Mental Health Support

Sojan Joseph Excerpts

Thursday 10th October 2024 Westminster Hall

[Sojan Joseph (Ashford) (Lab)]

I beg to move,

That this House has considered improving support for mental health.

It is a pleasure to see you in the Chair, Mr Dowd, and I am pleased to have secured this important debate. As today is World Mental Health Day, it is particularly appropriate that we have the opportunity to raise awareness of mental health issues and the mental health system in this country. It is important to reflect on how far we have come in this country in removing the stigma around mental health, and I hope this Parliament will play its part in continuing that progress. However, if we are to do so, we must be honest about the many challenges we still face. I also want to declare a personal interest: before being elected in July, I spent 22 years working in the NHS, primarily in mental health.

One of my main motivations in standing for Parliament was to play my part in building an NHS fit for the future. Improving support for mental health will be an integral part of that. With that in mind, I want to put on record my thanks to my former NHS colleagues working in the mental health system. They do an incredible job in incredibly difficult circumstances. It is important to say at the outset of this debate that any criticisms of the current system are not directed at the workforce. Without their hard work and dedication, the problems faced by those in need of mental health services would be far worse. I know from my own experience that in recent years, their work has often been made more difficult by policies imposed at a national level by the last Government. Even when it was clear that those policies were having a detrimental impact, Ministers were unwilling to make concessions.

Although the mental health workforce has expanded in recent years, it has only reached the same number of staff as it had when the last Labour Government were in office in 2010. More needs to be done regarding the recruitment and retention of staff, as underlined by the high number of vacancies. NHS data shows that in September last year, there were 28,600 vacancies, amounting to 19% of the total workforce and causing an increased reliance on agency staff. In the year to September 2023, there was a 19% turnover in the overall workforce. Those figures from the King’s Fund highlight the extent of the recruitment and retention crisis.

From my work as a manager in mental health services, I know that experienced staff play a vital role, and a vast amount of time has to be spent recruiting new experienced staff when they move on to different posts. That has meant that often the most challenging environments have been run by staff with the least experience. That obviously has a negative impact on patient care and can lead to an increased incidence of aggression and abuse of staff. It is therefore not a surprise to see staff shortages having a negative impact on staff morale. The King’s Fund has shown that in in-patient services, staff regularly work extra hours or additional shifts and often find themselves in environments and with patients they are unfamiliar with. Similarly, staff in community services say they are worn out and find their work frustrating and stressful.

For 14 years, we have had a string of Prime Ministers and Ministers speaking about achieving parity of esteem between physical and mental health in the NHS. While I do not doubt the intentions behind achieving that goal, after 14 years of Conservative Government we do not have that parity. Indeed, as Lord Darzi made clear in his excellent report:

“There is a fundamental problem in the distribution of resources between mental health and physical health. Mental health accounts for more than 20 per cent of the disease burden, but less than 10 per cent of NHS expenditure.”

Although there has been increased investment in mental health services at a higher rate than the overall NHS budget, there is still a large gap between resources and demand. It is little wonder that all the talk of parity has seemed little more than warm words. I genuinely hope that under this Government things will finally change. I should point out that when we talk about waiting lists, those waiting in the mental health system are never included. Will my hon. Friend the Minister say something about that and explain how the Government plan to put parity of esteem into practice? Can he also say whether the Government will continue to increase investment in mental health services at a higher rate than the overall NHS budget during this Parliament?

Lord Darzi’s recent report states that around 3.6 million people are in contact with mental health services, and in April this year around 1 million people were waiting for mental health services. As he makes clear, it has become all too normal to have to wait a long time to access mental health services. The NHS’s own data shows that in April this year, 10% of people who had been in contact with mental health services and were waiting for their second contact in adult community mental health services had been waiting for at least 116 weeks. All the evidence indicates that today we have a mental health system that is overstretched and under-resourced. In fact, there has never been so much demand for mental health support, with one in four people experiencing a diagnosable mental illness each year.

Figures from the British Medical Association indicate that last year there were a record 5 million referrals to mental health services in England. That is up by 33% on the number of referrals in 2019. The increase in the prevalence of depression over the last decade is a good example of how our mental health as a nation has got significantly worse. In 2012, the prevalence of depression was 5.8%. By 2022 that had more than doubled to 13.2%. In my own constituency of Ashford the figure was even higher, at 17%.

Given the increased prevalence of mental health issues, I was pleased that in the first King’s Speech of this Labour Government we saw mention of legislation to modernise the Mental Health Act 1983. The proposed legislation has been welcomed across the sector. It is an important opportunity to improve care and strengthen safeguards for people who are admitted to mental health hospitals. I hope the new Bill will address the fact that someone who is black or living in a deprived area is almost four times as likely to be sectioned under the Act.

Will my hon. Friend the Minister tell me when we can expect to see the Government’s legislation introduced in Parliament? As Lord Darzi identified in his report, the lack of capital investment in places where people are sectioned means that a lot of those places are unsuitable, outdated and unsafe. From my own experience, I know that nurses, managers and matrons spend a lot of time trying to get capital works done in an NHS trust.

People living with a long-term physical condition are 50% more likely to suffer from mental ill health, while those with Parkinson’s disease are twice as likely to be at risk of suicide. That underlines the importance of a wholesale change so that support can be accessed at an early stage. Too often, people can access support only after they have ended up in crisis. NHS figures show that in July there were just over 40,000 new urgent, very urgent or emergency referrals to crisis care teams. At that point, the treatment that patients receive is not only more intensive for them, but more costly for the NHS.

The difficulty of accessing mental health services explains why increased numbers of people who require support end up being admitted to accident and emergency departments. To illustrate that, I will use the example of my own integrated care board in Kent and Medway, which has recently launched several safe havens to provide support for anyone in a mental health crisis. They have helped to reduce the number of people who seek support by going to hospital emergency departments when they experience a mental health crisis. In my constituency, there is not yet a safe haven. That may explain why William Harvey hospital in Ashford has one of the highest rates of individuals presenting with primary mental health needs at an A&E. I welcome plans that are under way for a safe haven at the hospital in the near future.

When patients end up in hospital, there are significant difficulties in getting them a bed. This is a challenge in Kent and Medway, but the picture is not dissimilar across the rest of England. The Royal College of Psychiatrists recommends a maximum occupancy rate of 85% of beds for mental health patients. However, between April and June, the average occupancy rate of the 444 mental health beds in Kent and Medway was 91.7%. Across England, the average occupancy rate was 89.9%.

Then there is the issue of discharging patients. When they are clinically ready to leave hospital, there is often nowhere for them to go. That leaves them stuck in hospital, causing blockages in the system. In my own experience, nurses, doctors, managers, matrons and directors spend many working hours looking into moving people out of hospital, when they should be focusing on patient care. I believe that more appropriate housing must be built that is open for people leaving hospital. I urge the Department of Health and Social Care to work across Government to ensure that as the Government’s planning reforms are introduced, that point is taken into consideration.

We have seen an increase in adults being treated in hospitals for their mental health, and the situation is the same for children and young people. A recent report from the Education Policy Institute shows that the number of young people admitted to hospital increased by one fifth between 2017 and 2023. As the report indicates, that suggests that more young people are reaching a crisis point and are experiencing multiple admissions. The evidence also indicates that a large number of young people are not getting the necessary mental health support. A survey for Young Minds revealed that at least 60% of children considered to have a diagnosable mental health condition had not had contact with the NHS.

Research from the Maternal Mental Health Alliance published last week shows that more than 20% of women will face mental health challenges either during their pregnancy or in the perinatal period. It is clear from the research that many women struggle to access support, particularly those from racialised communities, young mothers and those experiencing domestic abuse or living in poverty.

We know that intervening early to ensure that people are kept in good health is not only better for the individual but tends to be far less costly. However, until now, efforts to prevent mental ill health have been severely underfunded and they have not been given the priority they deserve. I hope we will see a marked change in approach under this Government. With that in mind, I ask my hon. Friend the Minister whether greater priority will now be given to community-based support for mental health services. I hope he will agree that the easier it is for people to access mental health services locally, whether in a traditional health setting or through more informal drop-in services, the quicker they will be able to get the treatment they need.

Will my hon. Friend update us on the Government’s plans for Young Futures hubs for children and young people? These open-access drop-in hubs will be an important step in providing community-based mental health support for children and young people. Will he say something about the roll-out of those hubs?

Our manifesto commitment to introduce a specialist mental health professional in every school will be important in helping to identify mental health conditions early on so that they can be prevented from developing into more serious conditions in later life. Will that include access to counselling? Research from the British Association for Counselling and Psychotherapy indicates that children whose mental health difficulties are initially too complex for lower intensity interventions but not complex enough to be referred to higher intensity interventions, such as child and adolescent mental health services, can easily miss out on the mental health support they need. They could instead be helped by forms of provision such as counselling.

All the evidence shows that being active helps people’s mental health. Helping them back to work will also help to grow our economy. Lord Darzi’s report identified that, since the pandemic, the number of people who are economically inactive has increased by around 800,000, with people with mental health conditions accounting for most of the increase. I welcome the Government’s new initiative to work across Departments and create links between long-term unemployment and health. I also hope that they will look to reform the benefit system, ending the blame culture identified by the Secretary of State, so that we can treat people with mental health problems with dignity. I welcome the greater emphasis that Ministers have said will be put on prevention of illness, and I hope that my hon. Friend the Minister will be able to reassure me that the same emphasis will also apply to mental health.

As the Mental Health Foundation has said, there is clear evidence that place and the circumstances in which people are born, grow, study, live and work have a powerful influence on their mental health. Therefore, there must be a fundamental reform of the way in which we deal with mental health. We should be addressing the complexity of interactions and relationships, and how they affect individuals, families and communities. Rather than starting from the point of treating mental health, we should put the emphasis on creating a society that prevents mental ill health in the first place.

Beginning with central Government, I want to see a co-ordinated approach to developing effective policies to protect people’s mental health. With that in mind, the priority that this Government have already given to cutting pollution and building high-quality houses is welcome. I also welcome the proposed pre-watershed junk food ban and the steps that Ministers are taking to create a smokefree society. Going forward, I want to see greater cross-Government working to address the social determinants of our mental health.

In the coming months, the Government are set to publish their 10-year plan for the NHS. As my hon. Friend the Minister and his colleagues work on that, I hope that they will consult with campaigners and organisations working in mental health, as well as representatives of the workforce. By doing that, the Government will be able to grasp the opportunity to transform the way we approach the issue of mental health, ensure that there is true parity of esteem and provide real, meaningful change in the mental health system.

[Several hon. Members rose—]

--- Later in debate ---

[Sojan Joseph]

I thank the Minister for his brief answer, and I thank the shadow Minister and the Liberal Democrat spokesperson for their responses to the debate. I also thank the other Members who took time out of their busy schedule to be here.

I thank all the organisations that contacted me in advance of the debate. There are too many to mention them all, but they include the Education Policy Institute, the Royal College of Paediatrics and Child Health, the Royal College of Psychiatrists, the Royal College of Nurses, the Children and Young People’s Mental Health Coalition, the British Association for Counselling and Psychotherapy, the Maternal Mental Health Alliance, YoungMinds, the King’s Fund and, finally, Flourish, which is based in my Ashford constituency. I hope that the Department of Health and Social Care will actively engage with these organisations from across the sector to draw on their knowledge and experience.

Question put and agreed to.

Resolved,

That this House has considered improving support for mental health.