Psychological Therapies

Debate between Seema Malhotra and Andrew Selous

Wednesday 16th October 2013 Westminster Hall

[Andrew Selous]

As colleagues have already stated, data on the type of therapies available under IAPT show that couple therapy is available in less than a quarter of cases. The data came from the “National Audit of Psychological Therapies for Anxiety and Depression, National Report 2011”, so they are official. The figure for couple therapy is only 24.6%, while interpersonal therapy is available in under half, or 48.3%, of the settings in which provision is made. For psychodynamic and psychoanalytic therapy, the figure is under 40%, at 39.8%, whereas cognitive behavioural therapy is available in 94.9%—just under 95%—of cases.

Those figures demonstrate the significance of CBT, which for some people with mental health issues is absolutely the right treatment, but it is important to realise that CBT is clearly not the appropriate treatment for all those with mental health conditions. We should also remember that all those therapies are approved and recommended by NICE, and the evidence shows that all such treatments are effective for the right patients.

I am particularly concerned that the benefits of a relational approach to the treatment of depression are not being realised and that, in many cases, individual CBT counselling is given where it is not appropriate. I want to tell a true story of one young couple’s experience of interacting with the IAPT programme. Figures and sums of money give the broad picture—they are our stock in trade as Members of Parliament—but they are a bit high-level and do not capture the essence of mental health provision on the front line.

Let me tell the story of Polly and Mark—to protect their anonymity, those are not their real names—who experienced considerable challenges in having two children, with several miscarriages and a stillbirth. Polly became very low and left her successful career. The hon. Member for Feltham and Heston (Seema Malhotra) has already pointed out the cost to the economy when people have mental health issues. Polly’s husband, Mark, had a very difficult childhood, and he was badly affected by his parents’ violent and stormy relationship.

When Polly and Mark’s youngest child was two, Polly confessed that she had had an affair seven years earlier, which left her feeling guilt and shame long after it ended. On learning that, Mark was utterly devastated by the revelation and fell into a deep depression, with unmanageable rages during which he threatened to kill the other man. Polly developed severe headaches, so she went to her GP and was sent for tests. On finding nothing wrong, the GP recommended that Polly have individual counselling focusing on the stillbirth four years previously. After being unable to work and having three weeks of sleepless nights, Mark also visited his GP. Mark was referred to a psychiatrist, who diagnosed him as suffering from acute depression and prescribed him antidepressants.

The couple were acutely conscious that their relationship was about to break down. Not having been offered any form of couple therapy by IAPT, they approached a voluntary sector service, and for six months, they went to weekly couple therapy. At the same time, they were offered cognitive behavioural therapy through IAPT. They believed that the problem was their relationship, but health professionals clearly thought that the depression needed treatment. In couple therapy, Polly was able to share her anxieties about her parents’ divorce and about how she did not want her children to suffer as she had. As the couple therapy progressed, Mark and Polly became more open with each other and began to understand how their relationship problems were a product of both recent and past difficulties.

An important point is that that couple therapy—it was not provided through IAPT; Mark and Polly had to go to the voluntary sector for it, because IAPT had offered them CBT that they did not need—was voluntary help that lasted for six months. My concern is that IAPT provision, whether of CBT or other measures, is often given for only a short period, which is not always appropriate or likely to be successful in such cases.

That true story illustrates powerfully why we need to look again at the IAPT programme, excellent though much of it is, and to take a relational approach to many of the issues where appropriate. I hope that it has been helpful to Members to put that real-life case study on the record.

Academic studies show why what I have said is important and matters. Evidence reveals links between relationship quality, depression and re-employability. For example, a meta-analysis conducted by McKee in 2005 concluded that lack of social support by partners in a relationship has negative impacts on the physical and psychological health of the unemployed person and is especially associated with more frequent development of psychosomatic symptoms, stress and depression.

The all-party parliamentary group on strengthening couple relationships, which I chair, and the newly formed Relationships Alliance published only last week a report that said that relationships were the missing link in public health. That report showed that relationship quality is often a key determinant of health and well-being, and that it has strong links with the ability to deal well with cardiovascular disease, obesity, alcohol misuse and mental health issues. All those issues link up, and strengthening the health of couple relationships is often right at the heart of them.

If we look at what has happened since the IAPT programme began—I understand that it receives funding of about £400 million a year—we can see that the investment has been very much towards cognitive behavioural therapy, with interpersonal psychotherapy, counselling for depression, brief dynamic therapy and couple therapy the poor relations in the area.

In a written parliamentary question, answered on 8 January 2013 and printed in volume 556, column 258, of the Official Report, we learn that of 1,225 sessions in 2012-13 only 99 were for couple therapy, whereas 459 were for CBT low-intensity therapy and 322 for CBT high-intensity therapy. If we look at the period from 2008-09 all the way through to the projections for 2013-14, we will see that of nearly 8,000 different sessions—7,958 to be precise—only 297 were for couple therapy. The story that I have just given of Polly and Mark shows that such sessions are needed up and down are country and can indeed make a significant difference.

[Seema Malhotra]

The hon. Gentleman is making a powerful speech on the importance of having a relational base to services. In my own constituency of Feltham and Heston, I visited a service that was started a year ago by the National Society for the Prevention of Cruelty to Children. It works with children who have parents with drug and alcohol problems. I am struck by what the hon. Gentleman is saying. Is he able to talk a bit more about, or perhaps give a comment on, how having such a focus in a service can help children who are the victim of the illness of their parents?

[Andrew Selous]

I am grateful to the hon. Lady for her comments. May I extend to her a very warm invitation to come to the next meeting of the all-party parliamentary group on 6 November when we will consider such issues further? She is absolutely right that these issues are intergenerational. If she was following the example of Mark and Polly, she would have learned that it was their own parents’ stormy relationships that had affected them. Of course their children were suffering deeply from the problems that they were having in their own relationship or marriage. Such issues are deeply related, and she is completely right to say that the children suffer hugely when there are relationship problems between the parents. It is vital that we get this matter right for the children, and I would welcome her support on a cross-party basis on these important issues; they are just too important to be bipartisan about. I would love to have cross-party agreement on the importance of relational issues in public health, because I feel so passionately about the matter.

Another concern is the geographic differences in the ability to get couple therapy through IAPT at the moment. Ruth Sutherland, the chief executive officer of Relate, told me only yesterday that the programme is very geographically bound. Provision is better in the north of England—I note that there are not many colleagues from the north of England in the Chamber today—than in the south, so there is an inequality of access geographically, as well as there being fewer of these sessions available across the UK as a whole.

Let me make one further point to the Minister about why one part of IAPT provision is an incredibly serious matter for the whole NHS. As a clinician, he will know about the huge importance of long-term conditions, which are faced by so many of our constituents. He will be well aware of the significant demands that they will make on the NHS in years to come. I am talking about strokes and dementia and all sorts of other long-term ailments that many of our constituents will live with for a very long time.

I heard a moving story a couple of weeks ago from a gentleman who was visiting his elderly parents in Manchester. He said that between them as a couple they could function. Between the two of them, they had one pair of eyes, ears and legs that worked. They were both sick in different ways. They could cope and look after each other, but what would have happened if they had split in younger years? They might have been like Polly and Mark and had difficulties and not been able to receive the type of help that I have outlined. Let us say that they did sadly split up, like so many couples do today. They would be in two different flats in different parts of Manchester needing far more help from their GP and far more adult care, and that would fall on the clinicians for whom the Minister is responsible and on adult social services. Yes, it would have an impact on their families, and we would all be paying more through our taxes and there would greater burdens on business as well from having to look after that couple in two different settings. The importance of strong couple relationships in older age, in later life, is critical not least to deal with the increase in long-term conditions, which are becoming more and more prevalent and which many of our constituents will be coping with for many years to come. That is my final pitch to the Minister.

We are talking specifically about mental health and IAPT. I understand that a lot of good work is being done under IAPT and that it is an excellent programme, but I ask the Minister, when he goes back to his Department and talks to his colleagues and the Secretary of State, to take back with him the absolute centrality of strong relational health up and down are country as far as public health, the burdens on the NHS and his Department are concerned.

Cost of Living

Debate between Seema Malhotra and Andrew Selous

Tuesday 14th May 2013 Commons Chamber

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

I am honoured to speak in this year’s debate on the Loyal Address and to make some comments on Her Majesty’s Gracious Speech.

I join the sentiments expressed by other Opposition Members that Britain could and would have hoped for so much more from this Queen’s Speech. After three years of low growth, rising unemployment, increased borrowing and a rising cost of living, including fuel and food bills and transport fares, Britain deserved much more. We got no answers on tackling the rising cost of living, at a time when real wages have fallen by £1,700 since the election, and there was nothing to help the increasing number of Londoners struggling to afford food. It is clear that, after three years of failure and U-turns, this Government are out of touch, out of ideas and unable to bring the change this country needs.

Last year, I spoke in my first Queen’s Speech debate as the Member of Parliament for Feltham and Heston. I spoke of local unemployment and how Her Majesty’s Gracious Speech last year offered no hope to these local families and young people, but 12 months later the situation is worse. More than 550 local people in my constituency who were unemployed 12 months ago are still unable to find a job. More people are out of work now than there were when this Prime Minister took office, and a growing number of food banks are now opening across the country—these are the most visible manifestation of the growing crisis of food poverty in Britain. Food is the most basic of human requirements, yet in one of the richest cities in the world, local families and children cannot afford to eat and are going hungry. The Trussell Trust, which runs the largest chain of food banks in the country, fed more than 34,000 people in London in the past year. In my borough of Hounslow two food banks have opened in the past two months alone, with the local council, local charities, places of worship and volunteers doing all they can to help local families and a growing number of children in poverty.

[Andrew Selous]

Perhaps the hon. Lady would like to put on the record the fact that food banks increased tenfold under her Government. Will she condemn the fact that her Government refused to let Jobcentre Plus signpost people to food banks because they were worried about the political damage? That was a callous way of treating people in need.

[Seema Malhotra]

Yet again, we see how the Conservative Government are so out of touch and so complacent, not acknowledging any of the challenges—rising unemployment and a rising cost of living—that people in Britain are facing today; they are not taking any responsibility.

A recent report by the London assembly found that more than 95% of teachers asked in London said that children in their schools regularly went without breakfast—more than half of such instances were because families could not afford food. That is completely unacceptable in modern Britain. The health, educational attainment and life chances of these children are threatened by hunger, and the Government continue to do nothing to help with the cost of living.