. The problem is that professionals, no matter how dedicated they may be, often do not have enough information and understanding when it comes to meeting the needs of children and young people with autism. It places those people at a disadvantage for treatment in the health service.

There was some excellent news last week in the publication of statutory guidance for adults with autism as a result of the Autism Act 2009, and I welcome the carefully set out guidelines, which have been the subject of proper consultation. They have been strengthened and improved through lobbying by hon. Members and other organisations with a key interest. For example, particular emphasis is placed on the need for local child and adolescent mental health services to develop agreements with adult mental health services about the transition of children with autism who use those services into adult mental health care. We hear a lot about the problems of transition, and I am glad that concrete action is being taken. That will be welcome news for many children and young adults in Swindon and elsewhere.

A further enhancement of those guidelines in the form of a quality standard, together with commissioning guidelines, will increase and improve that provision even more. It has worked elsewhere. For example, for services for children with a learning disability, the introduction of a national indicator, a vital signs indicator and an annual health check all required self-reporting on training needs by the staff in child and adolescent mental health services. By last year, that resulted in almost all CAMHS services—98%; a remarkably good statistic—reporting that they provided specialist learning disability support. However, in sad contrast, only 10% of child and adolescent mental health services reported that they provided targeted autism support.

I accept that NICE is autonomous, but the National Quality Board’s prioritisation committee selects the topics for discussion and adoption as NICE quality standards, with referral by Ministers. The Government therefore have a role in being able to refer a topic for the adoption of a quality standard, which is more than a guideline because it builds on the guidelines to provide a framework for professionals. It will also help patients find their way around the system. Further, it will help NHS bodies to assess the quality of the service that they provide. That information, with evidence of best practice, will help commissioners to plan better services for the future.

I am extremely keen for those measures to be adopted at the earliest opportunity. I will revert to them as often as I have to in the new year if the message has not yet got through. I urge the Government to refer the proposals to NICE to help chart a brighter future for the treatment of children and young adults with autism in the health service.

Mental Health (Infants)

Robert Buckland Excerpts

Tuesday 26th October 2010 Westminster Hall

[Andrea Leadsom (South Northamptonshire) (Con)]

On the face of it, infant mental health might appear to be a bit of a narrow topic, but I want to explain why the mental health of infants in fact makes a huge difference to the whole fate of our society. Human babies are unique in the animal kingdom in terms of the extent of their underdevelopment at birth. What other animal cannot walk until it is one year old or fend for itself until it is at least two years old? Physical underdevelopment is only a tiny part of the matter; the human brain is only partially formed when a baby is born. The billions of neurones in the brain are largely undifferentiated at birth and parts of the brain are simply not there. A human baby’s earliest experiences will literally hard-wire their brain and have a lifelong impact on their mental and emotional health.

I want to set the scene by giving a couple of fictitious examples that are common in 21st-century Britain. I shall then explain how those situations might affect the babies concerned. First, let us consider the case of a fictitious 15-year-old called Sarah who lives with her mum, stepfather and three half-brothers in social housing. Her stepfather abuses her and she has told her mum, but she does not believe her or does not want to believe her. Sarah feels unloved and unsupported and, when she is 15, she meets a boy at school and gets pregnant. She applies for a council house as a single mum and gets it—so far, so good. Sarah is really looking forward to the birth of her son because, at last, she will have somebody to love her. The trouble is, when Jack is born, he does not seem to love her at all. He just screams, messes his nappy and eats. After a few weeks of doing her best, Sarah cannot stand it any longer. She leaves Jack screaming in his cot and goes out for the evening. She gets back late and rather drunk, and Jack is still screaming in his cot. Sarah loses her temper, kicks his cot and screams at him to shut up and leave her alone. We can imagine how things carry on for Sarah and Jack. She is an unloved child herself and Jack pays the price.

Let us consider another fictitious story that is just as common. Liz and John are successful lawyers in their 30s who are well off and enjoying life. They leave it quite late to have a baby and end up using in vitro fertilisation to help them conceive. Luckily, Liz becomes pregnant quite quickly with twins, but the joy stops there. She feels sidelined in her career and resentful of her husband because he is fine and she is not. The babies are born prematurely and are whisked off to incubators for several weeks. When Liz finally takes the babies home, it takes a long time for her to realise that they are truly hers. She is one of the three in 10 women who suffer post-natal depression. She looks after the twins as best she can, but more than a year passes before she can truly say that she loves them.

I am sure that most of us in this room have heard of such cases. Stories of poor bonding or, to use the more technical term, insecure attachment are all too common in the western world. However, what is not so well understood is the impact on the baby’s brain development of a key carer—usually the mum—being unable to meet the baby’s needs. So what is meant by the term “having your needs met”? When a baby cries, they do not know that they are too hot, too cold, bored, tired or hungry. All they know is that something is wrong. So they cry and rely on an adult carer to soothe their feelings. Many of us will remember long nights spent walking up and down the landing, joggling a baby and saying, “Go to sleep, go to sleep.” That is what loving adults do for their babies.

This is not about giving parents a guilt trip. We all feel guilty at times about the things we wished we had done, the times we shouted at our babies or the times we left them to cry because we could not take any more and so on. This is about being a good enough parent. That does not always mean being there the instant the baby cries every single time, but being there enough for the baby to realise that generally the world is a good place and that generally adults are kind. The baby who learns about the world as a good place will retain that sense almost as an instinct for life. The baby’s brain will be hard-wired to expect a certain reaction from other human beings and that baby’s mental health will be secure throughout the child’s life. Such an individual will be more robust than a baby whose needs are not met. However, for the small but significant minority of babies who are neglected or abused, there are two critical impacts on the development of the brain.

A baby cannot regulate their own feelings at all. If their needs are not met, they will simply scream louder and louder. If nobody comes, eventually they will take refuge in sleep. So the first impact is that a baby left continually to scream will experience raised levels of the stress hormone cortisol. Excessive amounts of cortisol can do permanent damage to the baby’s immune system. Evidence suggests that a baby left to scream throughout babyhood will have a higher tolerance to their own stress, and that violent criminals have a very high tolerance to their own stress levels, which they developed back in babyhood. Inevitably, if someone has a high tolerance to stress, they need to indulge in high risk-taking behaviour even to feel the same level of excitement that we might get from an exciting hand of bridge. There are real issues surrounding leaving babies to scream incessantly.

The second and most amazing impact on the baby who is neglected or abused concerns the social part of the brain—the frontal cortex—which starts to develop only at around six months. The peak period for development of that part of the brain is at six to 18 months old. Growth is stimulated by the relationship between the baby and the carer, for example, through things such as peekaboo games, hugging, looking into each other’s eyes and saying, “I love you. You’re gorgeous.” Such activities between a loving parent and a baby all play a very strong role in the development of the social, empathetic part of a baby’s brain.

If a baby does not receive any attention—I am sure we all remember the Romanian orphans who were left in cots to hug themselves, and did not speak to anyone or have any emotional or physical contact whatsoever—that social part of the brain may never grow. There can actually be a long-term brain damage impact on the baby, the child and later the adult. That has profound implications for society. A human being without a properly developed social brain finds it extremely difficult to empathise with other human beings. In particular, if a baby has what is known as disorganised attachment—where one or both parents are frightening or chaotic—they cannot form a secure bond precisely because the person who is so frightening and chaotic is also the person whom the baby should be turning to for comfort. The baby’s brain is confused and they experience disorganised attachment, which leads to very significant problems for that baby.

If we look into the babyhood of children who brutalise other children, of violent criminals or of paedophiles, we can often see plenty of evidence that sociopaths are not born; rather they are made by their earliest experiences when they are less than two years old. Evidence shows that more than 80% of long-term prison inmates have attachment problems that stem from babyhood. It is believed that up to two thirds of future chronic criminals can be predicted by behaviour seen at the age of two. A study conducted in New Zealand showed that a child who exhibits substantial antisocial behaviour when they are aged seven has a twenty-twofold increased chance of criminality by the age of 26.

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

I congratulate my hon. Friend on securing the debate. She makes a very important point about the correlation between people in prison and the problems she has outlined. Is she also aware that a very large number—I think it is some 75%—of our young inmates have some form of speech, language or communication difficulty that, no doubt, at least partly results from the circumstances of their upbringing and the early years that she is talking about?

[Andrea Leadsom]

I thank my hon. Friend for his intervention, with which I completely agree. There is no doubt that all sorts of developmental issues are affected by the earliest relationship, including communication. Why does poor attachment arise? Often, it is the result of parents’ unhappy lives. A mother who was not attached as a baby to her own mother will often struggle to form a secure bond with her baby, as might a woman who suffers from post-natal depression.

Child and Adolescent Mental Health Services

Robert Buckland Excerpts

Wednesday 7th July 2010 Westminster Hall

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

Thank you, Mr Benton, for giving me my father’s name. Robert Buckland is my true name. I am grateful for the opportunity to speak in this debate, and I congratulate the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) on an excellent and comprehensive analysis of the report from the National Autistic Society, which many of us have read and found extremely useful.

I declare an interest because, like the hon. Gentleman, I am the parent of a child on the autistic spectrum. My experience, although initially negative, is something that I have decided to try to be positive about, again like the hon. Gentleman. Having had the honour of being elected to this place, I regard it as my duty to raise those experiences, talk about them and do whatever I can to advance the cause of children, young people and adults with autism, the autistic spectrum disorder and Asperger’s syndrome.

The “You Need to Know” campaign touches on an issue that all of us, whether Members of Parliament, parents, professionals or members of the public, may have experienced in recent years, as the extent of the diagnosis of autism has dramatically increased. A group of individuals and their families feel utterly isolated because their experiences have, in the words of the hon. Member for Mid Dorset and North Poole (Annette Brooke), resulted in their having to scream and shout from the rooftops, bang on doors and adopt behaviour that they might never have contemplated at the beginning of their journey. I simply ask the eternal question: why does it have to be like this? Why on earth are we still in this position in the second decade of the 21st century? The National Autistic Society was founded nearly 50 years ago. Medical research on, and analysis of, the condition that we now know as autism began as long as 70 years ago. I appreciate that the calls on the public purse are immense, but progress on this issue is too slow, and that is betraying an entire generation of children and young people.

Provision for the transition from youth to adulthood is—I hesitate to say this, but I will press on none the less—nothing short of scandalous. The excellent provision in the education and children’s services sector suddenly vanishes when the young person reaches the magic, or should I say tragic, age of adulthood. Time and again, I have met constituents who are crying out for the help and support that they thoroughly deserve, but who are not getting it. They understand and are conscious of the fact that they are increasingly a burden on our society, but it should not be like that. They should not be a burden on the rest of us; they should be making a valuable and meaningful contribution to our society. We should not forget the talents, idiosyncrasies and amazing abilities of children and young people with such lifelong conditions. I talked about the initially negative experience of learning and understanding that one’s child has autism. As I said at the beginning, however, the positive aspect of such conditions must not be forgotten. These children and young people are not a burden; they add to the mosaic of human experience, and we need to understand and embrace that as we address the questions.

I know that we have touched on this point in the debate, but we should not forget the position of parents and carers of young people with autism. All of us with experience and knowledge of the position of parents and carers will understand that the pressure on them is often intolerable. They often need support and access to mental health services themselves if we are to avoid some appalling scenarios. In one appalling case in south Wales recently—I will not go into it, because it is sub judice—a parent was detained under the Mental Health Act 1983, and a young child lost his life. In the second decade of the 21st century, that is unacceptable in any book.

Hon. Members have eloquently outlined the need for training, and I need not repeat what they have said. Professionals who are outside this place, or who may be present, will say that they are doing all they can with limited resources to deal with the huge variety of problems they are presented with as paediatricians in the national health service or as mental health practitioners. I understand that resources are tight, but as has been said—I make no apology for repeating it—there is huge potential for saving money by intervening early and recognising problems. In these times, when finance is understandably the Government’s paramount consideration, is that not a strong and persuasive argument for supporting provision?

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

My hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) mentioned west Berkshire. As a result of the pressure that I and others in my locality have put on our local health board, we now have an integrated ASD network, with speech and language therapists and a whole host of professionals. The hon. Gentleman has hit on the central point: early intervention, with good, sound, solid professionals working together as a team, will make the difference. That can save money in the long term, but, more important, it can alter the quality of life for young people and their families.

[Mr Buckland]

I thank the hon. Gentleman for that important intervention, which leads to the point that I was about to make. We could spend hours in a chicken-and-egg argument about whether mental health conditions precede autism. Let us not forget that autism is often accompanied by physical disabilities and a range of other conditions, so it is a complex area. Similarly, mental health problems will accompany autism in some families for hereditary or genetic reasons, so it is probably not worth getting into the chicken-and-egg argument.

There is, however, no doubt that a number of young people who present themselves to CAMHS will have had an imperfect or late diagnosis of their condition, and I am afraid that my personal experience in that respect has been rather negative. Experienced paediatricians, whom I will not name, because they are distinguished in their field—one in particular is very distinguished in the medical-legal field—told me that diagnosis at two or three was not possible for autism and ASD. I was a mere layman in those days, and I had not made the journey that I have now, so I accepted what I was told at the time, but I learned later that it was not the case. If that attitude is still prevalent, we have a problem. I do not want to criticise health care professionals, who do a wonderful job, but the point being made by the National Autistic Society is that we need more training, awareness and understanding. That is all we ask for in this debate.

The hon. Member for Mid Dorset and North Poole asked the proper question about transition provisions. We now have the Autism Act 2009, and we await the statutory guidance, which is all-important in fleshing out the bones of the Act. The guidance is key, and we need the Government to give a clear steer in it as to how we manage the transition from childhood to adulthood. That is a key time, but there is, as I have said, a scandalous dislocation in provision, which needs to be dealt with properly.

As the hon. Member for Dumfries and Galloway (Mr Brown) so eloquently said, we need to look at key intervention at the earliest stage. A lot of the mental health conditions that accompany autism can be avoided through early intervention, which would mean that there was less pressure on CAMHS and less of a crisis in the key early and mid-teen years.

I know that other hon. Members want to contribute, so I will finish on this point. We have seen some excellent examples of provision, and west Berkshire has been cited. In authorities such as mine in Swindon, the PCT and children’s services are integrated and work very well. They are starting to do the outreach work in CAMHS in the primary sector that will help to identify problems and improve early intervention. However, although that integration is all very well, the question, which the hon. Member for Mid Dorset and North Poole posed, is whether there is proper integration with adult services. Therein lies the problem, and more work needs to be done.

I am grateful for being allowed to contribute to the debate. I hope that this will be the first of many contributions that I make on the subject in the years ahead. I thank you for allowing me to speak, Mr Benton.