Backbench Business — [1st Allotted Day]
Nicky Morgan (Loughborough, Conservative)
I beg to move,
That this House
has considered the matter of mental health.
I am particularly grateful to all members, old and new, of the Backbench Business Committee for allocating time for this debate in the Chamber. The effort to secure the debate has been done jointly with my hon. Friend Mr Walker, the chairman of the all-party group on mental health, which he has led so well, and with my hon. Friends the Members for Worthing West (Sir Peter Bottomley), for New Forest East (Dr Lewis) and for Halesowen and Rowley Regis (James Morris)—I hope I have pronounced that one correctly—and the hon. Members for Dagenham and Rainham (Jon Cruddas) and for Foyle (Mark Durkan).
We were quite clear when we put in our bid that we wanted a full debate on the Floor of the House. Why? It is at least four years, and probably slightly longer, since the general topic of mental health was debated in Chamber. That is a long time, given that 25% of the population—one in four people—will experience a mental health problem at some point in their lives. Just imagine if this were a physical health condition and it had not been talked about by Members in the House of Commons other than in very specific ways such as Adjournment debates for a very long time.
Mental health comes at an economic and social cost to the UK economy of £105 billion a year, yet mental health has been a Cinderella service—poorly funded compared with other conditions and not spoken about nearly enough either inside or outside this House. It is the largest single cause of disability, with 23% of the disease burden of the NHS, yet the NHS spends only l1% of its budget on mental health problems.
Kevan Jones (North Durham, Labour)
Does the hon. Lady agree that it is not only a matter of the effects on individual mental health because mental health issues can lead to physical disabilities, leading to extra costs to the NHS on top?
Nicky Morgan (Loughborough, Conservative)
I entirely agree with the hon. Gentleman. The Centre for Mental Health has shown that for a person who has a physical and a mental health condition, the costs of treatment are increased by 45%. Those are additional costs around mental health problems, which are often untreated initially and then have to be treated at a later stage, so the hon. Gentleman is absolutely right.
According to the Centre for Mental Health, only a quarter of people with mental health conditions—children as well as adults—receive any treatment. I have no reason to doubt that statistic, and I find it shocking that
three quarters of people with mental health conditions are not being treated. We should ask ourselves why that is.
Recent figures have shown that depression alone is costing the economy £10 billion a year. As we all know, we do not have a lot of money to spend, so we should be working as hard as we can on preventive measures. One in every eight pounds spent on dealing with long-term conditions is linked to poor mental health, which equates to between £8 billion and £13 billion of NHS spending each year.
I welcome the Health and Social Care Act 2012. I hope that today’s debate will be conducted on pretty non-partisan terms, but I realise that that may strike Opposition Members as a controversial comment. I welcome the opportunities that the Act offers for the commissioning of mental health services. I spoke in the Third Reading debate, and I especially welcomed the Government’s acceptance of an amendment tabled in the other place to ensure parity between physical and mental health. Although those are only words in a Bill, they are very important words, and they send a very clear signal not only to sufferers from mental health conditions and their families, but to those working in the NHS. I hope that, in his annual mandate to the national commissioning board, the Secretary of State will insist that the board prioritise mental health.
How are we to achieve parity between physical and mental health conditions? The question is about money, certainly, but it is also about awareness. Confessing to having a mental health condition carries far too much stigma. That is part of the reason for our wish to hold a debate on the Floor of the House. If we do not start to talk about mental health in this place, and encourage others to talk about it, how can we expect to de-stigmatise mental health conditions and enable people to confront their problems?
I find it interesting that, when I was preparing for the debate, a few people who had initially said to me “Yes, go ahead, mention my name” came back after thinking about it for a couple of days and said “Actually, I would rather you didn’t, because I have not told my employer,” or “I have not told all my friends and my family.” It is clear that mental health conditions still carry a considerable stigma. Admitting to having been sectioned is traumatic, especially when the information appears on Criminal Records Bureau checks connected with job applications.
I welcome the work of Time to Change, which has been funded partly by the Department of Health as well as by Comic Relief. I also welcome the Sunday Express campaign on mental health. However, the de-stigmatisation of mental health conditions is down to all of us, and it is especially important for those of us who are employers not to discriminate against people who may be working for us and who tell us that they have a mental health condition. I hope that today’s debate will constitute another firm step on the path to ensuring that mental health conditions are de-stigmatised, because I think that without that de-stigmatisation, successful treatment will be very hard for a person to achieve.
We asked for today’s debate to be kept deliberately general, so that Members in all parts of the House could raise many different issues on behalf of their constituents and, perhaps, themselves or their families as well as looking at the mental health policy landscape. Mental ill health is no respecter of age or background.
It can strike anyone, often very unexpectedly. That includes people in senior positions such as Members of Parliament, company directors and school governors. I am sure that my hon. Friend Gavin Barwell will refer to the private Member’s Bill that he will be presenting, which would end discrimination against people in such positions who have mental health conditions.
I expect that during today’s debate we shall hear about new mums with post-natal depression. For them, a time of life that should be one of the happiest is often one of the most difficult. I welcome the recent Government announcement that health visitors will be properly trained to recognise signs of post-natal depression, which I think was long overdue. I expect that we shall also hear about veterans from our armed forces who suffer from mental health conditions, and about older people who suffer from dementia. Particular issues affect our black and ethnic minority communities, as well as those who find themselves in the criminal justice system. I am sure that we shall hear from the Minister abut the Government’s widely welcomed framework document “No health without mental health”, which was published last year. We now await the detailed implementation plan on which the Department of Health is working alongside leading mental health charities.
I want to talk, very briefly—I have noted Mr Speaker’s strictures about time limits—about three specific matters: listening to patients, integrated care, and the wider mental health well-being landscape. We made it clear during the passage of the Health and Social Care Act that one of the developments that we wanted to see, as a Government, was “No decision about me without me”. That means patients having a voice in their care. It seems to me from my discussions with those in the mental health system who have been sufferers that once the initial crisis has been dealt with, they tend to want choice and involvement in their treatment. They are facing a lifetime condition. They will have to self-medicate, look after themselves and identify the point at which they may be deteriorating or potentially reaching crisis point for years and years to come. They want a voice. They want to be heard by the health care professionals, and I think that it is up to us as a Government to help them to achieve that.
John Pugh (Southport, Liberal Democrat)
The hon. Lady has just said that people who suffer from mental health problems have a lifelong condition. I think that many people have an occasional mental health problem.
Nicky Morgan (Loughborough, Conservative)
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”,
“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 anti-depressants 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 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.
Robert Buckland (South Swindon, Conservative)
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 (Loughborough, Conservative)
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 destigmatise 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.
Jeremy Corbyn (Islington North, Labour)
I congratulate the hon. Lady on securing this important debate. Many smaller voluntary sector organisations give a very good
service and understand their communities. Under the commissioning process, however, they often lose out to very large enterprises—large charities and medical companies—that have no real understanding of the local community, particularly ethnic minority communities. Does the hon. Lady agree that the Minister needs to consider that issue further?
Nicky Morgan (Loughborough, Conservative)
I agree; that is an issue. The commissioning structures are being changed, with local GPs now deciding what care they want to buy and where they want to buy it from. I hope that change will allow them to explore the value of smaller organisations, which tend to know particularly well the people they are treating. Although such organisations might not have the clout of large organisations, they are often more successful in terms of patient care. I am sure the Minister has heard that point.
I want to thank one of my regular correspondents, Mike Crump of My Time, a community interest company based in the west midlands. He may well be in the Public Gallery for this debate. My Time provides evidence-based, culturally sensitive professional counselling and support services. He said to me that a great deal of many people’s recoveries
“is owed to therapies based on basic common sense not the miraculous powers of a tablet or the mysterious wonders of the medical profession.”
Let me turn briefly to policing. My chief constable in Leicestershire is also the Association of Chief Police Officers mental health lead. In Leicestershire in 2011-12 there were 444 detentions under section 136 of the Mental Health Act 1983, which gives powers to take a person to a place of safety. Leicestershire police deals with serious incidents involving mental health issues on a daily basis, and it has provided me with a snapshot of what happened on the jubilee weekend. From 8 pm one night to 7 am the next morning it had dealt with 10 incidents in which mental health conditions or concerns were clearly prevalent. That night, police officers spent four hours with a man in hospital after he was detained under section 136. I therefore ask this question: are the police the right people to be dealing with such incidents?
I hope Members will talk about the criminal justice system, and the fact that nine out of every 10 prisoners have a mental health problem. The Government are investing more than £19 million this year in diversion services, but it is still taking too long to get prisoners out of prison and into secure hospitals.
Finally, I want to talk about the mental well-being landscape. All of us have mental health; it is just that some people’s is better than other people’s. We need to get to a situation where it is as normal to talk about our mental well-being as about our physical well-being.
Public health policy has a role to play. Local authority public health services are key in promoting good public health. I welcome the Leicestershire joint strategic needs assessment chapter on mental health, which was published recently. It makes it clear that mental health is important and says that it cannot be seen in isolation, as many factors contribute to mental ill-health, including the economic instability at present—which I am sure we will hear about this afternoon—and the welfare reform changes, such as asking people whether they are fit enough to go back to work. I think such questions need to be
asked, but I thank my constituent Jo Gibbs, who recently brought me a letter outlining her concerns about these changes and the anxiety and pressure they are causing her and others.
Julie Hilling (Bolton West, Labour)
I congratulate the hon. Lady on securing this debate, and on her speech. On welfare reform, does she share my concern that people with mental health issues are being kicked off disability support allowance? Increasing numbers of people in that situation are coming to see me. Recently a constituent came to me who is bipolar on the Asperger’s spectrum and who scored zero in the assessment for that allowance.
Nicky Morgan (Loughborough, Conservative)
I thank the hon. Lady for her intervention. I am sure we will all have similar constituency cases. A survey by Mind found that most people with mental health problems want to work but may not be well enough. For some people, employment—the right employment with the right employer and the right support—is the right way forward once they are better. For other people, however, employment is not the answer. The hon. Lady is right that assessors have not always understood the mental health needs of certain people. The Government have tried to address that through the two Harrington reviews. The system is never going to be perfect. That is where Members of Parliament come in; we will be making arguments on behalf of our constituents. I understand the hon. Lady’s point, however. We need to do more, and we need to promote awareness of these issues.
Other aspects of modern life do not help, such as loneliness and isolation. We live in an ever busier world, but people lead more isolated lives. We must not forget the question of families either. Sometimes they can be the cause of a person’s problems, but at other times they can be the solution. I commend the Centre for Social Justice for its work and its report, “Completing the Revolution”, about the importance of families and how significant family breakdown can be in respect of mental health problems.
This is an important debate, but it is only one step along the path of giving mental health the priority that Members clearly feel is needed given the number of them present today. I look forward to hearing their views. We need to talk about mental health far more openly, and we need to make it much easier for people to find out information about how they can get help before they need it. It is too late when people reach crisis point.
I look forward to the no health without mental health framework being implemented. Talking must never stop, but we must now also start implementing. I thank everybody who has contacted me in the run-up to this debate and shared their often very personal stories about their experiences in the mental health system. The House is all too often known for Members shouting at each other. I hope today shows that we are about more than that, and I hope we can all agree with the motion before us, as mental health is a huge priority for Britain and for our constituents, whether they are sufferers or carers. Working together, we can come up with integrated care that responds to the needs of patients and gives our mental well-being the prominence it merits.
Kevan Jones (North Durham, Labour)
I congratulate Nicky Morgan and the Backbench Business Committee on securing this debate, and I pay tribute to her very well-informed contribution. She is obviously a great champion for people who in many cases do not have a voice in the health system. Let us hope that by securing this debate we can give those people the voice they need, and not only, as she says, in the health service; we also need to get the message across to employers and others that mental health issues are not an inhibitor to a good and successful career and a fulfilled life. I shall discuss that in a moment.
I declare an interest as the president of my local Chester-le-Street Mind group. I have had an interest in mental health for a number of years. The hon. Lady mentioned the role of the voluntary sector. It plays a fantastic role, not only in promoting the issue of mental health but in delivering services. In some cases, these organisations are better vehicles for delivering this localised help than some of the larger companies referred to by my hon. Friend Jeremy Corbyn, or even the NHS itself.
The hon. Lady said that one in four people could suffer from mental health problems in their lifetime. John Pugh, speaking from the Lib Dem Front Bench, is both right and wrong in what he said. Some people do have mental health issues because of events in their life—crises happen and people can get over them in a short time—whereas others have long-term conditions that have to be lived with throughout their life, by way of drug treatment and other effective therapies, as the hon. Lady said. There is a big difference between those two situations. Anyone in this Chamber or any of their family members could suffer from short periods of mental health illness or be long-term sufferers. That is the important thing to get out of today’s debate.
We also need to address the cost, which the hon. Lady mentioned. I am thinking not only about the cost to the NHS, and the personal cost to individuals and their families, but about the cost to UK plc. I reiterate that mental health issues can affect anyone. I know general practitioners who have gone through periods of severe depression. I know one who works as a consultant cardiologist and is brilliant in his field but who lives with mental health issues, and has for many years. He has a very understanding employer and is very open about it. Let us not say that there are any boundaries in mental health, because there are not; these issues can affect anyone in society.
I wish to discuss two issues, one of which is the effect of funding on mental health. The other relates to the welfare reform changes, to which my hon. Friend Julie Hilling referred. They are having a disproportionate impact on people with mental health issues. I accept the view of the hon. Member for Loughborough that we do not want to get into a party political debate, but there is unjoined-up thinking in some parts of the coalition’s policy. I must say that I saw exactly the same thing when I was a Minister, when one Department does something that has an effect on others, and it is sometimes difficult to get round those circles. However, local authorities in the north-east are clearly having to cut back on funding for
this. Mind has said in the briefing note it sent to us for today that about 22% of its funding at the local level has been cut, That is a shame because, as I said, those organisations are sometimes the best at not only being advocates for local mental health services, but at providing care. In regions such as my own in the north-east, funding is vital for those organisations. When I talk to local mental health professionals and charities, I find that it is unfortunately a fact of life that economic conditions at the moment mean that the demand for services is increasing.
The hon. Member for Loughborough referred to the Health and Social Care Act 2012, and I agree with her that it does present some opportunities, if things are done properly. Chester-le-Street Mind, under the great leadership of Helen McCaughey and her husband, Charles, delivers a local therapy service, commissioned by the primary care trust, and it is great. It is carried out in the community, and that is the model that I like to see. The only concern I have, from talking to GPs over the years, is that although some of them are passionate about mental health and understand it, others do not. The challenge for the new commissioners is to take a bold step and say that some of these services can be delivered in the community by groups such as Chester-le-Street Mind and others. The Government might have to be aware of that nationally. As my hon. Friend the Member for Islington North said, this does not have to involve just large companies, because the approach I have described would be effective. That is my only concern: that although I know some very good GPs, including my own, who have a clear understanding of mental health issues, others are not very good at giving this appropriate priority—I am sure that hon. Lady is aware of some of those. We are thus presented with both an opportunity and a risk.
Simon Burns (Minister of State (Health), Health; Chelmsford, Conservative)
I am extremely grateful to the hon. Gentleman because he is making an extremely good point, but does he agree that, under the reforms and the new NHS, a crucial role will be played by the health and wellbeing boards, which are there to monitor and ensure that the local health needs of local communities are provided for?
Kevan Jones (North Durham, Labour)
Yes, that is one of the key roles of those boards. Again, however, it will be important to ensure that we get the right people on those boards—for example, counsellors who really understand mental health on those boards. As the hon. Member for Loughborough said, people have empathy in respect of cancer, but do not quite understand mental health. I agree with the Minister that it is important that the boards are the counterweight to ensure that that happens, but I think that central Government also have to play a role in ensuring that it happens. As I say, we have some great opportunities here and the commissioned work that Chester-le-Street Mind delivers is excellent. In addition, it is cheap compared with some of the major contracts in terms of delivery, because it is delivered by well-trained professionals and by very committed and hard-working individuals in the community.
A lot of mental health charities also rely on charity funding from organisations. In the north-east this funding comes from, for example, institutions such as the Northern
Rock Foundation, which has now been taken over by Virgin Money. There is real concern that as those sums contract, the money going into mental health services from those groups will also contract. We need to keep an eye on the situation to ensure that, be it through the lottery or through organisations such as the Northern Rock Foundation or the County Durham Community Foundation, where funds are limited because of the economic crisis, mental health gets its fair share of the funding available. I mean no disrespect when I say that people give happily to Guide Dogs for the Blind or to cancer charities, but it is very much more difficult to get a lot of people to recognise and give money to mental health charities, unless they have been through or had a family member who has been involved in mental health issues. We need to be wary of that, too.
I now wish to discuss the welfare benefit changes, which my hon. Friend the Member for Bolton West mentioned. I commend Mental Health North East, a very good group in the north-east that has interacted with the Department of Health. It is an umbrella group of mental health charities that not only campaigns for and raises awareness about mental health but delivers services to mental health charities and individuals. The organisation is run by a very dynamic chief executive, Lyn Boyd, and is made up of paid individuals and a large number of volunteers, many of whom have personal experience of mental health issues. They are very good advocates, not only ensuring that mental health is kept high on the political agenda but interacting very successfully with the Department of Health in consultations and so on.
One piece of work that that organisation has considered is on a matter that I have increasingly seen in my constituency surgeries. There are people with mental health issues who were on the old incapacity benefit and are now on the new employment support allowance and who are, frankly, being treated appallingly. The way that is being done is costing the Government more money in the long term. I know that it is not the direct responsibility of the Department of Health, but some thought needs to go into how we deal with the work test for people with mental health illnesses. I am one of the first to recognise that, as most of the professionals say, working is good for people’s mental health; it is important to say that. However, we must recognise that certain people will have difficulties with that. If we are to get people with mental health problems into work, we must ensure that the pathway is a little more sympathetic than the one we have at the moment.
Another massive problem is the work needed with employers. If employers are going to take on people with mental health issues, they will have to be very understanding to cope with those individuals.
Jeremy Corbyn (Islington North, Labour)
Many of those who are taken for work-related interviews by ATOS are declared fit for work, only to win an appeal to show that they are not. On many occasions, the levels of stress they have been through in going for the interview, failing it and winning an appeal are very detrimental to their health. Does my hon. Friend agree that the Department must be far more sensitive about that and think a lot more before it starts to call people in for these interviews?
Kevan Jones (North Durham, Labour)
I totally agree and I shall give some examples of that in a minute.
We must try to get a system in which employers, even in these tight economic circumstances, understand the mental health issues and can make adaptations. Whether we support employers who take people with mental health issues on for a certain period or whether we do other things, we need to think it out a bit more than it is at the moment.
Nicky Morgan (Loughborough, Conservative)
One statistic that I did not use in my speech was that only 1% of the access to work funding, which employers can use to help to smooth someone’s path back into employment, is used for mental health facilities. It could be used for counselling or support workers, but only 1% is spent on such provision in the context of the prevalence of mental health issues in the general population.
Kevan Jones (North Durham, Labour)
The hon. Lady makes an important point that should be considered. That is where we need to join up the two relevant Departments.
Mental Health North East has carried out a survey and I thank that organisation and Derwentside citizen’s advice bureau for the examples I am going to use. Like the hon. Member for Loughborough, I asked whether I could use names. One person said that I could, but late last night she rang me to say no. I am sure that people will understand why I use letters to refer to these individuals rather than their names.
The first case is that of Mr A, a 50-year-old man who lives alone and received ESA. He suffers from depression, anxiety, agoraphobia and anger issues. Despite the support he is getting and the drugs that he is taking, he was called by ATOS to a work-related interview. He got no points at all even though he finds it very strange to go outside the House, let alone to interact with people. He decided to appeal and attended the appeal. There is a huge backlog in the appeals system that is adding to people’s anxiety as they are having to wait a long time, and the pressure on citizen’s advice bureaux and local welfare rights organisations to support those appeals is creating a crisis in some of them. When I give some of these examples, Mr Speaker, you will see that they should never have gone to appeal in the first place.
This case was very interesting. Mr A turned up at the appeal, which, as my hon. Friend the Member for Islington North mentioned earlier, caused him huge stress as he thought he was going to lose. He turned up in the afternoon, and his appeal had been heard that morning without his being present and his award had been granted on the basis of the medical evidence. If the appeal hearing could do that, why could ATOS not do so? The reason is that ATOS is not taking medical evidence into account at all.
The second individual is from Stanley in my constituency and I have known this young lady since she was in her early 20s.
Kevan Jones (North Durham, Labour)
Having seen the form, I think it was according to the contract, and this is where things needs tweaking. We need a special form for people with mental
health issues, rather than using the generic form for people with other disabilities, too. That is the important point that needs change.
Miss B, as I will call her, is 36 and a single parent who lives in Stanley in my constituency. She has a very supportive family and receives huge support from her local Sure Start and her local community mental health team. She has been unemployed, suffers from bipolar depression and is on a cocktail of medication. Although everyone has been told not to contact her directly but to contact her mother, ATOS contacted her directly. She lives independently just down the street from her mother, which is good, but everyone has been told to contact the mother because she does not quite understand. When ATOS contacted her with a telephone request for interview, according to her mother it sent her into an absolute panic. If her neighbour had not been there to help her, it would have caused huge problems.
Miss B went to the interview and failed it, getting no points. She is now having panic attacks, she has had episodes where she has felt suicidal, and without support her child would have been taken into care. She was nearly hospitalised because of the stress. She has now had to wait upwards of eight months for her appeal to be heard, but in the meantime, and not just because of the ESA, her housing benefit has been stopped so she is in debt. It is one thing after another, which is not what someone with severe mental health illness needs and that is why we must refine the system. That woman has been waiting for an appeal for eight months now and, knowing the case as I do, I have no doubt that she will win.
My final example is Mr J, a 52-year-old who suffers from mental health illness, partly as a result of his separation from his partner a few years ago. He suffers from very severe depression and is on antidepressants. He has tried to help himself by going to cognitive behavioural therapy sessions. In January 2012, the Department for Work and Pensions wrote to ask him to attend an ATOS interview, which caused him to withdraw from his treatment programme. That was not good for him. Very insensitively, ATOS then rang him on Christmas eve to organise the appointment. Again, despite the fact that a lot of medical evidence was presented, ATOS did not take any of it into account.
There is another thing that ATOS is getting completely wrong, or at least has an inconsistent approach to. Mr J took his son, who is one of his key supporters, along with him and asked whether he could make representations on his behalf. He was told no. In other cases, people have taken their community psychiatric nurses with them only for them to be told to sit outside the interview while the individual goes in. ATOS is being inconsistent in its approach and is clearly not taking on board any of the medical evidence that is put forward. Mr J appealed and, as in the first case I cited, the appeal went through on the basis that the medical evidence presented was good enough. What is ATOS doing? What concerns me about these cases is the cost not just to the individual but to the health service and the local NHS.
Let me highlight the findings of the survey I mentioned and read some quotes from it. In response to a question about whether medical evidence was taken into account, someone said that it was “not even looked at.” Another response was:
“Not at all and there was a great deal including an advocate (myself) attending the Medical. Nothing that I said”
seemed to make a difference. Yet another:
“Generally, clients feel that mental health is not taken into consideration”
and is not being focused in the way that physical disabilities are.
“Most clients believed that their own medical evidence had been completely disregarded”
at the interviews they attended. Another issue that was commonly raised was how little time it took—less than 15 minutes in most cases.
Question 6 asked about the impact on individuals. Let me quote some of the answers directly:
“Despair. Resignment to the cruelty dished out”
by the system.
“Very distressed, anxious, scared”.
“Very stressed, confused, angry and frightened as you can imagine, these people are already existing below the poverty line”
and this increases stress levels.
Judging by those examples, the system needs to be changed. It is inefficient, it is causing huge problems for individuals, and is also costing the system more. What we need to do, possibly through the Department for Work and Pensions and the Department of Health, is come up with a specific work test for people with mental health issues, and recognise that individuals have to be supported.
Now I am going to throw my notes away—I thought long and hard last night about whether to do this—and talk about my own mental health problems. 1n 1996, I suffered quite a deep depression related to work and other things going on in my life. This is the first time I have spoken about this. Indeed, some people in my family do not know about what I am going to talk about today. Like a lot of men, I tried to deal with it myself—you do not talk to people. I hope you realise, Mr Speaker, that what I am saying is very difficult for me.
I have thought very long and hard about this and did not actually decide to do this until I just put my notes down. It is hard, because you do not always recognise the symptoms. It creeps up very slowly. Also, we in politics tend to think that if we admit to fault or failure we will be looked on disparagingly by the electorate and our peers. Whether my having made this admission will mean that the possibility of any future ministerial career is blighted for ever for me, I do not know. I was a Minister in the previous Government and I think that most people on both sides of the House thought I did a reasonable job.
We have to talk about mental health issues in this place, including people in the House who have personal experience of it. As I have said, I thought long and hard last night about doing this and I did not come to a decision until I put my notes down just now. Whether it affects how people view me, I do not know; and frankly I do not care because if it helps other people who have depression or who have suffered from it in the past, then, good.
Politics is a rough old game, and I have no problem with that. Indeed, I am, perhaps, one of the roughest at times, but having to admit that you need help sometimes is not a sign of weakness. I also want to say to you, Mr Speaker, that we need to do more here to support Members with mental health issues. In terms of
occupational health, we have an excellent individual in Dr Madan, who understands mental health issues very well. I know of only one other Member who has suffered from mental health problems because a colleague on the Labour Benches has spoken to me about her mental health issues and depression, but it is important to get the message across to individuals that if they are having problems they can go and see Dr Madan and her team.
May I also highlight to you, Mr Speaker, the problems that Dr Madan has with getting funding for treatment afterwards? The hon. Member for Loughborough mentioned drugs, and they are part of the answer, but they were not the solution for me. Things like cognitive behavioural therapy can be far more effective. As I learned over many years, it is about how you think. Dr Madan raised an issue with me regarding an individual for whom she was trying to get funding, but the House authorities were not prepared to do it. If she comes to you, Mr Speaker, regarding any Member who wishes to have mental health support you have to say yes because it is not easy for Members of Parliament to go to their own GP or local community to talk about these issues. Sometimes, it is perhaps better for them to have treatment and find solutions here rather than in their constituency. That is a plea to you, Mr Speaker, and I would be grateful if you took that on board.
As I have said, I do not know whether I have done the right thing. Perhaps I will go home tonight and think I have not, but I think I have. I hope that it does not change anyone’s view of me. Most people might think, “Christ, if it can happen to him, it might happen to anybody.” On that note, let me put on record my thanks for the opportunity to debate this issue. Let us go out and champion this issue.
Finally, let me say to every hon. Member present and to those who are not present that although being an MP is a great privilege—I have always thought that; it is a great thing that I love—it also has its stresses. Unless someone has done it, they do not know what those stresses can be personally, in terms of family, and in terms of what is expected of us in the modern technological age. A little more understanding from some parts of the media and some constituents about the pressures on the modern-day MP would be very valuable.
Charles Walker (Broxbourne, Conservative)
It is absolutely fantastic to follow Mr Jones. I was a researcher here in the early 1990s and a few Members present were here at that time. They will remember the debates about homosexuality. There were some discriminations, as there still are, in relation to homosexuality, and people were beginning to feel very uncomfortable about that. Many colleagues came to this place to take part in those debates, and they would say, “These discriminations against homosexuals are disgraceful, but I am not gay myself.” They did not want to be perceived as gay because they had an interest in those matters.
I am delighted to say that I have been a practising fruitcake for 31 years. It was 31 years ago at St John’s Wood tube station—I remember it vividly—that I was visited by obsessive compulsive disorder. Over the past 31 years, it has played a fairly significant part in my life. On occasions it is manageable and on occasions it becomes quite difficult. It takes one to some quite dark
places. I operate to the rule of four, so I have to do everything in evens. I have to wash my hands four times and I have to go in and out of a room four times. My wife and children often say I resemble an extra from “Riverdance” as I bounce in and out of a room, switching lights off four times. Woe betide me if I switch off a light five times because then I have to do it another three times. Counting becomes very important.
I leave crisp and biscuit packets around the house because if I go near a bin, my word, I have to wash my hands on numerous occasions. There has to be an upside to a mental health problem. I thought that the upside would be that I would not get colds, because apparently if you wash your hands a lot, you don’t get colds, but I wash my hands hundreds of times a day and I get extremely cheesed off when I end up with a heavy cold.
OCD is like internal Tourette’s: sometimes it is benign and often it can be malevolent. It is like someone inside one’s head just banging away. One is constantly striking deals with oneself. Sometimes these are quite ridiculous and on some occasions they can be rather depressing and serious. I have been pretty healthy for five years but just when you let your guard down this aggressive friend comes and smacks you right in the face. I was on holiday recently and I took a beautiful photograph of my son carrying a fishing rod—hon. Members may know that I love fishing. There was my beautiful son carrying a fishing rod, I was glowing with pride and then the voice started, “If you don’t get rid of that photograph, your child will die.” You fight those voices for a couple or three hours and you know that you really should not give into them because they should not be there and it ain’t going to happen, but in the end, you are ain’t going to risk your child, so one gives into the voices and then feels pretty miserable about life.
But hey, there are amusing times as well. I do not feel particularly sorry for myself, because my skirmish with mental health is minor. There are people who live with appalling mental health problems day in, day out, which is why I when I became an MP, I regarded it as a wonderful opportunity to try to help them. I hope that I have an insight into some of their pain and agony and the battles that they go through on a daily basis. Many people are frightened and feel excluded.
My first year and a half in Parliament was absolutely appalling. It was very, very difficult. My constituents thought that I was a jolly fellow—that is how I came across—but I remember sitting in my office going through my post. A book arrived with a letter saying, “Managing your Tourette’s”. I thought, “Oh my word, someone has spotted me on television. I’m done for. They’ve sent me a book and I’ll be outed in the newspapers: ‘Walker’s a loony’”. My constituents will turn their backs on me, my association will throw its hands in the air, and my children will be chased through the playground.” I sat in cold terror for 10 minutes, wondering how I would navigate my way through this. I then picked up the letter and realised that it was a circular that it had gone to all 650 MPs, so I took great comfort from the fact that probably 50 others were having the same emotions as me.
We can talk about medical solutions to mental health problems, and of course medicine has a part to play. In reality, however, society has the biggest part to play. This is society’s problem, and we need to step back from
our own prejudices, park them and embrace people with mental health problems. You only get one chance at life. You get about 80 years-ish. If you have severe mental health problems, you get about 65. Can you imagine going through your whole life feeling miserable, excluded, discriminated against, with little hope? I cannot. I have a wonderful vocation, I have a loving family, and I have a comfortable lifestyle, so I know, even when things are bad, they will get better, but a lot of people are not in that position, and we need to reach out to them.
I am really excited about the speech by the hon. Member for North Durham—I am very excited about that—and I am excited about the fact that my hon. Friend Nicky Morgan secured this debate. We are making progress and moving in the right direction. We will hear from my hon. Friend Gavin Barwell in a few moments—or hours—about his private Member’s Bill. Many colleagues in the House are taking part in the debate. I think that some colleagues would like to be here but, again, if they are here discussing mental health, some people might feel that they have a problem. Look, it is a not a problem, it really is not: let’s get over it guys, and move on.
Media reporting has improved and we do not often see headlines such as “Frank Luno”, which was totally indefensible. The media are beginning to get on board, because there are many people in the media who suffer from mental health problems. As the hon. Member for North Durham alluded to at the beginning of his speech, who are these people out there? They are doctors, nurses, teachers and soldiers; they are all around us. Why would the hon. Gentleman’s constituents think any differently of him now than they did 20 minutes ago? In fact, they will respect him a great deal more. Why would my constituents think any differently of me now than they did 10 minutes ago? Those who disliked me will continue to dislike me; those who like me will continue to like me; and those who were slightly agonistic could go either way.
Here we are, having a great, great debate. The all-party group on mental health is going from strength to strength and, for the first time, I am feeling really positive and very happy. I am not going to speak for much longer, but I want to say two things. We need to sort out independent mental health advocacy for people who face incarceration or are on community treatment orders. Access to representation is patchy across the country, and we need to sort that out, because we cannot lock up people who do not receive proper advocacy or constrain their liberties without proper advocacy.
We also need to address Criminal Records Bureau checks under the heading “Any other relevant information” that are entirely at the discretion of the chief constable. I am aware of a number of people who have had mental health problems and have been detained for a short while. The police became involved, because they took those individuals into detention or to hospital. They go for a job perhaps as a counsellor or working in the charitable sector. They have a clean record but under “Any other relevant information” the chief constable can say, “We are aware that this person was detained for a mental health problem at this institution. We are not aware that they are a threat to adults or children”. That
is that. That is the end of the matter, because we recognise that there is stigma and discrimination. I am afraid that in our ultra risk-averse world, that is a career death sentence for those people. We need to sort that out.
I join the hon. Member for North Durham in saying that I am not frightened any more. Like him, I am pretty middle-aged, and I do not care what people think of me any more. When people come up to me and say, “Mr Walker, we think you an absolute rotter and so-and-so”, with OCD, I would probably have said a lot worse to myself 20 minutes earlier. It is not such a big deal. I am not frightened any more. It is a really good place to be, and we need to ensure that many hundreds of thousands can be in that place as well. Not being frightened is a really good thing. Hon. Gentlemen, hon. Ladies and friends: rock and roll, as they say. Thank you.
Jim Shannon (Strangford, DUP)
I am privileged to be in the Chamber to hear some of the speeches that have been made, including those by the hon. Members for Broxbourne (Mr Walker) and for North Durham (Mr Jones). It is a great privilege to hear what they said. I congratulate Nicky Morgan on raising the matter in the Chamber. She said that everyone has mental health issues; I suppose it is a matter of how they deal with that and control it. We all have a breaking point. I hope that I never reach that breaking point, and that others do not do so either.
As an elected representative, in my interaction with constituents in my office, I see very clearly how people deal with depression. As the hon. Member for Strangford, I wish to express views on behalf of my constituents, ever mindful of the fact that health in Northern Ireland is a devolved matter. However, the debate is on mental health generally, so the issues in Northern Ireland are every bit as relevant as those in Broxbourne, North Durham, Loughborough and anywhere else in the United Kingdom. Every day I deal with those issues, whether through employment and support allowance appeals or disability living allowance appeals, or by interacting with people and the way in which they deal with their benefits.
An issue that has been highlighted in the Chamber is the difficulties that can arise. That was an issue before the economic downturn, but it is a bigger issue today, because people find it harder to deal with the economic and financial realities that face them, which compounds their problems. In all honesty, over the past year or 18 months, I have seen greater need in people who suffer from depression, as they have had to deal with issues with which they have never had to deal before. We have debated many great issues in the Chamber in the two years in which I have been an MP, but this issue is certainly one of the most important.
I want to deal with two issues. I want to talk about mental health from the perspective of Northern Ireland, and I also want to touch on an issue the hon. Member for Loughborough mentioned when she talked about the armed forces. There are problems for our soldiers and service personnel returning from the battlefield, whether Afghanistan or Iraq, because their memories of those conflicts do not finish when they get off the plane or boat after returning home; they are still with them many years after the conflict. I feel strongly about that for those who returned from both Iraq and Afghanistan.
Good mental health should be a priority for us all, as every Member who has spoken so far has indicated. In Northern Ireland we have also made it a priority. However, Northern Ireland—I say this with respect—has been underfunded for many years, owing to direct Government reasons and others. The figures show that mental health is a greater issue in Northern Ireland than it is in other parts of the United Kingdom. People would say that that is perhaps because of the 30 years of the troubles, which I think is probably true. When someone is under pressure or stress and worried about whether they will live or die, they turn to drink, drugs or other things, and that affects their lifestyle. Ultimately, a great many people in Northern Ireland suffer from depression and mental health issues because of our country’s past. I am glad to say that we have moved on. We now have a partnership Government and we are working together to ensure that there is a future for everyone, and that in the future there is a lessened threat of terrorism.
The British Medical Association in Northern Ireland has done significant research on mental health there. When the hon. Member for Loughborough introduced the debate she mentioned a number of the points that are also in the BMA’s report, so I could not help but wonder whether she had perhaps seen the same report. It contained a number of points that she referred to and commented on. I think that the reason those points are so similar to what she said is that the same issues are just as relevant in Northern Ireland as they are in Loughborough and the rest of the United Kingdom.
I would like to touch on how we can improve the situation. I know that the Minister will have a detailed and helpful response to the debate. To start with, it is a taboo subject. I think that the Government and policy makers must strive to ensure that the stigma, which Members have talked about, and the clear discrimination and fear that surround mental health are eliminated or addressed by focusing on promotion, education, prevention and early intervention. Those are the four headlines the BMA puts forward in its suggestions. There is clearly a work force planning problem that, in some occasions, occurs simply because of reductions in staffing levels. There are a number of things we need to do, and perhaps the Minister, when he responds, can tell us how the issue of mental health will work within the staffing restrictions and assure us that that concern will be taken on board.
The Northern Ireland Executive’s programme for government made a commitment to work for a healthier people and identified mental health as a priority. It also set out targets to try to address the issues. The person who suffers from mental health problems is only part of the problem. When a constituent with mental health problems comes to my office, as they do to the offices of other Members, there is not just one person sitting in a chair in front of me, because they are usually accompanied by someone else; there is a family circle, children, mums and dads and everyone involved. While one person might suffer from mental health problems, half a dozen people could be affected by the ripples.
I am also concerned about teenagers who suffer from depression. Between 10% and 20% of our teenagers will suffer from depression at some point in that short period of their life. I believe that there has to be recognition of mental illnesses, notably depression, and it means that we need to look beyond good mental health and at
preventing mental health problems and ensuring early intervention. Many personal issues affect mental health, including drink, drugs, working conditions, homelessness, poverty, unemployment and risk-taking behaviour, whether smoking or unsafe sex, and those issues affect many of the people who come to my office with these problems.
Let us address these problems first by strengthening individuals, by addressing emotional resilience and by promoting self-esteem, life skills, coping skills and communication skills. We also have to strengthen communities. Those are the issues I feel are important. That means addressing the issue of social inclusion, improving neighbourhood environments, which make a difference. In relation to teenagers, we also have to try to address the anti-bullying strategies in schools. Those are important because bullying is one of the things that lead to young people having these depression issues.
We also have to reduce the structural barriers to mental health, which means access to education and meaningful employment. I know that that everyone will agree with that, but at the end of the day we need to have a strategy in place to address mental health issues, and that is what we are seeking to do through this debate. We all agree that there is absolutely no doubt that we all support the issue and the vulnerable people affected, people who we meet every day and who need real help.
Suicide in the community is a great worry for us all as elected representatives. Every one of us will have dealt with families, with people whom we know personally or with people from families that we know personally who have lost loved ones—who took their own lives because they felt that there was no way forward. They were coming off the back of terrible depression or terrible pressure, and did not know where they could go next.
Kevan Jones (North Durham, Labour)
We have been talking about the voluntary sector, and in my constituency there is a very good organisation, which also came about as a result of a personal tragedy for the individual—a woman called Shirley Smith, who runs If U Care Share. Her 19-year-old son died, and it is about young people and talking about those issues. She goes into schools, youth groups and football clubs to do so. Does the hon. Gentleman think we should have a national strategy on that to ensure that it is part of the curriculum as well?
Jim Shannon (Strangford, DUP)
Yes, I do. When a constituent of mine died in a car accident on a Sunday night, I went to her house on the Monday night, and her father just wanted to speak and to talk about his daughter. That is the issue. On many occasions, it is just a matter of having someone to talk to, someone who can lend a sympathetic ear when it is needed most, so I wholeheartedly agree with the hon. Gentleman on that matter.
Back in 2005, the then Secretary of State for Northern Ireland, who had some responsibility for health, Mr Woodward, set up a task force to develop a suicide prevention strategy for Northern Ireland. It is paying some dividends in relation to a decrease in the number of suicides, but the number is still at a very high level.
Other Members have touched on dementia and Alzheimer’s, and after wearing my hat as a councillor for 26 years and as an Assembly Member for 12 years, before being privileged to enter this House, I must note
that the number of people with Alzheimer’s and dementia is greater today than ever before. I do not know the reasons why, but they are real, the statistics prove it and we have an issue there as well.
On employment and support allowance appeals, the hon. Gentleman made an interesting point about those who have mental health issues, because when they go to an ESA appeal the issue is clearly not a physical one, because physically they can walk about, move their hands, brush their hair—if they have any, unlike me—or put a hat on their head. They are asked whether they can do those things, but those are not the questions that a person with mental illness needs to answer. They need to answer the questions, “Are you moody?”, “Do you fall out with people?”, “Are you aggressive?”, “How do you cope with difficult situations?”, “Do you start a task that you cannot finish?” Those are the questions for a person who is depressed, and I agree with the hon. Gentleman, because the appeals panel—the chair and those who deal with such tribunals—need to understand those issues better, so that an appeal can be presented in a way that people understand.
It has been stated that everyone has mental health issues. No one is immune, and although stress is greater among the poor and the unemployed it applies throughout society. Good mental health is crucial to the overall well-being of an individual, of societies and of countries.
In Northern Ireland there are about 150 suicides each year: 41% are single males, and 22% are males between 25 and 34 years old. Some 50% of suicides in the UK involve psychiatric patients, and one reason is a loss of contact; in that context I want to talk about soldiers, about a loss of contact by the health service and about treatment non-compliance, whereby people do not take the medication that doctors give them.
Figures for the United Kingdom as a whole indicate that depression accounts for about 60% of the country’s main health problems, alcoholism about 10%, Alzheimer’s about 8% and severe stress about 6%. That leads me on to that second issue, which is to do with our soldiers.
The week before last I had the opportunity to go to Cyprus with the armed forces parliamentary scheme. Some MPs in the Chamber will be members of that great scheme, some will be aware of it and some will have been members in the past. We have an opportunity to meet soldiers and to hear about strategic issues so that we can present them to the House in an informed and knowledgeable way.
When we were in Cyprus two weeks ago, we noted its importance from an Army and a strategic point of view, but we had not realised that it is halfway to Camp Bastion in Afghanistan. There is a new scheme in Cyprus whereby soldiers returning home from Afghanistan come through a so-called decompression centre in Akrotiri; last year 30,000 did so. They call it decompression because it helps them to unwind after what they have experienced in Afghanistan over the previous few months. The sun is usually shining, which makes a big difference. They have a chance to shower, to have their kit completely dry-cleaned, and to have a good meal. They have access to mobile phones, and they are able to speak to their doctor, padre or commanding officer. They have a chance to get back into normal life—to step down and get themselves ready to go back home to their family.
The work done for our soldiers in the Akrotiri centre, which cost £4.5 million to build, gets them ready for life back home.
Those soldiers have seen in Afghanistan the most horrific things that we cannot begin to visualise. They have seen friends and colleagues killed or injured, some with life-changing injuries. We know of those people because we have met some of them, and we are humbled when we do so. The bullets and the bombs are intermingled with the stress, the trauma, the bad memories and the nightmares—those are all part of the things they have to face long after they leave the Army. While the Army, the Royal Navy and the Royal Air Force look after their personnel, the forces associations do likewise. We recognised from our time in Akrotiri, as we have in our constituencies, that once soldiers are out of the Army they are often distanced from those associations too. The Royal British Legion might not always be at hand for them. They might have no friends or their marriage might have split up. They might turn to drink and drugs, but that will give only temporary relief and they are still on their own. I am mindful that defence is not the Minister’s portfolio, but I hope that when he replies he will consider the welfare of our soldiers who have returned from Afghanistan, are not in the forces any more because they have left or retired, and are now apart from the ritual and discipline that they were once very much part of.
Every one of us will be aware of constituents who have lost control because of the memories and nightmares of what they have seen. Whenever the memories flood back and the flashbacks reappear, they relive what they have come through, and then they face their demons alone. We need to face up to this issue confronting those who have served, and are serving, in the Army, the Navy and the Air Force. The health service needs to address it UK-wide, in England, Wales, Scotland and Northern Ireland. The plight of our soldiers should be a priority for this Government, as I know that it will be. I commend the motion to the House and hope that Members will support it.
Paul Burstow (Minister of State (Care Services), Health; Sutton and Cheam, Liberal Democrat)
There is no health without mental health. In that simple statement I sum up the coalition Government’s approach to mental health.
In contributing to this important debate, I start by congratulating my hon. Friends the Members for Loughborough (Nicky Morgan) and for Broxbourne (Mr Walker), among others, on tirelessly pursuing the case for having this debate on the Floor of the House. It is one of the rare debates that we have on this subject, and it clearly airs the issues that are so important to so many of our fellow citizens.
Mr Jones said that it was a privilege to have the job—the vocation—of being a Member of Parliament, and I could not agree with him more. Sometimes, that privilege involves the surprise that we can still experience in the Chamber when debates are genuinely authentic and when people speak from the heart. I thank him for his candour and honesty; we need more of that. The chair of the all-party parliamentary group on mental health, my hon. Friend the Member for Broxbourne, talked, with humour and much besides, about his experience with obsessive
compulsive disorder. Anyone living and struggling with such conditions, who has not perhaps reached the point of wanting to talk about it, will feel huge respect for both Members for bringing the attention of the House to these matters. They have made us all wake up to something that we ought to know, but that we too often forget. That is that mental health is not a “them and us” game; it is about us—all of us. It touches us all in one way or another.
I am probably not going to be able to do justice to every contribution in the debate, not least those that I have not yet heard, but I assure hon. Members that I will continue to listen throughout the remainder of the debate, and that if any issues arise that I have not covered in this speech, I will write to the Members concerned to address those points.
Jim Shannon made some important points about the support for our veterans, and for our armed forces more generally. This Government have done a lot in that regard—not least the commissioning by the Prime Minister of my hon. Friend Dr Murrison to produce his report, “Fighting Fit: a mental health plan for servicemen and veterans”. The report deals with many of these issues, and the Government take them, and the action that they require, very seriously.
Kevan Jones (North Durham, Labour)
Paul Burstow (Minister of State (Care Services), Health; Sutton and Cheam, Liberal Democrat)
I hope that there will be cross-party consensus on these issues today, and I shall take the hon. Gentleman’s question in that spirit. He makes a fair point. This is about building on what is working, and ensuring that it can work even better. The work done by my hon. Friend the Member for South West Wiltshire has certainly accelerated the pace.
When the Deputy Prime Minister and I launched the mental health strategy last year, we recognised the need to tackle the root causes of mental illness as well as ensuring that community and acute services provide timely treatment and care. We placed a strong emphasis on recovery from a human, rather than just a medical, perspective. We also made it clear that delivering significant improvements in people’s health and well-being requires parity of esteem between physical and mental health.
I know that some hon. Members are concerned that not enough emphasis has been placed on acute and in-patient care. Let me be clear. Our plans to provide a safe, modern, effective mental health service give equal emphasis to the full range of services, from public mental health and prevention through to forensic mental health services. This is about people receiving high quality, appropriate care when they need it. If services can intervene early—the case for that has already been powerfully made—so that mental health problems can be managed in the community before more serious problems develop, that should result in acute in-patient care being made available more quickly for those who need it.
My hon. Friend the Member for Loughborough mentioned the concerns raised by the Association of Chief Police Officers about places of safety. In partnership with the Home Office and the police, we are examining
how to ensure that health services are properly commissioned in custodial situations. I would be only too happy to meet her and the ACPO mental health lead to discuss those issues further.
Jeremy Corbyn (Islington North, Labour)
Will the Minister look carefully into the circumstances of people who die either in police custody or in a mental health institution as a result of a mental health issue, to determine whether adequate forms of inquest and inquiry exist, and whether adequate lessons are being learned from the experiences? In view of what is going on in one or two inquests at the moment, I feel that there are some quite serious deficiencies in that area.
Paul Burstow (Minister of State (Care Services), Health; Sutton and Cheam, Liberal Democrat)
I thank the hon. Gentleman for his question. May I undertake to write to him about that matter in more detail? It has come up in our work on our suicide prevention strategy in relation to the nature of suicide verdicts, and narrative verdicts in particular, in coroners’ courts. I would be happy to come back to him on that issue.
In the past year, we have made progress across a broad front. We have committed £400 million to make psychological therapies available for adults of all ages, as well as for people with long-term health conditions and with severe and enduring mental illness. When it comes to our focus on recovery, the latest figures show that 44.4% of those who complete programmes recover and that more achieve lasting improvement. That puts us on track to achieve our target rate of recovery of over 50%.
Given that we know that the first signs of more than half of all lifelong mental illnesses can be detected in adolescence, we have to go further. That is why the Government are breaking new ground by investing in a new training-led approach to re-equip children and young people’s mental health services to offer a range of psychological therapies. I pay tribute to the leadership shown by YoungMinds. Without its support, we would not have come as far in this area as fast as we have.
I want to say something about the necessity of achieving the best possible outcomes for people in mental health crisis. Secondary mental health services across the country have made significant changes, both in community and hospital settings, including the provision of alternatives to psychiatric hospital admission. For example, more than 10,000 people with an early diagnosis of psychosis were engaged with early intervention services last year. That is the highest figure ever recorded. The improvements in community-based early intervention services are driving up standards of care, as well as reducing the demand for hospital admissions. I freely acknowledge that there is more to do and I take on board the point that my hon. Friend the Member for Broxbourne made about the need to look at the variability in the accessibility of mental health advocacy.
The development of recovery-focused services is a critical part of the Government’s strategy. That work is being led by the NHS Confederation’s mental health network and the Centre for Mental Health. They are supporting pilot sites that cover almost half of England and are making the kind of changes that service users have sought for years. The programme has identified 10 key changes to the way in which staff work, the types of services that are provided and the culture of organisations to embed recovery principles into routine practice.
When I visited the South West London recovery college, I heard powerful personal testimonies from people who were living purposeful and fulfilling lives, and who were living with their illness rather than having to be cured of symptoms or illnesses. It is important that recovery is not just seen in medical terms, but is self-defined. Students at the college learn not only how to manage their condition, but skills to help them back to work and to form new relationships. Some become lecturers at the college themselves. I was told that being called a student, rather than a patient, helped people take control of their recovery, gave them more confidence and, crucially, made them feel normal, as opposed to being treated as a helpless, passive recipient of care.
Part of a good recovery is the ability to exercise more control over one’s life. In health care, that means that there must be more shared decision making and choice. In opening the debate, my hon. Friend the Member for Loughborough mentioned the principle of “no decision about me without me”. Undoubtedly, the any qualified provider policy and tariff reform have a part to play in that.
Adam Afriyie (Windsor, Conservative)
Many of us recognise that many people who come to our constituency surgeries, perhaps with a housing benefit inquiry or other benefit inquiry, are actually struggling with mental health challenges. It seems to me that the lack of control that results from the way in which Government services are designed can be a great contributing factor to stress and, therefore, to depression. The Minister is speaking about control. Can the design of public services, such as housing benefit and other benefits, be taken into account as a way of relieving the stress on a great number of our constituents?
Paul Burstow (Minister of State (Care Services), Health; Sutton and Cheam, Liberal Democrat)
That intervention rather helpfully moves me on to the point that has been made by several hon. Members about Atos. Although it is not my ministerial responsibility, a number of important points have been made about how it operates in particular cases. I will ensure that those points are taken into account by my ministerial colleagues at the Department for Work and Pensions. I will gladly pass them on.
Stephen Timms (East Ham, Labour)
The Minister will know that mental health charities have proposed changes to the mental health descriptors in the work capability assessment for employment and support allowance. There seems to be some delay in implementing those. Will he pick that up in his discussions with his colleagues?
Paul Burstow (Minister of State (Care Services), Health; Sutton and Cheam, Liberal Democrat)
I will certainly act as the messenger and pass that point on, as the right hon. Gentleman has requested.
Stigma has been referred to in this debate. It is undoubtedly one of the biggest barriers to access to mental health services in this country. The Government are determined to reduce the prejudice and discrimination that surround mental health, but we recognise that we cannot do that on our own. That is why Mind and Rethink Mental Illness have developed a major anti-stigma programme called “Time to Change”. That campaign is working and is delivering significant behavioural change across society. That is why the Government are contributing the substantial amount of £16 million up to April 2015.
Matthew Offord (Hendon, Conservative)
The Minister says that the Government wish to reduce the stigma surrounding mental illness, and I accept that. Does he agree that the decision of the Department of Health in 1994 to hold an independent inquiry into every death involving someone who has suffered mental illness or been part of the mental health system continues to perpetuate that stigma?
Paul Burstow (Minister of State (Care Services), Health; Sutton and Cheam, Liberal Democrat)
That is an important and challenging point, and I will want to go away and think about what we do. For patient safety, we still need to learn lessons when things go wrong in our system, acknowledge when things have not been done properly and put them right. In that sense, confidential inquiries are an important part of the learning mechanism. One point of frustration that I hear in debates in the House and see in correspondence from hon. Members is the sense that lessons are not learned. As part of our reforms, with the NHS Commissioning Board taking on responsibility for patient safety, we need to ensure that that is not the case in future.
We are investing £16 million in “Time to Change”, and we were delighted when Comic Relief decided to put in an additional £4 million, one of the biggest grants that it has ever made.
I wish to make another point that touches on the contributions of my hon. Friend the Member for Broxbourne and the hon. Member for North Durham. One in five people still think that anyone who has a history of mental health problems should not be allowed to hold public office. How many former Presidents, Prime Ministers or Ministers would have been excluded if that view had been applied? [Hon. Members: “Churchill.”] Precisely. Such a law is as outdated as asylums and as outdated as many of the attitudes that sit behind it. It has to be consigned to the history books just like asylums have been, and under the coalition Government’s watch, it will be. I congratulate Gavin Barwell on securing a slot for a private Member’s Bill on the subject.
Looking ahead, although we have made progress there are still big challenges to tackle. Reference has been made to the implementation framework that will be published to support the roll-out of the “No health without mental health” strategy. That framework has been produced in conjunction with five national mental health organisations—Rethink Mental Illness, the NHS Confederation, the Centre for Mental Health, Turning Point and Mind—and many others have been involved.
We have previously had a very good debate about “Listening to Experience”, Mind’s excellent report on acute and crisis care, and Mind’s policy team have been directly involved in ensuring that the framework delivers on those issues. It will provide a route map for every organisation with contributions to make to improve the nation’s mental health. It will spell out how progress will be made, measured and reported.
What does success look like? To me, it means more people having access to evidence-based psychological therapists; services intervening earlier, particularly for children and young people; services focusing on recovery and people’s needs and aspirations above all; and service users and carers being at the heart of all aspects of planning and service delivery.
Today, economists tell us that mental ill health in this country costs £105 billion a year, and that is just in England. If we succeed and put in place the right combination of public health, anti-stigma policies, accessible psychological therapies and excellent community and acute services, we can dramatically reduce that figure. Put another way, if we can deliver the right evidence-based treatment to children and young people so that their conditions do not persist into adulthood, we can prevent as many as two in five of all adult mental health disorders. As a society, we have made huge progress in how we recognise people’s mental illness, but despite that we have not fully accepted that mental health is equal to physical health and that parity of esteem is needed between the problems of the body and the problems of the mind. That is the challenge—
Julian Lewis (New Forest East, Conservative)
I have waited many years to intervene on a Minister in his final sentence, and I have achieved that today.
Does the Minister accept, having made a convincing case for people being able to live with their illnesses by being at home, that part of the reassurance that they need to do that is to know that in periods of acute crisis, there will be a bed available for them should it be needed? That should be not only for detained patients but for voluntary patients.
Paul Burstow (Minister of State (Care Services), Health; Sutton and Cheam, Liberal Democrat)
One thing I did not say—I was trying to cut down my remarks—was that there is an essential need to give more people the ability to control their health care through crisis plans. Crisis plans are an opportunity for people to make a statement in advance on how they wish to be treated in the event of a mental health episode that requires an intervention from mental health services. We know that when the plans are in place, they make a huge difference to the need for admission, and that they can reduce the length of stay. We need to ensure that there is a sufficiency of beds so that people can get appropriate treatment, but we also need to ensure that there is much more focus on good, community-based intervention at an early stage. Getting that balance right is always difficult for health commissioners to achieve—I know my hon. Friend is struggling with that in his patch at the moment.
Those are the challenges the NHS faces. They are challenges not just for our health commissioners and providers but, as this debate has clearly demonstrated, for our whole society. We can transform mental health in this country only if we transform our attitudes. This debate plays an important part in that.
Andy Burnham (Leigh, Labour)
I begin by giving my apologies to Nicky Morgan for missing the beginning of her speech, and by congratulating the Minister on his excellent and thoughtful speech, to which I can hopefully add something.
I have high hopes for the debate. I hope it will help us to confront a major paradox: how can a subject that is so central to the big public policy challenges we face as a country—the challenges are not just of public health
provision, but of worklessness, benefits, the criminal justice system and addiction—still exist on the fringes of our national debate, getting so little airtime and attention. As other hon. Members have acknowledged, the House, sadly, rarely applies itself to mental health. Perhaps that reflects our national stiff-upper-lip tendency not to talk openly about mental health, which in turn might help to explain why our public services are designed for the 20th century rather than the 21st.
Andy Burnham (Leigh, Labour)
I am proud of the improvements we made in the last Parliament, but I did not come here today to say that everything the previous Government did was right and wonderful. I will talk a little about those improvements, but given my failure to sing Labour achievements, I am grateful to the hon. Gentleman for doing so.
We are reticent to talk about mental health as much as we should. There is a complacency in the public debate—that is not to make a political point, because it involves hon. Members on both sides of the House. The complacency goes throughout the civil service and the Government. To reflect on my time in government—not just in the Department of Health, but in the Treasury and the Home Office—it is remarkable how few submissions or meetings I had relating to mental health, given that it underlies the spending of hundreds of millions of pounds of public money. Indeed, £105 billion is the estimated cost of the full burden of mental health to this country.
That complacency is not shared by everybody and I congratulate the hon. Lady on introducing this debate. We have heard two unbelievably powerful speeches, from my hon. Friend Mr Jones and Mr Walker, to which I will turn at the end of my remarks. My hon. Friend Ms Abbott, who leads on these matters for the shadow health team, has rightly pointed out how mental health lies under the whole public health challenge. We will soon introduce Labour’s public health review.
We are beginning to wake up from our complacency. I am leading the debate for the Opposition to show that that comes from the top. We see the mental health challenge as central to health policy. Indeed, I made a point of making my first speech on returning as shadow Health Secretary on the subject of rethinking mental health in the 21st century at the Centre for Social Justice.
I must be honest: I shared the complacency about the mental health debate, or perhaps did not give it enough attention, but two things changed that when I was a Health Minister. First, I spent a day work-shadowing an assertive outreach team in Easington. I will never forget what one of the team told me about the early ’90s, when the mines closed and GP referrals for support were piling up on clinic desks, but there simply was no support to offer people. She said that that lay behind the social collapse in those mining communities. People facing difficult times were given no help.
A second thing made me think differently. When I became Health Secretary in June 2009, I inherited Lord Bradley’s report into mental health problems and learning
disabilities in the criminal justice system. I will never forget sitting in my office at Richmond house reading that about 70% of young people in the criminal justice system have an undiagnosed or untreated mental health problem. If that is not truly shocking to every Member and does not make us do something, frankly nothing will. That was the moment that changed how I thought, and I have tried to follow it through ever since.
I mentioned that we had a public service designed for the 20th century, rather than the 21st century, and I want to illustrate that point with reference to my own constituency. The world that gave birth to the NHS was a very different place. When the NHS was set up, Leigh, like Easington, was a physically dangerous place to live and work in. Working underground exposed people to coal dust, explosions and accidents, and people had no choice but to lock arms, look out for each other and face the dangers together—that is how it was—and that spirit of solidarity was carried over into the streets above.
Like many places in this country, then, Leigh in the ’50s was a physically dangerous place but emotionally secure, because people pulled together. In the 21st century, however, that has completely reversed. We now live in a physically safe society—our work does not generally expose us to dangers—but it is emotionally far less secure than it was for most of the last century. The 21st century has changed the modern condition. We are all living longer, more stressful and isolated lives, and have to learn to cope with huge and constant change. Twentieth-century living demands levels of emotional and mental resilience that our parents and grandparents never needed, yet the NHS does not reflect that new reality; essentially, it remains a post-war production-line model focused on episodic physical care—the stroke, the hip replacement, the cataract—rather than the whole person. That is the issue to confront.
The demands of this society and the ageing society require a change in how we provide health and social care. We need a whole-person approach that combines not only the physical but the mental and social, if we are to give people the quality of life that we desire for our own families. That one in four people will experience a serious mental health problem makes this an issue for all families and people in the country. It also means that mental health must move from the margins to the centre of the NHS.
I shall say a couple of things about that necessary culture change. How can it be that an issue that causes so much suffering and costs our society so much still accounts for only a fraction of the NHS budget? It cannot be right. We also have to consider the separateness of mental health within the NHS. This has deep social roots—the asylum, the separate place where people with mental health problems were treated, the accompanying stigma and suspicion about what went on behind those four walls. Essentially, we still have the same system in the NHS, with separate organisations—mental health trusts—providing services on separate premises. That maintains the sense of a divide between the two systems and raises a huge health inequalities issue.
The wonderful briefing that Mind, Rethink and others have prepared for this debate contains this startling statistic: on average, people with severe mental health problems die 20 years earlier than those without. What an unbelievable statistic! Why is that? It is partly—not
completely—explained by the separateness within our system. If someone is labelled a mental health patient, they are treated in the mental health system, and consequently their physical health needs are neglected.
Andrea Leadsom (South Northamptonshire, Conservative)
Is the right hon. Gentleman aware that, right from the very start, the way in which a baby’s brain develops—whether development is healthy, through a loving bond, or not—can have profound implications for future physical health, and therefore life expectancy? It starts as early as that.
Andy Burnham (Leigh, Labour)
I completely agree, and obviously that was one of the major conclusions of the Field report, which the hon. Lady’s Government commissioned. The problem is not just the separateness of the system, although that is one of the factors; rather, it starts much earlier. We need to take that broad view.
More co-location of acute care and mental health care within the same hospital would be a good thing to encourage. We heard on the radio this morning about the RAID—rapid assessment interface and discharge—service in Birmingham, which is an excellent example of that and something we need to follow. That is part of the culture change we need in the NHS. The other part of that change is that practitioners dealing with mental health, particularly GPs, at the primary care level, should not just reach first for medical interventions, rather than social or psychological interventions. However, I am afraid that that is what we do. Let us look at these, more startling statistics. In 2009, the NHS issued 39.1 million prescriptions for anti-depressants—there was a big jump during the financial crisis, towards the end of the last decade. That figure represented a 95% increase on the decade, from the 20.2 million prescriptions issued in 1998. Were all of those 40 million prescriptions necessary? Of course they were not.
Prompted by my north-west colleague, John Pugh, let me pick up the point about Labour’s successes. We did address some of these issues. The improving access to psychological therapies programme is something I am very proud of taking forward as Secretary of State, because it began to give GPs an alternative to anti-depressants and medication to refer people towards. That was an important development, and—credit where it is due—it was Lord Richard Layard who made such an incredible change, by pushing so determinedly for that programme.
Jeremy Corbyn (Islington North, Labour)
My right hon. Friend is making an important point. Too often GPs reach for medicine when they should be reaching for counselling. They should be offering a more supportive environment, but when we get high-speed GPs with little time to talk to patients, they tend to prescribe medicines when they ought to be doing something else. Does my right hon. Friend agree that we need to go a lot further than we already have?
Andy Burnham (Leigh, Labour)
I completely agree. I do a lot of work shadowing, and I recently shadowed a GP. What amazed me was how many of the people coming through his door were the people who also come through our doors on a Friday and Saturday. They are not necessarily looking for something to take to the chemists; they are
actually just crying out for help, in one way or another, with a problem they are struggling with. That GP was very good and did not prescribe, but referred lots of people to the IAPT service, as I sat there with him. However, he said that across Coventry, where he was based, many others were not doing the same.
Chris Ruane (Vale of Clwyd, Labour)
The Minister mentioned the number of prescriptions that have been issued. I received a parliamentary answer a couple of days ago which said that in 1991 there were 9 million prescriptions. The Minister mentioned the figure of 42 million, but from 2010 to 2011 the number went up by 4 million. In the years before that the increase was usually 2 million a year, but in one year the figure increased by 10%, or 4 million. When I asked the Minister what his assessment was of the reason for those increases, there was no conclusive answer. We must get to the bottom of why these prescriptions are being issued and why they have gone up by 500% in a 20-year period.
Andy Burnham (Leigh, Labour)
We must. Perhaps I am about to make more of a political point, but as has been mentioned so eloquently today by my hon. Friend Jim Shannon, although the trend is upwards—that is happening come what may: I mentioned the financial crisis, during which the rate has jumped up, including in our time in government—the cumulative effect of some of the benefits changes on some of the most vulnerable members of society, coupled with the withdrawal of social care support by councils, means that, right now, some people out there are suffering very badly indeed. That is part of the explanation of the worrying figures that my hon. Friend has just given the House. The Government need to have a look at what is happening out there and whether or not some people are struggling with mental health problems because of the extra stress that other factors, particularly financial, are putting upon them.
I welcome the Minister’s commitment to the improving access to psychological therapies programme, but I hear that waiting times for it are increasing in parts of the country where GPs face much longer referral times. Indeed, a Mind survey of 2011 said that 30% of GPs were unaware of services to which they could refer patients, beyond medication. That tells us that we still have quite a long way to go. IAPT needs protecting and nurturing; it needs to come with a national direction in the operating framework. In the new and changing NHS world, we cannot allow it to be simply whittled away. More broadly, we need to look carefully at commissioning and find out whether GPs have the right skills to commission properly for mental health. We need to consider what the precise commissioning arrangements for mental health are, as there is still some confusion out there about them.
Paul Burstow (Minister of State (Care Services), Health; Sutton and Cheam, Liberal Democrat)
One of the key aspects of the NHS Commissioning Board’s work in authorising clinical commissioning groups will be to assess their capacity to commission in mental health. As I am sure the right hon. Gentleman knows, the Royal College of General Practitioners is currently exploring what the extra year of education and training will involve, as we move forward to ensuring that mental health is part of it. I think it is a very important innovation.
Andy Burnham (Leigh, Labour)
I welcome what the Minister has said, but I say clearly to him that we are going to be vigilant about this. We do not want to see things slipping backwards, as we fear they may well do under this NHS reorganisation.
The hon. Member for Strangford made an important point about service personnel. I would like to pay tribute to the organisation Combat Stress, which has done a wonderful job—voluntarily, I think, for many years—giving some help and hope to people who come back here only to find that the statutory services are not providing anything for them. We have to absorb what it has done and the changes it has made into the mainstream to provide much better support. It is beginning to happen, but there is further to go.
On benefits appeals, I echo a point made by my hon. Friend the Member for North Durham. As he said, the number of employment and support allowance cases going to appeal is ridiculous. In 2009-10, the first full year of the ESA regime, 70,535 cases went to appeal at a cost of £19.8 million. In 2010-11, there were 176,567 cases at a cost of £42.2 million. If the Government want to cut waste from the benefit system, they have to get a grip on that. What we find is that 38% of cases—almost four in 10—are overturned on appeal; those cases should not have to go to appeal. My hon. Friend also mentioned the human cost. The financial cost is bad enough, but the stress that people with mental health problems are put through as they go through that process is, in many cases, unbearable. The Minister really needs to talk to his Department for Work and Pensions colleagues to encourage them to get a grip on this important problem. The Atos system is simply not working; it is actually making life a lot harder for some of the most vulnerable people in our society. Ministers need to look urgently at it.
Let me conclude with a point about stigma. I have picked up from today’s debate the fact that Gavin Barwell is bringing forward a private Member’s Bill along the lines of the Bill introduced in the other place by Lord Stevenson, to whom this House should pay tribute. It is wonderful to hear that the hon. Gentleman will introduce that private Member’s Bill. Currently, a person who has had a serious breakdown and has been sectioned under the Mental Health Act 1983 is barred from being an MP, a juror, a school governor or a company director. What message does that send out? It says that recovery is not possible—a message that we might have put out about cancer in the ’50s or ’60s: “Once you have had it, it is a black mark; that’s it, you’re finished.” We urgently need to change that. Today’s debate has probably achieved some change. The Minister indicated his full support for the private Member’s Bill and I can pledge the full support of the Opposition for it. We wish the hon. Gentleman all good luck with it.
I think that today’s debate can begin to change social attitudes in the broader debate on mental health in this country. For the reasons I have set out, I think our debate has been historic, but we have a long way to go. When the Norwegian Prime Minister, Kjell Magne Bondevik had to take some time off, he publicly admitted that it was for depression. That was the reason he gave. Imagine a Prime Minister doing that! But he did so, and he changed the culture in Norway. Moreover, he went on to be re-elected and to become Norway’s longest-serving
non-Labour Prime Minister since the second world war. That constituted incredible bravery and political leadership, and I think that we have seen two more examples of those qualities today in the speeches of my hon. Friend the Member for North Durham and the hon. Member for Broxbourne. That is the kind of leadership that changes social attitudes to mental health. Both Members deserve enormous credit for what they have said today, and I think that both have taken a major step towards changing the political debate.
I believe that we must all go back to first principles. I mentioned the start of the NHS. In 1948, the World Health Organisation defined health as
“a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
Whatever differences we may have about precisely how we should construct the NHS, I think that today Members in all parts of the House can unite behind that definition, with the emphasis on prevention and well-being. I think that we can all commit ourselves to making major changes in the way in which mental health is seen in the House of Commons, the Government and the country, and begin to create a system of care for the 21st century that recognises the difficult, stressful lives that people are leading and gives them support when they need it so that they can fulfil their potential.
Lindsay Hoyle (Deputy Speaker; Chorley, Labour)
Order. Given that 19 Members wish to catch the eye of the Chair, it would be beneficial if each of them could aim to speak for about eight minutes. I hope that that will make it possible for everyone to contribute.
John Pugh (Southport, Liberal Democrat)
Let me begin by commending those who have spoken about their own problems today. I assure them that they have done their prospects no harm whatsoever. They have risen appreciably in the esteem of the House, although whether that is the key to promotion I do not know.
Kevan Jones (North Durham, Labour)
I am grateful to the hon. Gentleman, but the use of language is very important when it comes to mental health. I do not consider it to be a problem. My own experience has made me stronger. I think we should be careful about how we use language: we should not describe mental health as a problem, because it is not.
John Pugh (Southport, Liberal Democrat)
We will settle for “experience”, then.
In the 18th century, it was possible to cross the river to Bedlam and gawp at people gesticulating, ranting, performing odd rituals, talking to no one in particular, exhibiting delusory beliefs in their own power, or expressing paranoid fears about their foes. The nearest 21st-century equivalent is probably Prime Minister’s Question Time. [Laughter.] That is not an entirely facetious point. The dividing line between robust mental health and mental illness is, in fact, a fine one. Statistics show that the bulk of people of working age who either report or are diagnosed with mental health problems are not, in general, those who suffer from the terrible scourge of schizophrenia. The hallucinations and delusions often associated with that disease currently affect less than 1% of the population, and are treated more benignly and more effectively than ever before. Moreover, numbers are not substantially on the increase.
Most mental health problems occur when the anxieties, the fears, the stresses and the dark moods to which we are all prone become insupportable, prolonged and disabling, and the individual is no longer able to cope in any ordinary sense but breaks down and loses control, social capacity and, sometimes, insight into his or her condition. That is on the increase: it is the major mental health challenge that we face.
Mental health is a genuine continuum. The mentally ill do not have viruses, germs, cellular patterns or physical impairments that the well do not have. They have the same gamut of emotions that we all have—often exaggerated, accentuated or uncontrollable, but in no way unique or uncommon. We all possess a shared vulnerability to mental health issues which could be described as a tendency to neurosis, managed with differing degrees of success at different times in our lives. That is why I took issue with some of the comments made by the hon. Member for Loughborough.
There is a nugget of truth in the American belief that we could all benefit from an element of psychiatry. As I have said, we share a common vulnerability, and for a variety of reasons—fairly complex in many cases—one in four, or one in six, citizens falls victim to that vulnerability. We have learnt not to be too judgmental about those who do, and not to stigmatise them. We recognise that the vulnerability they display is often a product of circumstance, and that it is as frequently related to desirable traits—empathy and sensitivity, for instance—as to undesirable ones such as self-obsession or lack of self-control. However, although that recognition is now widespread, it does not eradicate stigma, nor does calling everybody “service users” as if they are some kind of consumer, and nor does saying mental illness is just the same as physical illness, because it is not.
The big problem for those with a record of mental health issues—particularly, perhaps, in respect of the workplace or getting off benefits and back into the workplace—is the bias of the wider world in favour of those who have not illustrated our common vulnerability. That bias is rather like having a—rational—preference for people with a stronger immune system. There are other vitiating factors at play, of course. People who suffer from mental illness often suffer from a lack of confidence, for example. There is also the fact, which has not so far been acknowledged, that a mental health diagnosis can sometimes be misused for employment and benefit reasons. The big problem is this bias and discrimination, however.
There are only two real remedies for that. One is better public education about what mental health actually is and what mental illness and frailty actually are. I would put more faith in the second remedy, however: having a public mental health campaign that is geared in positive directions, as described by the hon. Member for Loughborough. Having said that, we must acknowledge that the active pursuit of mental well-being is a bigger and more significant task than we currently recognise. Corporate Britain, business Britain and every public service in Britain needs to be seriously engaged with the Layard agenda and to accept that we need to promote well-being at work—including here in Parliament. We must create a wholesome workplace, and therefore bother about the happiness of the workplace and the individuals in it.
We may need to tackle a huge fallacy, however: the idea that we either have mental health or we do not, so we are either employable or we are not. That ignores the fact that many people in employment—in senior jobs, even—have mental health issues, some of which might not always be diagnosed. Sometimes they work them out in the office and the workplace in a wholly unsatisfactory way, and sometimes to the detriment of their colleagues—although not always, in certain professions, to the detriment of customers and profits. Sometimes people mask their symptoms and problems through alcoholic self-medication.
There was a time when employers would have walked away from considering issues such as personal safety at work, and there was a time when they would have walked away from issues of employment legislation and the rights of people at work. Nowadays, however, most employers are keen to stick “Investors in People” logos on their notepaper to show that they are a good employer in that respect. The next, and most obvious, stage is the pursuit of the wholesome workplace, in a move beyond the “Investors in People” initiative. That must be encouraged by public health bodies and by large public and corporate organisations. Indeed, to some extent it already is encouraged: 41% of large companies now have a mental health policy. That represents appreciable progress.
For most of us, work is where we spend most of our time, and it is where our feelings of self-worth are either confirmed or demolished—that is certainly true of this place. It is where people find meaning to their lives—although we do not always succeed in doing that here. Indeed, we in Parliament cannot honestly say our working environment is wholly conducive to good mental health.
Let me conclude by reiterating my key point: we cannot help people with mental health issues without making it manifestly clear that in everyday work and everyday life mental health is everybody’s issue.
Jeremy Corbyn (Islington North, Labour)
I welcome this debate, and I will do my best to stick to the eight minutes that you have suggested, Mr Deputy Speaker, to ensure that everybody gets to make a contribution. It is valuable to have this debate and to raise the whole issue of the stigma surrounding mental health. I pay a huge tribute to my hon. Friend Mr Jones and Mr Walker for speaking out, because it is necessary to do so. The public need to understand that everyone knows somebody who has suffered from degrees of depression or many other conditions. I am sure that all of us, even if we do not believe that we have suffered
from this ourselves in our own lives and in our own families, know people who have. Public attitudes have come a long way since the late Tom Eagleton was driven out of the US vice-presidential nomination in 1972 because he had had treatment for severe depression. He, to his credit, later went on to become a Senator, elected with 60% of the vote, so the timidity of the political establishment in the US in 1972 was overturned by a much more generous political atmosphere some years later. We should remember people like him, who, in many respects, paved the way for it.
We have to understand that about 4,000 people a year in this country commit suicide. The figure varies a bit from year to year, but it is about 4,000. That is a very large figure indeed, which is why I intervened on the Minister on the question of deaths when people are in care or in custody, and I am looking forward to his response. As a society, we have to think a bit more carefully about the terror that some people live their lives in, which ends in a lonely suicide. These are people who were unable to seek help or support from anybody else, and were probably reading in the papers, hearing jokes on television and being the butt of comedians’ jokes about “sad nutters”, “desperate people” and so on. As a society and as a community, we need to reach out to people who are going through their own tensions and their own crises. If we cannot do that, the number of suicides will not fall and is likely to increase.
In my community, we have a good mental health service. We have a trust that operates in Camden and Islington, which is quite a small geographical area for it to operate across. It is certainly much smaller than many others in other parts of the country, and my right hon. Friend Frank Dobson and I fought very hard to ensure that it was operated on a relatively small basis because we felt that that would provide for a better service that was more in touch with the local community. I hope that it will be able to continue in that way, but I am saddened to have to report that this year the trust plans to deliver what it describes as
“£75.1m savings across the acute sector; £46.7m from acute productivity and £28.4m through changes in care setting and other demand management initiatives.”
That is quite a big cut in desperately needed services in an area that suffers from a very high level of need for mental health care and treatment.
My own local Islington borough council, to its credit, instituted the fairness commission after the 2010 elections. The council has said:
“The work of the Islington Fairness Commission highlighted the wide-ranging impacts of challenges to mental health and wellbeing for people, communities and services in Islington, particularly during a period of economic uncertainty and financial hardship.”
A number of recommendations are then made, with the council going on to state:
“Levels of need are exceptionally high in Islington. There were 3,152 patients on serious mental illness primary care registers in Islington in 2010/11, representing 1 in every 65 patients. There are an estimated 31,000 adults and 3,000 children and young people…experiencing mental health problems…There are an estimated 3,500…drug users, and 10,000 problem alcohol users, with 46,000 adults in total drinking at hazardous or harmful levels. Underlying rates of mental health and substance misuse problems in prison reach in excess of 90%.”
My borough contains two prisons. We have to examine those issues seriously as a House and as a society.
The other point I wanted to make was that the economic issues associated with stress are very serious indeed. Obviously, one such issue is unemployment, but others are housing and overcrowding and, often, the domestic violence that results. My hon. Friend Ms Abbott and I share the Finsbury Park Homeless Families Project unit, which is based in her constituency but does wonderful work to support families in both our constituencies. The unit’s staff point out that the severe problems of the people who come to see them are usually related to serious overcrowding, housing uncertainty and lack of secure tenancy. Various levels of stress and mental health issues pertain to that. In solving these issues, we must consider the economic factors.
We should also consider very seriously the levels of stress and depression among young people. Growing up as a young person in any community is not easy. They are faced with enormous pressures from a consumerist society to achieve and to have. Many cannot fulfil those ideals and will never be able to fulfil those ambitions. The levels of stress we are forcing on to young people result in some cases—although, thankfully, only a very small number—in serious illness or even suicide.
Yvonne Fovargue (Makerfield, Labour)
To return to the social pressures, does my hon. Friend agree that debt is a considerable social pressure? I ran a scheme where debt advice was provided on prescription and paid for by the PCT. Independent analysis reckoned that at least three suicides had been prevented by early access to debt advice. Does my hon. Friend share my concern that that access might well now be restricted?
Jeremy Corbyn (Islington North, Labour)
I completely endorse what my hon. Friend has said and the great work she has done in supporting advice agencies and dealing with such issues. My borough recently opened a new citizen’s advice bureau—I congratulate the council on being able to fund and reopen it—and it has been inundated with people with serious debt issues. It offers serious debt advice and a great deal of help. We have also given a lot of support to a credit union that is working very well with a large and fast-growing membership. People are accessing a limited amount of credit and support, and it is far better that it comes from that source than from the high street loan sharks who are appearing all over the country and bleeding people dry with the excessive rates of interest that they charge.
There are some things we can do, but my point is that if a young person worked hard in school, did well, studied hard and got good grades but is still unemployed and after a while becomes almost unemployable, it becomes a source of enormous stress about the future.
I want to bring up two more issues before I conclude. In my part of London and, I suspect, many other parts of urban Britain, many victims of domestic violence, usually women, seek support and therapy. The voluntary sector is often best placed to provide that support and therapy and that was why I intervened on Nicky Morgan when she introduced the debate to make the point that when commissioning is done by the primary care trusts or the wider trusts that deal exclusively with mental health issues, it tends to be skewed in favour of the very large and
financially burgeoned organisations rather than local charities and voluntary sector groups with a specific base, which are often much more effective and provide a very good service. I would be grateful if the Minister could give us some good news on that, or if he could write to me about how those issues could be brought out.
In my community, we have a number of very effective charities that work with victims of domestic violence and racist abuse, which, fortunately, is not an enormous issue but nevertheless exists. We also have a large number of people who have experienced torture and violence and are either asylum seekers or have achieved refugee status. I thank those charities for the work they do. Nafsiyat, an intercultural therapy centre based in Finsbury Park, has done good and groundbreaking work on cultural values and dealing with stress and the victims of violence. The Maya centre deals with women who have suffered similar problems. We also have the Women’s Therapy Centre, ICAP—Immigrant Counselling and Psychotherapy—which gives enormous support to other people, and the local Refugee Therapy Centre. They all do very good work, all have difficulty coping with the demands placed on them and all have financial issues. When the Government talk about increased money for mental health, they should think very carefully about how the contracts are negotiated, as they often force very low rates of pay on the voluntary sector to undertake the kind of work that is done. The Minister needs to think quite carefully about that.
The housing issue has been referred to and the number of homeless people in this country is rising, as is the number who are suffering from stress. Locally, we have a group called the Pilion Trust which has recently been given a donation—I am grateful to the Amy Winehouse Foundation for that—to help in its work in providing a night shelter, but a night shelter is not a solution to homelessness problems. A solution to homelessness problems is having a requirement regarding re-housing and a much more aggressive housing programme in this country.
I conclude by saying that too many people commit suicide and suffer from mental health issues and stress in their lives. We cannot change all of that but we can change the approach to mental health issues. We can look at the good work that is done and support people in that work. We can say to those who have gone through depression and crises, “That is not the end.” Such people are contributing to our society and will succeed later in life. We should recognise the value of everyone and not consign people to a mark that indicates they have become unemployable and have no future. That is as bad as what the asylum system did in the past. We can do better than that and learn from others and the good experience they have had.
Gavin Barwell (Croydon Central, Conservative)
First, I thank the Backbench Business Committee for securing this debate. In my limited experience in the House, the Committee’s debates often show the Chamber at its best. I also want to congratulate my hon. Friend Nicky Morgan, who is one of the stars of the 2010 intake on the Government side of the House. She is an example of the work that Lord Maples, who sadly passed away this week, had done to diversify the make-up of Members on our Benches. That is about a lot more than tokenism.
As a number of Members have said, I came fourth in the private Member’s Bill ballot. I found that out because my inbox was suddenly swamped by a large number of e-mails congratulating me, and my mobile phone and desk phone started ringing at the same time. For a Back-Bench Member it is a fairly rare opportunity to change the law of this country. I have taken my time and thought long and hard about what I wanted to bring forward. On Wednesday, I will be presenting the Mental Health (Discrimination) Bill, which was introduced by Lord Stevenson of Coddenham in the last parliamentary Session, as Andy Burnham has said. I am doing that partly for personal reasons. Two of my closest personal friends suffer from mental health conditions, and two teachers who had a very formative role in my education, when I was a teenager, have also suffered from mental health conditions. My predecessor, the former Member for Croydon Central, Andy Pelling, who some Members in the House will have known, also suffered from a mental health condition.
In addition, since I have been a Member of the House, in my surgeries I have met a significant number of constituents who are suffering, including people whose children have been detained under the Mental Health Act 1983. There is one gentleman I will never forget who came to my surgery suicidal because he had lost his job and was at risk of losing his home and the ability to support his family. A couple of weeks ago I visited the South London YMCA and met a man who had witnessed someone commit suicide and had gone to his GP for help but had not received proper help and had suffered a breakdown. His marriage had broken up, he had lost his job and he had ended up sleeping in the park. So my decision has been prompted by a mix of personal reasons and what I have seen as a constituency MP.
The Bill is supported by the Royal College of Psychiatrists, Mind, Rethink Mental Illness and the Law Society. Its purpose is very simple: to remove the last significant form of discrimination in law in our society. This country has changed a huge amount since I was a young child. I remember the first Asian family moving into our road when I was growing up. Some of the people who lived in our road put pressure on the people selling their house not to sell to an Asian family. I also remember the arguments about section 28 and the language that was used in my school playground. We have made a huge amount of progress since then as a country, but we have not got there yet. To our shame, however, the law still discriminates against those with a mental health condition. An MP or a company director can be removed from their job as a result of a mental health condition even if they go on to make a full recovery. Many people who are perfectly capable of performing jury service are disbarred from doing so. If my private Member’s Bill is approved by the House, we will look back in a few years’ time and be amazed that the nonsense I have described was on the statute book in 2012.
As my hon. Friend the Member for Loughborough said, one in four of us will experience a mental health condition in our lifetime; three in four of us will see a member of our immediate family experience such a condition. As the right hon. Member for Leigh said, the numbers have increased because, while the physical conditions in which we live and work have improved, our lives are busier and much more stressful. The World Health Organisation estimates that by 2030 more people
will be affected by depression than any other health condition. The law as it stands sends out the message that if someone has a mental health condition their contribution to public life is not welcome.
Lord Stevenson’s Bill had four aims: first, to repeal section 141 of the Mental Health Act 1983 under which a Member of Parliament, of the Scottish Parliament, of the Welsh Assembly or of the Northern Ireland Assembly automatically lost their seat if they were detained under the Act for more than six months. There is no equivalent provision to remove an MP if they suffer a physical illness that affects their ability to perform their role and, furthermore, someone who lacks mental capacity, as defined by the Mental Capacity Act 2005, can be detained for up to 12 months and not lose their seat.
Secondly, the Bill would amend the Juries Act 1974 significantly to reduce and better define who is ineligible for jury service. At the moment, the Act says that mentally disordered persons are ineligible. The definition of a mentally disordered person is extremely wide and includes people who manage their mental health condition through a prescription from their GP or counselling from a psychiatrist, thus eliminating all sorts of people who would make excellent jurors. Only 2% of people tick the box, but many more should probably do so. Not only is the law discriminatory but it is ineffective. If someone is on trial, they have a right to be confident that the jury is of sound mind. The Bill would better define who should be ineligible, thus making it much more likely that those people would identify themselves in the process.
Thirdly, the Bill would amend the Companies (Model Articles) Regulations 2008, so that someone no longer ceased to be a director of a public or private company purely because of their mental health. All companies are required by statute to have articles of association, and model articles operate where a company has failed to draw up its own. Many companies incorporate them into their own articles. They include a provision that someone ceases to be a director if a registered medical practitioner who is treating them gives a written opinion to the company stating that they have become physically or mentally incapable of acting as a director and they remain so for more than three months—in other words, the correct test of capacity. However, they go on to include a totally unnecessary additional provision relating solely to mental health.
Finally, the Bill would amend school governance regulations so that people detained under the Mental Health Acts would no longer be disqualified from holding office as school governors. Clearly, while someone is detained they are unable to attend governors’ meetings, but that may be for only a short time, and there is no reason why they should not resume their role.
I am delighted that the Government have dealt with one of those issues—the School Governance (England) (Amendment) Regulations 2012 came into force on
service, and he hoped that the Bill would be reintroduced in this Session. I hope that it receives all-party support, and I was delighted to hear what the right hon. Member for Leigh had to say.
I want to end with two simple contentions. First, Parliament, schools, companies and the court system benefit from the involvement of people with experience of mental health conditions. Indeed, our debate has been illuminated in particular by the contributions of my hon. Friend Mr Walker and by Mr Jones. I do not know the hon. Gentleman very well, but I have always pictured him—and I think he would regard it as a compliment—as a bit of a political bruiser. For someone with that reputation to have the courage to say what he said will change people’s opinion of him, and very positively. The whole House has a high regard for what he has said, but I am sure that when we move on to other debates, normal hostilities will be resumed.
A school may have a pupil with a mental health condition; in a court case, the accused’s state of mind may be a key issue. How much better will that school be if a governor has experience? How much better will that court case be if there is a juror with the necessary experience? The Bill will directly help a relatively small number of people, but it also sends a clear message that discrimination is wrong: people have a right to be judged as individuals, not labelled or stereotyped.
In September, the excellent Time to Change campaign, run by Mind and Rethink Mental Illness, surveyed 2,700 people with mental health conditions. Of those, 80% said that they had experienced discrimination, two thirds were too scared to tell their employer, 62% were too scared to tell their friends and, worst of all, more than a third were too scared to seek professional help. Having a mental health condition is nothing to be ashamed of or to keep a secret. It is high time we dragged the law of this land into the 21st century.
Chris Ruane (Vale of Clwyd, Labour)
Most of the contributions we have heard so far today have concentrated on mental ill health, but I also wish to address mental health and well-being, and not just for those who have experienced mental health problems, but for the whole population in general.
Over £400 billion worth of illegal drugs are traded around the world ever year, which is the same amount that is spent on energy, or 8% of the world’s wealth. When that is combined with the amount spent on alcohol, cigarettes, legal drugs to help us over depression, over-eating and the amount spent trying to fix all those problems, we are probably talking about 20% of the world’s wealth being spent on, essentially, escaping from reality. That is a modern reality that has many causes. We need to look at the debate in the round and consider all the factors, including nutrition, advertising, the farming industry and work practices, because they all have an impact on what certain Members have so eloquently described today. We should look not just at the pinnacle of the problem, but what is behind it.
Statistics show that 29% of US school children have mental health problems. At what point will American society say, “Enough is enough”? Is it when 39%, 49%
or 59% of their children are mentally ill? The UK is not far behind. We follow the Anglo-American pattern, because 22% of our children experience mental health problems, and they are the lucky ones, because 74% of children in care homes experience mental health problems, as do 46% of those who are fostered. Some 90% of prisoners have mental health problems. Obesity is also a problem. At age five 10% of UK children are obese, but by age 10 the figure is 20%. What is happening in that five-year period to make those kids consume the sugars, fats and salts that will react with their bodies? Those fats will react with the fats in their brain and their myelin sheaths and neural pathways. It is an epidemic that is growing out of control, and we will be picking up the costs, including the financial costs and health costs for the individual and their families, for decades to come.
I recently received an answer to a parliamentary question. It showed that in 1991 almost 9 million prescriptions for antidepressant drugs were dispensed in the UK, but by 2011 the figure had increased to over 46.5 million, a 500% increase. When I asked the Minister for his assessment of why that was so, he replied:
“We are unable to provide a conclusive account for the increase in the number of prescription items dispensed.”—[Hansard, 30 April 2012; Vol. 543, c. 1286W.]
We do not know what is making the kids obese and we do not know what is turning our population into legal addicts. Those statistics are just for antidepressants and do not take into account the other drugs taken to help us sleep, keep us awake, keep us happy or manage our sex lives, although I never use them. There are other ways, because drugs are just one way of handling it. One-to-one counselling is another way, but it is very expensive. There is a third way: self-help. One of the best ways of self-help is mindfulness.
Mindfulness has been around for 2,500 years. To give a definition, mindfulness means paying attention in a particular way; on purpose, in the present moment and non-judgmentally. In other words, it means someone just focusing—not being chased by their past or worried by their future, but experiencing what they are experiencing there in the moment.
Mindfulness has been taught very effectively in America over a 30-year period and more recently in this country over a 10 to 12-year period. It involves an eight-week course, two-and-a-half hours’ taught lessons a week and 45 minutes’ meditation at home for six days a week, and it is taught in groups of eight to 20, so the costs are minimal and the benefits are unbelievable. It is out there, but it has not been taken up—even when NICE recommended it as a more effective means of treating repeat-episode depression. In 2004, it recommended the programme as being better than pills, but it has not been taken up. GPs and, dare I say it, Ministers do not know about it. I have quizzed Irish and British Ministers, and they do not know about it.
Kevan Jones (North Durham, Labour)
I am listening carefully to my hon. Friend, but my experience is that, although group therapy might work for certain individuals, for many it does not. One thing that my right hon. Friend Andy Burnham did in the previous Government, and which has made a real difference, was to open up cognitive behaviour therapy treatments, as they have been a substitute for drugs. So no one treatment is a silver bullet for mental illness.
Chris Ruane (Vale of Clwyd, Labour)
Absolutely. Cognitive behaviour therapy is fantastic, and mindfulness has now been tacked on to it to make it even more effective. The group therapy lasts only for eight weeks; after that the individual can handle it themselves. I have practised it for five years now, and I have been on the formal course.
It was Descartes who said that the mind is separate from the body and the body separate from the mind, but in eastern philosophy and medicine that is not the case: body and mind are inter-related. Mindfulness can be used to combat pain, stress, eating disorders, addiction, anxiety and psoriasis, but it has been recommended in the UK only for the treatment of repeat depression—and it has not even been used for that.
In America they use it in the prison service, in the police, fire and emergency services, including on those with witness trauma, in the health service for a range of medical conditions, to improve heart and cancer treatment and, even, in Congress. Congressman Tim Ryan, its expert on the subject, has just written a book, “A Mindful Nation”, about how mindfulness can be used across the board.
So there are other ways that we have not explored, but they have been around for 2,500 years and proved to be effective. There are experts in mindfulness, such as Jon Kabat-Zinn who pioneered it in America, and experts in positive psychology, such as Martin Seligman. Freud believed that if a person was mentally ill the most they could achieve was wellness, not happiness, but Martin Seligman, who headed the American Psychological Association, turned that around 20 years ago and developed positive psychology in America.
We have our own experts: Professor Richard Layard, a Labour Lord in the other place; and Felicia Huppert, the mother of a famous Liberal MP based in Cambridge, who has a theory that if we shift the whole wellbeing curve, including on the right-hand side those who are mentally ill and on the left-hand side those who are positive, across and make the whole population happier, the greatest impact will be on the unhappiest—on those with mental health problems.
There are also impacts on the polices that we develop throughout society and on what makes people happy. On the Office for National Statistics’ list of what makes people in the UK happy, No. 1 is living next to a park or having access to a swimming pool; No. 2 is having access to cultural services such as libraries; No. 3 is being physically healthy; No. 4 is having time to relax and enjoy oneself; No. 5 is living in a fair society; No. 6, the only one involving money, is having enough money to do what one wants; No. 7 is freedom; No. 8 is being content with one’s situation; No. 9 is people looking after each other; and No. 10 is the smell of freshly ground coffee.
Only one pertains to money, yet our whole society is geared to making money. Those are the values that we and Governments of both parties have adopted, but now we need to develop policies that recognise the situation and the position of mental health in society. It is the No. 1 issue affecting our society, and we need to look at it in the round.
Peter Bottomley (Worthing West, Conservative)
It is a delight to congratulate Chris Ruane on his speech. We are having a
debate of which the previous speakers and the Backbench Business Committee should be proud. I missed out on a lunch the other day and went with my hon. Friends the Members for Broxbourne (Mr Walker) and for Loughborough (Nicky Morgan) and others to appear in front of the Committee. They were tough and they were clear. We made our point that the subject needed a debate, and the issue then was whether it should be in Westminster Hall or in the Chamber. I think that if it had been in Westminster Hall the impact would not have been so great.
When I was first elected to the House of Commons, if a Member of Parliament was thought to have gone mad, the Speaker would refer them to two people nominated by the Royal College of Surgeons. One of my early interventions was to suggest that psychiatrists might be rather more useful. If the Bill taken up by my hon. Friend Gavin Barwell gets through, perhaps that approach will be thrown away in turn.
Again when I was first elected, The Times and The Daily Telegraph would report debates and pick up a good point from everyone’s speech. If that happened after today’s debate, people’s understanding of the experiences of the lack of mental health, and of more extreme, occasionally disabling mental illness would become greater, deeper and wider. That would give comfort to the hundreds of thousands of people who care for people who are experiencing the lack of mental health.
Andy Burnham (Leigh, Labour)
I apologise for interrupting the hon. Gentleman so early on, but he is making such an important broader point about media coverage of mental health. Would he want to pay tribute to the Sunday Express, which has led a campaign that was mentioned by Nicky Morgan? One would not necessarily expect a newspaper to run a mental health campaign, yet it has. That is precisely the kind of media leadership that we need to see on this issue.
Peter Bottomley (Worthing West, Conservative)
I join with the right hon. Gentleman in saying that. I was trying to say things that had not been said already, and there has already been a tribute to the Sunday Express. I would add that several journalists have been prepared to speak about their own medical conditions that have challenged their ability to live or to work effectively. I am not saying that we should all have to spend our time saying what our physical or mental experiences have been, but it does help if it is regarded as being as normal to talk about having had an episode of depression as of having had a basal carcinoma removed or having recovered from a broken hip.
I pay tribute to the hundreds of thousands of people who care for those experiencing the lack of mental health. I also pay tribute to the professionals, particularly to Lisa Rodrigues, who is chief executive of the Sussex Partnership Trust. She has spoken of the services it provides across East Sussex, West Sussex, Brighton and Hove and Hampshire, and the 27,000 young people with whom she and her colleagues come into contact each year. They are not all experiencing real disability, but some will.
When I became Roads Minister, one of my ambitions was to try to get the number of road deaths down below the suicide rate. Young people’s suicides number about 900 each year. The total number of road deaths among
adults and young people is 1,800. The road deaths figure has come down from 5,600 a year to 1,850. Would it not be good if we could do the same thing for self-destruction and the penalties that that imposes—not only the shortened life but the damage to those around the person who has died?
My wife was a psychiatric social worker before she became a Member of Parliament, a Health Minister, and then Secretary of State for Health, when she took mental health issues very seriously. She worked with those at the Maudsley Institute of Psychiatry where, with one of her colleagues, Peter Wilson, she ran a support service for teachers. If we are to start being concerned with young people, we need to make sure that those who are in contact with them—parents, and teachers in primary and secondary schools—have an understanding of what is normally unhealthy, if I can put it that way.
One young person in four experiences some kind of mental health episode. We need to know how much of that involves a relatively normal experience from which they will recover. We also need to identify the one in 10 who will probably need help from someone with experience or specialist qualifications, and the 2% or 3% for whom the experience will be disabling.
YoungMinds is an association with which Peter Wilson was associated—I think he might have created it. It has a manifesto in which young people say that if they can get help when they are young, many more of them could be kept out of prison and psychiatric hospital, and kept in work and leading the kind of life that contributes to society.
I once met someone who had had experience of schizophrenia. There was a fine mental health project just outside my former constituency, and he told me that he was glad to have got to know about it. He became a client of the project. Six months later, he became a volunteer. A year later he wrote to tell me that it was the proudest moment of his life, as he was now a taxpayer with a paid job. He was given the opportunity to take those steps forward, in an environment in which everyone knew what was happening and could share in it and give support when appropriate. Those opportunities matter.
Had there been more time, I would have been tempted to talk about a range of issues, giving a sentence or two to each, but I do not think that that will be possible. I would say, however, to those who suffer at times, or constantly, from depression, anxiety, obsessive compulsive disorder, phobias, bipolar disorder, schizophrenia or personality disorders—I could go on—that information on most of those conditions is available on the websites of the organisations that provide help.
About 31 years ago, I was appointed to the council of Mind, formerly the National Association for Mental Health. The reason for that was that the then Conservative Government wanted to give the organisation their support, and its then general secretary was thought to be left-wing; I was there to provide balance. I am not sure how my Whips would regard that decision today. [ Laughter. ]
The Mental Health Foundation does good work, and I also pay tribute to the Samaritans for the help that they give to people about whom they are concerned. Their website contains information on how we can help
someone, even if we are untrained. It suggests avoiding the “Why?” question, as that can be regarded as challenging. Instead, it suggests asking:
“When—‘When did you realise?’ Where—‘Where did that happen?’ What—‘What else happened?’ How—‘How did that feel?’ In an ideal world what would you like to happen next? Would you like me to come with you?”
Standing beside people in that way can be a pretty effective approach.
I want to give the House one or two examples from the weekly newsletter from Lisa Rodrigues of the Sussex Partnership Trust. I try to send it on to two or three other people each week, to whom some of the points might be relevant. One week she talked about cancer, describing how, in the 1950s, Sir Richard Doll and others had started to examine the causes of lung cancer, and to realise that asbestos could also have a serious effect on breathing. She wrote:
“So why am I talking about cancer? It is because today dementia is where cancer was all those years ago…Why Sussex? Because we have the highest percentage of old people in the country living here. And why me? Because specialist mental health services hold the key to unlocking the potential in primary care, acute hospitals, local authorities, the voluntary and nursing home sector to provide better treatment and care to people with dementia, and support for their families.”
Lisa Rodrigues also recently attended a conference on how to get the various groups to work together more effectively, which is vital for people and their families and carers. If only they could find a one-stop shop to refer them to a place where they could be embraced as a person, a household or a family unit. She said that if we could get our mental health services working more effectively, our physical health services would have far less to cope with. That point has also been developed by other hon. Members this afternoon. She also wrote in her newsletter:
“We have a dream. In our dream, our psychiatrists, nurses, social workers, psychologists, therapists, care staff, receptionists and anyone else who comes into contact with the 100,000 people we serve each year will have the best possible tools to do their jobs. This will include a small, lightweight…portable device via which they can access patient records”
and the background of all the people they are in contact with. Up to now, that has not been possible.
Lisa Rodrigues talks every two or three weeks about employees who have done something special. In one example, she talks about the staff who have worked on a clinical reception and their helpfulness to patients and other visitors. She goes on to mention a person whom I have not met called Jackie Efford, a nurse in the health team at Lewes prison, who
“works flexibly so that, when prisoners arrive late into the night, she comes in to assess them and respond to any urgent physical or mental needs. Imagine being a prisoner and what a difference it would make to have a meeting when you first arrived with a compassionate and effective nurse.”
Lisa Rodrigues also talks about the child and adolescent mental health services. She says that the name is
“no longer fit for purpose. The word adolescent has negative connotations. And young people don’t respond positively to the term mental health.”
We must find the right language, not for political correctness, but to help people more effectively.
It would be easy to say more on this issue. However, I want to end by saying that if we have to wait another year to develop these themes, Parliament will not be
doing its job properly. We should not have to rely on the pleading and cajoling that we provided at the Backbench Business Committee. Debates on this matter ought to be built in, rather than bolted on.
Lyn Brown (West Ham, Labour)
It is a pleasure to follow the thoughtful contribution of Sir Peter Bottomley. I am very glad to be in the Chamber to speak alongside those who have made exceptional speeches today, including my hon. Friend Mr Jones and Mr Walker to name just two.
I will highlight three things. The first is the key factors that are linked to mental well-being and the characteristics of my local borough of Newham. The second is what resources are available to my local health authorities and mental health services. The third is the need for those resources to be improved in the light of what we know works in improving mental health.
The need for a robust strategy to promote well-being is illustrated by the correlation between the determinants of mental ill health and some of the characteristics of the population of my borough. As my hon. Friend Chris Ruane, who is no longer in his place, attested so powerfully, one such determinant is age. The rates of mental illness vary across age ranges, but it is a sad fact that younger people are more likely than the elderly to experience mental ill health. A high proportion of mental health problems develop between the ages of 14 and 20. One in 10 children between the ages of five and 16 have a mental health problem, and such problems may well continue into adulthood.
The borough of Newham has one of the youngest populations in the country. The number of young people with mental health problems is therefore greater than elsewhere. Some 40% of the borough’s population is made up of people under the age of 25. As nearly 10% of people aged between five and 16 experience mental health problems, statistically we can expect 4,262 of the children and young people in Newham to experience such problems. That clearly has an impact on the needs of the population of Newham and on the type of service that it requires. It should be funded to cater for those needs.
We all know that there are other important determinants of the mental health of a community. One of those is deprivation. Common mental disorders such as depression, anxiety and obsessive compulsive disorder are more prevalent in deprived households. Again, Newham suffers from high levels of deprivation. It is ranked the third most deprived local authority in the country and 51.5% of its children live in poverty. The index of deprivation ranks the borough fourth in the country for the proportion of children aged between nought and 15 living in an income-deprived household. That is just one measure of deprivation, but I am sure hon. Members will agree that it is a worrying one.
In addition, the decline of owner-occupation and the increase in the private rented sector changes the very nature of local communities. Support networks that people rely on—their friends and family, and wider communities such as their church and faith—are disintegrating as housing pressures force families to move home, leave their communities or remain in overcrowded, sometimes
unhygienic and often poorly managed private rented housing, which is sadly a fast-growing sector of tenure in the London borough of Newham.
In my constituency, there is a high level of need for services that will enable the people of Newham to be self-sufficient and lead independent, successful lives. My concern is that the process used to allocate the resources needed to support those services is fundamentally flawed. It is skewed in a way that significantly disadvantages my community.
Since 2006, if not earlier, the population estimate for Newham has clearly been an underestimate by the Office for National Statistics. The under-count was estimated at about 60,000 people until, in November 2011, the ONS went some way towards recognising the historic underestimate by provisionally estimating the population at 272,000, an increase of 32,000. That significant increase of 13% is, by the way, the largest change in any London borough. However, the new figure still falls some 30,000 short of the population estimate made by an independently commissioned study. That is a shortfall in excess of 10%.
The real population of the borough stands at roughly 300,000. That is the figure that should drive resource allocation, because it relates to the real world and real need. However, the ONS mid-year estimates are used to determine how the national funding pot is allocated to local areas, even though they do not accurately reflect the true population of my area. Given the level of need in my constituency, to say that resources are not allocated on a level playing field is an understatement.
The effect of an inadequate allocation system is compounded by a reliance on historical spend to determine current needs. That means that my local primary care trust has consistently struggled to find resources to deal with persistent need. Figures in the House Library tell me that expenditure per head on mental health in Newham in 2010-11 was £208.93. That compares with £447.21 in Westminster and £331.81 in Kensington and Chelsea. I wish to hammer home the point that the spend for Newham is based on the ONS population estimate, so the real spend per head is even lower.
The shadow health and wellbeing board for the London borough of Newham has discussed the matter at length and agreed a robust strategy, with a clear focus on maintaining resilience within the community. It wants to support people by ensuring that they possess the skills and resources that will enable them to negotiate successfully the challenges that they experience.
Let us face it: we know from evidence what works. The health and wellbeing board has indicated that it wants to focus its activity on parenting skills and pre-school education to set up an early family environment that supports children’s emotional and behavioural development. It wants to support lifelong learning, with health promotion in schools and continuing education, as schools are a really important resource, particularly for children facing difficulties at home.
The board also wants to find a way of improving working lives in the borough, as one in six people in the work force are affected by mental health problems, and a way of supporting a good and healthy lifestyle by encouraging exercise and good diet. It wants to encourage the learning of new skills and the taking-up of creative pursuits—social participation that promotes mental well-being across the piece. The board is also supporting
communities through environmental improvements. Environmental predictors of poor mental health include neighbourhood noise, overcrowding, fear of crime, poor housing and so on. Finding out what to do is frustrating, but it is also frustrating that resources are being rather unfairly allocated. Newham is poorly served in that regard.
I thank the Backbench Business Committee for creating this opportunity to discuss an issue that is often invisible, and on which there is not enough focus and debate. Poor mental health has an extraordinarily detrimental impact on huge numbers of people in our communities. We could and should be dealing with the problem in a plethora of holistic ways in our local communities.
Newham is severely under-resourced in the face of significant pressures on mental health provision. I am glad to see the Minister of State, Department of Health, Mr Burns, in the Chamber. I know he has listened to me and, given that he is a former Whip, that he is a very honourable man. I shall write to him to push the case for greater funding for Newham as we continue to fight for the resources that my communities desperately need to access better life chances, which includes better mental health.
Paul Beresford (Mole Valley, Conservative)
It was beginning to look like a Whips’ cabal in the Chamber. I was quite worried. A number of hon. Members, particularly Jim Shannon, who is busy disappearing from the Chamber, mentioned care for, and the mental health of, veterans—[ Interruption. ] I am making a plea to keep my small audience. To my delight, the shadow Secretary of State mentioned a famous organisation in that field: Combat Stress—[ Interruption. ] He is also leaving the Chamber the moment I mention him. He can read my speech in Hansard as he has obviously been urgently called away.
Combat Stress was supported by the previous Government as it is by this one. Combat Stress clients—ex-servicemen, or veterans—suffer from the appalling conditions of post-traumatic stress disorder, depression or anxiety, or all three. Anyone who has seen such individuals with such conditions will recognise that they are exceptionally debilitating. They destroy the normal life of victims and those around them.
Combat Stress has three centres—the main one is in my constituency—an outreach service throughout the nation and a liaison team. It has been making a difference for some considerable time. Some 83.5% of Combat Stress clients are ex-Army. Three per cent. are female. Most of the veterans contact the Combat Stress service themselves or through family referral, but only 3.6% are referred by general practitioners, 6.9% by community health teams, and 0.3% by a hospital service. I hope the Minister thinks about that.
To make access to those services more available, Combat Stress set up a 24-hour helpline in March last year. It may interest the House and the Minister to consider statistics from the helpline from March 2011 to January 2012. Combat Stress received 6,279 calls, including voicemails. A few people hung up—a tragic few calls were silent, which I think says a lot.
Of the callers who were contacted, 74% were male and 26% female. Army veterans made a total of 2,248 calls. The second largest group of callers were family, friends and carers of the victims, who themselves were therefore victims. Seventy-seven per cent. of callers called about themselves. Perhaps tragically—I hope the Minister makes a note of this—just 6% of callers were given the number and contact details by a health professional. The call centre seems to be catching on. In March, it received 286 calls, but that doubled to 604 the following January. The organisation is funded by the Government, and I plead with the Minister to keep the funding going. I am sure he will.
The average post-service delay is a staggering 13 years. The Minister should be aware that after such a delay an individual’s condition will have developed in complexity, meaning that their recovery treatment can last for years, whereas if treatment is early, it can last just weeks and months. Early diagnosis and referral can lead to faster and cheaper treatment, and greater success, and can mean that the potential side effects of alcoholism, drug problems, which have been mentioned—[Interruption.]
Lindsay Hoyle (Deputy Speaker; Chorley, Labour)
Paul Beresford (Mole Valley, Conservative)
As mentioned by several Members, the result can often be imprisonment, yet all these side effects could be avoided. On average, it takes veterans just over 13 years from service discharge to first approach Combat Stress. This is an ongoing issue for veterans.
Community outreach teams across the country now provide much support for veterans. They provide support and advice in veterans’ own homes and nearby community-based clinical care. Yesterday, we made much of the Falklands war, which ended 30 years ago today, on
Having set the scene, I shall touch on a few key points for the Minister to consider. First, all the UK Governments must acknowledge the ongoing need. Most of the Governments contribute considerably towards Combat Stress and its costs. Combat Stress estimates that in 2012, 960 service personnel will leave the armed forces with the likelihood of suffering from PTSD. I shall follow up a point made by the hon. Member for Strangford. We must persuade the MOD to look specifically at their decompressing veterans-to-be and, if there is any suspicion, to refer them to Combat Stress. It would make treatment by Combat Stress easier, because it would be given earlier, and all the pain and suffering of these men and women could be reduced to a tiny fraction of what it is for many of those in Combat Stress now.
That brings me to the crux of the problem, which has been touched on. Because mental illness is not a physical but a mental wound, a stigma is attached to it. A lot of Members have mentioned that. Combat Stress tells me that 81% of veterans with a mental illness feel ashamed or embarrassed, which often prevents them from seeking help—it certainly delays them seeking help—and sadly one in three veterans are too ashamed of their condition ever to tell their families about it. As a result, many of those families break up. Among the other side effects are crime, disorder and alcoholism. This is a mental health problem, then, that could and should be alleviated early.
Much has been done to raise the profile of the condition and the availability of help, so that those individuals do not feel that they are unique or, perhaps, weak. Much needs to be done to encourage them and their families to seek assistance. We need to put these valuable individuals back on their feet—and they are valuable: they have already performed valuable service, and there is still valuable service available if we can do that. Amazingly, there appears to be a considerable lack of understanding among GPs. Research conducted in September 2011 showed that only 5% of the veterans receiving help from Combat Stress had been referred by their GP. Perhaps those GPs failed to recognise the condition or were unaware of the existence of Combat Stress—or, more likely, both. I urge the Minister to ensure that the word is spread among our GPs. Combat Stress has done a clinical audit, and it would appear that approximately 80% of the veterans who come to it for clinical treatment tried to get help from their GPs or other specialist services first, and did not get it. Appallingly, that support and treatment was not forthcoming. It should be.
I hope that the Minister will consider joining me in a visit to Combat Stress, to see the value of the work first hand, to understand its difficulties and to help to build on the opportunity to prevent some of the tragedies that we see. We need to remember that for those veterans the physical war is over, but the battle is still raging in their heads.
Heidi Alexander (Lewisham East, Labour)
I want to keep my remarks quite brief, because I know that many other hon. Members are keen to speak. Let me start by apologising to Nicky Morgan for not being in the Chamber for the start of the debate. I heard some of her thoughtful and comprehensive remarks on the television before I got in here, and I congratulate her on securing this debate. May I also say how powerful and honest the speeches that we heard from Mr Walker and my hon. Friend Mr Jones were? I echo what the Minister said earlier, which is that this place is often at its best when people speak from their personal experience, rather than quoting statistics from briefings that we have been sent or things that we have read in the newspaper. It reassures everyone outside this place that we are also human beings, as well as Members of Parliament.
I have little expertise in this matter. Having said that, I have a close family member who has suffered obsessive compulsive disorder and psychosis in the past, and I have two very close friends who also suffer from OCD. I know how difficult it can be for them to overcome some of the challenges they face, so I think it is important
that we have this debate today. I want to focus on the huge challenge of providing high-quality mental health services in what are difficult economic times. Given the tone of the debate, I do not want to turn this into a piece of political knockabout, but I do want to speak about the reality of the situation in my constituency, where a number of mental health facilities either are threatened with closure or have already been scaled back.
The shadow Secretary of State for Health spoke earlier about how the mental health system is somewhat separate from the rest of the NHS. However, the mental health system is also facing considerable budgetary pressures—just as the rest of the NHS is—which is having an impact on some of the people we represent. During the parliamentary recess I visited a continuing care home for elderly mental health patients which is wholly funded by the NHS. The patients there are elderly people, often in their 60s, 70s or 80s, who have been sectioned and who have significant mental health needs, in terms of both medical and care support. The centre, in Granville Park in Lewisham, is threatened with closure. The service is excellent and the care provided is exemplary, and the families of the people who live there are incredibly concerned by the proposal to shut the unit down. South London and Maudsley NHS Trust is consulting on the closure. It claims that it has too many beds of that kind and says that it wants to scale back provision in Lewisham.
My constituents know that many more elderly people have significant mental health needs so it is hard for them to understand why a mental health centre should be closed. I have to say that the way in which the consultation has been conducted is far from perfect. Parts of it just do not make sense. I have raised my concerns with the PCT and the South London and Maudsley NHS Foundation Trust.
Also threatened with closure are therapeutic care services for adults who have much lower mental health needs. A fantastic centre, known as the network arts centre in Lee, has been threatened with closure. I hope that the South London and Maudsley NHS Foundation Trust will find a way to maintain the provision by setting it up as some form of social enterprise. This is a place where adults with mental health needs—perhaps not as significant as others’, as I said—can come together and enjoy arts-based therapy in a setting that helps them to take the next step towards their recovery. I am hopeful of finding a way through that situation, but when services like this are threatened with closure, it is a matter of huge concern to the people who use them.
I said that I would focus my remarks on the challenge of providing high-quality mental health services in difficult economic times, and the budgetary pressures faced by public services is one of them. Another is the greater uncertainty that individuals themselves face, which some hon. Members have touched on. A few weeks ago, I visited Mencap in Lewisham and met a group of people who were primarily carers for people with mental health difficulties. The questions they wanted to ask me were about the work capability assessment for the employment and support allowance; they wanted to ask me about the process their loved ones would have to go through in transferring from disability living allowance to personal independence payments; they wanted to ask me about the changes to local council provision of day centres.
What struck me was the great deal of uncertainty in the lives of people living with mental health problems and the people who are caring for them.
We heard from the shadow Secretary of State about the importance of getting advice and support to people in difficult times, and he mentioned the miners in Easington. That brings it home that we all—the Government and councils—need to recognise the importance of getting that local advice and support to people when they face this uncertainty, which only adds to people’s stress and problems.
The mental health charity Mind sent me some details of its information line. It told me that in the last 12 months, it had received 40,000 inquiries, but that unfortunately, because of the pressure it is currently under, two out of five of those calls went unanswered. Since the start of recession, Mind has seen a 100% increase in the number of calls relating to personal finances and employment. We need to understand the worries of people out there, and find a way to do more to recognise the importance of the local services that provide support and assistance.
I said that I would be brief as others wished to speak. I think we have had a thoroughly excellent debate and I congratulate those who made it happen. I look forward to hearing the remaining contributions.
Sarah Wollaston (Totnes, Conservative)
I congratulate my hon. Friend Nicky Morgan on securing this important debate, and I pay tribute to my hon. Friend Mr Walker, whose speech has immediately entered the list of my top 10 favourite speeches. I thank and commend him for the work he has done over many years as chair as the all-party parliamentary group on mental health.
I state from the outset that I am married to an NHS consultant psychiatrist and that my husband is involved in providing briefings to all Members on behalf of the Royal College of Psychiatrists. For that reason, I think it best for me to confine myself mostly to some personal reflections and some concerns that have been raised in my constituency, and in particular to address the issue of stigma.
As we have been told today, one in four people will experience mental illness at some point in their lives. We have heard powerful speeches about that from a number of Members. Like Mr Jones, I have experienced severe depression: at the happiest time of my life I experienced an episode of post-natal depression, so I know what it is like. I am sure that many other Members and people who are following today’s debate will know exactly what it is like to genuinely to feel that your family would be better off without you, and to experience the paralysis that can accompany severe depression.
It has been rightly said today that there is concern about the way in which some GPs handle depression, but I want to make it clear that in my own case, accepting that I had a problem and seeing my GP was very much part of the road to recovery. I think that we should be careful when we talk about how GPs manage depression, because I can tell the House—not only on the basis of my personal experience, but on the basis
of what I have heard from others—that there are many GPs out there who provide an excellent service, which I think can only be assisted by a move towards longer appointment times and better training.
We have heard today about the various terms that people use for mental illness. Earlier, we heard it described as a mental health “experience”. I would say to anyone who is listening to the debate that an experience of depression makes many people stronger and more understanding. I am absolutely sure that my own experiences of depression and recovery—recovery is very important—caused me to become a much more sympathetic doctor, and I hope that it made me a more sympathetic and understanding MP, able to recognise the issues in others and respond to them appropriately.
I want to sound a note of caution about employment and depression. Many Members have rightly mentioned the issues surrounding Atos assessments, and I was glad to hear the Minister say that he would address himself to some of the concerns that had been expressed, but I think that we should be careful about making assumptions. We should not assume that people with depression are unable to work; we should individualise the position.
When I returned to work after having a baby, I was still suffering from severe panic attacks—especially when travelling on the underground—and in retrospect, I realise that I was still significantly depressed, but going back to work was part of my recovery. I know that it can be difficult to challenge the ideas of people who are depressed, but I think it important to present them with challenges and encouragement at some level, because depression is sometimes followed by a crisis of confidence, and getting back to work is part of the road to recovery from depression, however difficult it may feel. We should not make generalisations and assume that no one can return to work when they are depressed.
I pay tribute to all those who help people with mental illness, including the many volunteers in all our constituencies, and I pay particular tribute to a voluntary group in my constituency called Cool Recovery. It is an independent mental health charity which cares for a number of people—not only those who have experience of depression, or are currently living with depression or other forms of mental illness, but those who have recovered from mental illness, and those who care for people who suffer from it.
I feel that such voluntary sector groups are essential if we are to realise some of the benefits that can come from the Health and Social Care Act 2012. I was concerned to hear from the volunteers at Cool Recovery that they do not feel they have been sufficiently involved in the commissioning process, and that there are real anxieties about the extent to which the user voice and the voluntary sector voice are currently being heard in the new arrangements. Perhaps the Minister will give us an update on what is being done to ensure that there is adequate representation for the user voice and the voluntary sector at every stage on HealthWatch, on health and wellbeing boards, and right up to national level at the NHS Commissioning Board.
Sarah Wollaston (Totnes, Conservative)
I thank the Minister for that, and I look forward to reading his response.
I was pleased to hear that my hon. Friend Gavin Barwell will introduce a Bill to remove stigma. From talking to service users and those who have recovered from mental illness, it is clear to me that they are entirely capable of taking a full part in every aspect of life in their community and workplace, and in our national life. I was glad that the Minister and shadow Minister gave their full and unconditional backing to that Bill, as it will mark a very important step in removing the stigma of mental illness. I also join the Minister in paying tribute to the work of Time to Change, and I hope he will commit to continue to give support to that organisation.
Some 22% of the disease burden in England comes from mental health issues, and it is time that we recognised that in our local and national commissioning. The mental health strategy is excellent, but we now need to ensure it is implemented. I know the Minister has set up a cross-ministerial group centrally, but who in this new system will be accountable for the successful implementation of the strategy locally and regionally—and what levers for change can they exert, and what sanctions will there be if it is not carried out?
Alison Seabeck (Plymouth, Moor View, Labour)
It is a privilege to follow Dr Wollaston. She has great personal and professional experience in this field. I congratulate Nicky Morgan on securing the debate, and I apologise to her for missing her opening speech as I mistimed my arrival in the Chamber. I will read it in Hansard, however.
This is a very important debate. Mental health problems stigmatise. We have heard harrowing stories from colleagues on both sides of the House about how mental health issues affect our constituents—and also Members of Parliament. I pay tribute to my hon. Friend Mr Jones for his brave speech; he will now only have greater respect. It was interesting to hear how his experience made him stronger. The hon. Member for Totnes made that point, too, from her own experience. Mr Walker made a speech that managed to be entertaining despite the seriousness of the subject under discussion, and all I have to say in response is “rock ’n’ roll.”
Mental health problems are met with intolerance and discrimination, and sometimes fear. When I was growing up, the terms used to describe people with mental illness included lunatic, nutter, headcase and maniac, all of which have associations of dangerous or unpredictable behaviour. No real effort was made to understand or support. The usual solution chosen was to lock people away, or to stay away from them.
Many people, especially men, are reluctant to admit they have problems or that they are feeling depressed or are hearing voices. Some people do not understand that their lives are being affected by the state of their mental health. We find in our surgeries that people sometimes start talking about one problem, but when we dig we find layers of issues, including mental health issues. About 60% of the people I see have an underlying mental health issue, ranging from severe stress to serious psychotic conditions, and I do not think my constituency is unusual in that regard. Teasing out what support they have, or have not, sought can require great sensitivity,
and very few MPs are trained counsellors or therapists. At times, however, we find ourselves taking on that role and doing our best.
Plymouth has a number of organisations that work with people across the full range of conditions; the Samaritans and Plymouth Mind are excellent. Mind has been in touch with me to express serious concerns that, at a time when more people are struggling, money is a huge problem, relationships are failing, young men and women are returning from war and housing pressures are intolerable for some, the main provider of mental health services, Plymouth Community Healthcare, is no longer structuring mental health as a specifically defined directorate of health care and appears to be shifting resources from mental health to generic health services. My right hon. Friend Andy Burnham, on the Front Bench, talked about bringing mental health closer to acute care, and that is obviously a better approach. Mind is concerned that in Plymouth the limited funds are being shifted away from mental health support. The charitable sector, too, is struggling as a result of a reduction in resources. There are some truly excellent support groups in Plymouth, and I pay huge tribute to the staff and volunteers at those, many of whom have come through mental health illness themselves. There are far too many of them to name, but I just wanted to put that on the record.
I have mentioned housing pressures. How many of us have constituents who are living in desperately overcrowded situations? We encounter pressure on parents because their children have turned up, perhaps with their grandchildren. A woman who came to my surgery is sleeping on the sofa in her front room while the rest of the house is taken up by her children. These people are clearly struggling. Many of them are on antidepressants or more powerful medication, and some are suicidal. Our caseworkers also deserve enormous credit for the way in which they sometimes have to support people in those circumstances.
Equally, housing officers often cannot manage the tide of human misery that they face. People with mental health issues are much more difficult to deal with. A housing officer can understand someone who has a physical disability, as it is often obvious—it is there in front of them and it is not invisible—and they can offer adaptations or a possible move. Things do not work in the same way for people with mental health issues, and it is much more difficult to deal with those.
As we have heard repeatedly, mental health cuts across every area of our society. We have heard a great deal about the need and support for our armed forces and the excellent work done by organisations such as Combat Stress. We have heard about the iniquitous treatment of people at the hands of Atos and about problems faced by those in the criminal justice system, but there are other areas to address. The hon. Member for Totnes touched on the issue of young women, who clearly often need support both before and after childbirth. Midwives are potentially very important in that scenario, and I would be interested to hear from the Minister on what guidance and training they specifically receive on supporting women in those circumstances.
Work is also being done to address the needs of children. The Minister mentioned the work of YoungMinds, but we are still failing very many young people. Recent media reports on suicides highlighted just how difficult
it can be for young people who are being bullied or are struggling through other personal issues. Tragically, schools and other responsible adults have failed to recognise what was going on in their lives. I pay tribute to the incredibly well-informed speech by Sir Peter Bottomley, which specifically dealt with those issues. YoungMinds, which was praised by the Minister, is concerned by the service cuts and reductions in provision for child and adolescent mental health. We also have to address an issue about the transition from support in that area into adulthood. That area needs a lot more attention, and I hope that the Minister will address some of these specific issues in his correspondence with us.
Finally, I wish to offer my support to Gavin Barwell in his attempt to make significant changes on the whole issue of stigma. Intolerance or discrimination in employment, and preventing people from holding public office because they have been sectioned, is wholly unacceptable. He is right to say that this archaic piece of legislation needs to be binned, and I welcome the support that he has received from the two Front-Bench teams. I also welcome the fact that we will have a further opportunity to debate some of these crucial issues and just get it out there.
Nigel Evans (Deputy Speaker; Ribble Valley, Conservative)
Order. As hon. Members can see, about nine Members are trying to catch my eye and we have just over an hour. We want to get everyone in, do we not? If everybody speaks for only six or seven minutes we can accommodate everybody, so I ask Members to be time-focused, please.
Phillip Lee (Bracknell, Conservative)
I congratulate my hon. Friend Nicky Morgan on securing this important debate. There have been some very impressive speeches, not least from Mr Jones. I have the pleasure of being, like him, a member of the Administration Committee because very early on in my time here at Westminster I realised that there were quite significant mental health problems among my colleagues. A few of them had approached me so I went to the usual channels, wanting to know what support was available for colleagues. As a consequence, I was put on the Administration Committee and I am now also on the medical panel. I am encouraged by the support available to colleagues if they choose to use it.
I congratulate the shadow Front-Bench team on what appears to be a decision to lead with mental health. It is an important decision that is politically astute and those on the Government Front Bench ought perhaps to reflect on their goals in that area. My advice would be not to be overambitious.
I want to reflect on my experience in this area, my family experience and my professional experience before saying a few brief words on GP commissioning. I have heard mention of the police and the concerns about their involvement in this area, so I shall comment on that. Finally, I want to mention the Human Rights Act.
At a family level, at last count there were three suicides in my extended family. I know a number of people who have had depression and, unfortunately, a family member has recently been diagnosed with early onset dementia. I myself have had moments of, shall we say, fluctuating mood, perhaps a bit more so since I have been in this place, so I feel that I have first-hand experience through my family and myself of how prevalent the problems are.
I know from my professional experience that the nature of this topic means that it is something one does not forget. I recall clerking in a patient who was a survivor of Auschwitz—I remember the tattoo quite clearly—and the following day, that person hanged himself. I remember the relative of a senior member of the Ministry of Defence at the time breaking down in front of us, which was a quite shocking incident for me as a medical student.
Finally, I remember a case—I only remembered this as I listened to Jim Shannon—of somebody who had been a victim of the troubles in Northern Ireland and had been relocated to where I was working under the witness protection scheme. That gentleman had experienced guns being held at his temple, in his mouth and so on, and I was in a position to be able to help him.
The nature of this subject means that it tends to throw up cases that are quite memorable and emotive. I feel strongly about it. Locally, I have done my bit. I have met Rethink Mental Illness and the first hustings I attended during the 2010 general election campaign was run locally by a mental health charity. Broadmoor hospital is in my constituency, at Crowthorne. I have visited there and I would encourage everybody to visit Broadmoor hospital. It is a very interesting place to visit with recidivism rates that are, I imagine, the envy of the prison system.
I have done my bit to try to raise the profile of the discussion and debate around mental health services, because this is a significant area of concern. About 800,000 people have dementia in this country at the moment and that number will rise—it will double. That is because of ageing and lifestyle, depending on whether it is Alzheimer’s or vascular dementia. The estimated cost of mental health is £89 billion by 2026, although perhaps that figure is out of date as I heard the shadow Secretary of State give a larger figure. Half of that is due to loss of earnings in the work place. The significance of this topic cannot be overstated.
Unfortunately, more than half of people with anxiety disorders do not interact with the service and about a third of those with depression do not interact with it. The services we have cannot deal with the demands being placed on them, so God only knows what it will be like when everyone starts turning up to see me as a GP or, now I am here, me as an MP. I fear that this will need some realism on the part of the current Health team and any future Health team that might come from the Opposition side in terms of rationing and prioritisation of resources. For example, I read that we are now giving fertility treatment to everybody. I am sorry, but if I were to prioritise where my funding was going, I know it would go to mental health before it went to fertility treatment. I know that is a difficult thing for people to accept if they have fertility problems but we have to make decisions and I know where my priorities lie.
Let me address GP commissioning and some concerns that I want to raise with Front Benchers. There is some unease in my profession about the commissioning of psychiatric services—more so than for diabetes, hypertension or any cardiac service. In a recent poll that I saw, about 70% expressed significant concerns about this issue. I want to flag this up because most GPs do not get a lot of psychiatric experience when they are training. I happened to do a post in which I worked with depression and dementia as a junior but quite a few do not. That needs to be borne in mind. Perhaps we need to look at training in the way that my hon. Friend Dr Wollaston mentioned earlier. The commissioning of mental health services is complex and difficult, and we need to be cautious. I have been broadly supportive of the Government regarding commissioning but psychiatric services are different.
Another matter that I want to raise is about the police. I heard the earlier comments about the police force and I know that the police are not terribly enthusiastic about getting involved in acute psychiatric crises, but let me tell hon. Members an anecdote. A good friend of mine attended a psychiatric hospital at which someone had been brought in by the police. Six policemen had brought in that person, who was in a violent state of mind, and there was one female psychiatrist there. The six policemen had stab vests on and she was wearing a blouse. Somebody has to do that work and I am slightly concerned about who will do it if the police want to get out of it because the psychiatrists on the front line do not have the same protections that the police have.
On the Human Rights Act, let me highlight that whereas when people come on to the parliamentary estate they have their bags checked, psychiatrists cannot check the bags of a patient they are about to assess even if that patient has displayed violent intent. So someone could come in with a bag with knives and guns in it and the psychiatrist cannot investigate that bag or have it searched because of the patient’s human rights. I would very much like the Front Bench team to look at that and get back to me.
I want to take this opportunity to ask a few questions and re-emphasise that the knowledge base of GPs in this area needs to be improved, particularly for commissioning. I should like to know what the Government propose to do in this area. On the issue of choice, it is all very well wanting patients to be able to exercise choice but if they are not capable of doing so because they are profoundly depressed, demented or psychotic how on earth can they exercise that choice? Is the Minister confident that patients will get the care they need? I welcome the £400 million for talking therapies, but I should like to know where that money is being spent. What is the breakdown of the expenditure of that money? Is the Minister confident that it is being spent in appropriate areas? Anecdotally, I am hearing that it is not making much difference on the front line.
What can be done with regards to the Human Rights Act and the example I have given? We should look at this. Perhaps it is an issue for colleagues in another Ministry, but I would appreciate a response about this.
Finally, let me raise a local issue. The Royal Military Academy at Sandhurst is in my constituency—or at least the parade ground and the buildings are. The residential accommodation is in the constituency of my right hon. Friend the Secretary of State for Education.
The problem on the Surrey-Berkshire borders is that there is a difference in the mental health care provision from each trust. There is a perverse situation in which people registered at the Royal Military Academy, whether personnel or family members, receive different levels of care. I would appreciate a written response on this from the Minister or from the Ministry of Defence. We may be able to address that with commissioning groups, but it is important, particularly given the comments by some of my colleagues, with reference to our armed forces.
Finally, may I congratulate everyone in the mental health sphere and anyone who is delivering care. They do so in often challenging circumstances. Doctors, nurses and so on need all the support that they can get in a service that will be increasingly important to us in future.
Julian Lewis (New Forest East, Conservative)
Unlike the doctors who have spoken from the Conservative Benches, my hon. Friends the Members for Bracknell (Dr Lee) and for Totnes (Dr Wollaston), who spoke with such expertise, I have absolutely no medical qualifications whatsoever, but that has not stopped me giving my opinions on this subject in the past, and I am afraid that it is not going to stop me today.
I see from the index on my website that this will be the ninth speech that I have made on the Floor of the House or in Westminster Hall on mental health. Many of those speeches were supported by my hon. Friend Mr Walker, and I do not think we will ever hear a finer speech than the one that he made today. In passing, I pay due credit to Mr Jones, whose interest in these matters I have known about for a long time, although not his personal history.
The speeches that I have made in the past have tended to concentrate on three themes: the importance of separate therapeutic environments for people who have to be admitted when they are acutely mentally ill—it is obviously unwise to have psychotic patients cheek by jowl with people suffering from suicidal depression, for example; the importance of single-sex wards, particularly in mental health units, although that applies to the NHS hospital network as a whole; and the importance of making adequate bed numbers available for people who require periodic admission to a mental health unit.
We heard from the Minister about the new emphasis on recovery-based programmes, and I am all in favour of that. There is everything to be said for that, but even its most ardent advocates do not deny that there will always be a need for in-patient beds for some people some of the time. I am concerned that the cuts imposed on in-patient beds may mean that if we are not very careful indeed there will be enough beds available in future only for people who are sectioned. Those people who wish to receive the support and the underpinning—the fall-back position—of an in-patient bed when they are experiencing an acute episode may be unable to secure one.
It has rightly been said that a debate at national level brings out the best in people in the House of Commons. However, the debate at local level does anything but bring out the best, given some of the schemes, plans and measures that have been introduced. In that connection, I pay tribute to Heidi Alexander who, in a measured and thoughtful
way, made a speech that has become all too familiar to me. She talked about the way in which Granville Park in her constituency has been scheduled for closure on the basis of a consultation that she regarded as somewhat suspect.
I refer the hon. Lady to the Adjournment debate on the Floor of the House introduced by my hon. Friend Andrew Griffiths, who discussed similar techniques that were used in his constituency, and to my own experience with the Southern Health foundation trust, which used a similar method to make 35% cuts in in-patient beds for acutely ill adults, even though bed occupancy figures were consistently over 90%. The pattern seems to be something like this: they hold a consultation; they make assertions based on, at best, subjective surveys of what they say people want; they then rely on pseudo-independent “expert” research, which usually turns out not to be independent at all; and finally they bulldoze their pre-existing plans through.
Therefore, to take the message that Mr Speaker always used to give when teaching the art of rhetoric, which is that a speech should have at most two main points, the main point in my speech is the need for the objective monitoring of statistics so that when we are reconfiguring services we at least know whether there really are spare beds before we close services down.
I would like to be fairly positive in this debate, brief as my contribution necessarily is, so I would like to say that the health overview and scrutiny committee of Hampshire county council, despite the harsh words I have had to use about it in the past, appears to be taking on board some of my concerns by seeking to ensure, as it has stated in its minutes,
“that further bed reductions are being safely managed”
and that it is
“made aware by the commissioner and provider should future acute inpatient bed demand regularly exceed bed availability in the service.”
I think that it is terribly important that in the process of reconfiguring we do not simply say that we are recreating a new system in the community while decimating the system that allows people the safety net of an acute bed during those episodes when they are really ill. As I said in my brief intervention on the Minister, if people are to have the confidence to get on with their lives and know that they can have useful and fulfilling careers even while living with and managing a mental illness, it is absolutely vital that they also know that, on the rare occasions when they really need the ultimate support of a few nights or even a week or two in an acute unit, a bed will always be available for them.
Matthew Offord (Hendon, Conservative)
I will keep my remarks short, as time is certainly against me. I want to focus on the stigma of mental illness and the reasons why I think it continues to exist. We often recoil in horror when we think of the old asylum system in which people were locked up for various reasons. I believe that the care in the community system has been welcomed by most people, and I say that with evidence from the 1994 Richie inquiry into the care and treatment of Christopher Clunis, which broadly endorsed the community care policy.
Even though the community care policy is widely accepted, the issue of mental health is not accepted by the majority of the British public. I say that with evidence from the 2010 public attitudes survey showing that, although people are broadly sympathetic towards those who suffer from mental illness, some of their attitudes are worse than when the Department of Health first commissioned the poll in 1994. I believe that it is fear that drives this county’s mental health system; not the fear of those who suffer from mental illness, but a fear that is perpetuated by the actions of vested interests and perpetuates the stigma. I believe that it occurs through three main areas: mental health lobby groups, politicians and the media.
First, fear of those who are mentally ill has been fuelled by lobby groups that use the rare cases of homicide to keep mentally ill people in the public’s consciousness. Although their motivations are honest, the reality is that their actions promote a fear that is not always conducive to their aims. I do not intend to criticise individuals who have suffered terrible personal tragedies, but highlighting mental health issues as aggravating causes in deaths will not reintroduce a policy of asylum hospitals for severely mentally ill people. That behaviour alienates other mental health charities, which consider it to be unproductive.
Secondly, we as politicians have to take responsibility for reducing stigma. As I have already said to the Minister, the political decision to hold an independent inquiry into every homicide involving a mentally ill person has exacerbated public fear. Following the Ritchie report in 1994, the Department of Health ordered that an inquiry should be held into every homicide involving mental health services, but mental health professionals describe the environment in which they now have to work as an inquiry culture, whereby staff are made aware that any variation from recommended perfect practice could lead to an unpleasant afternoon in front of a cynical committee and the humiliation of being named in one of their reports. Those inquiries are viewed by mental health professionals as a threat, rather than as a corrective mechanism to enforce a “safety first” culture that promotes a perception among the public that every death is preventable.
It is easy for politicians to fall into that trap of trying to face both ways; indeed, the previous Government did fall into it to some extent. They were described as “compassionate” when they embarked on what the Mental Health Commission called
“the quickest and most dynamic transformation of policy in the history of state intervention in mental health illness,”
The third influence on mental health policy is provided by the media. Comments have already been made about the front page of The Sun in 2003, when it faced a significant backlash for branding Frank Bruno “Bonkers” after he had been taken to a psychiatric hospital. But that was not an isolated story. There have been many others, such as “Doc freed psycho to kill” and “Psycho killer was a time bomb waiting to explode”. They all inflame public outrage and continue to promote among the public a perception that mental illness equates to dangerous murderers whom doctors allow out on to the street, free to roam and to kill at will, but that is simply not the case.
Figures show that there has been no increase in killings by people with a mental illness in the past 40 years, during which time many mental hospitals have been closed in favour of care in the community. Less than one in 10 murders is committed by someone with a mental disorder, and over the past 40 years that number has decreased as a proportion of all homicides, as the overall murder rate has increased over the same time.
On the representation of mental illness on television, the Scottish Recovery Network found that 45% of characters with mental health problems in soap operas were portrayed as violent or as posing a threat to other people. In real life, it was very concerning when in 2007 Nikki Grahame, someone who clearly has mental health issues, and Pete Bennett, who suffers from Tourette’s, were allowed on “Big Brother” simply to increase its viewing figures.
Kerry Katona has admitted that when she sought to go on the same programme on Channel 4 in 2010, she failed the psychological test, as she had just come off her bipolar medication and a doctor advised her that it would not be sensible to appear. In 2011, however, when the show went over to Channel Five, that broadcaster did not produce any psychological tests and she was allowed to go on, the consequences of which could be seen each day.
The biggest change over the past decade has been the increase in protests from people with mental health problems who use the services on offer. Their dissatisfaction is with treatment, its greater emphasis on risk reduction and containment and its narrow focus on medication. Those who suffer from mental health problems dislike the heavy use of antipsychotic and sedative drugs, given their side effects, with some even rejecting completely the biomedical approach, which defines mental health problems as illnesses to be medicated, rather than as social or psychological difficulties to be resolved with other treatments, including talk therapies, for example.
There were some good measures in the Mental Health Act 2007, but there were also some negative ones, so I ask the Minister to address them and, in particular, to outline the benefits that he thinks the 2007 Act has introduced or, if he does not think that it has introduced any, the coalition Government’s policies to address the need for legislation that is fit for the 21st century.
The public and politicians want to be assured that the services people receive from mental health organisations are safe and will protect people from such rare but catastrophic attacks as those that have occurred in the past. People with mental health problems, and their families, however, want to be assured that the services are responsive and supportive, not coercive. They want to be included as active partners in, not passive recipients of, their care. However, a coercive service whose priority is public safety is vote-catching, while concern with civil liberties for a minority group, and one with a dangerous image at that, is not.
Patients continue to be treated with drugs rather than therapy, yet the constant cry is for more talking treatments, which NICE now accepts work for conditions such as schizophrenia. Carers are still neglected; their views are ignored and they lack support. There is huge variability, with some places having great services while others, as has been described today, have appalling services.
Perhaps the biggest scandal in mental health provision is in physical health. Evidence shows that people with
severe, enduring mental illness die 15 to 20 years younger than on average. That is partly due to high levels of smoking and use of other drugs—in effect, self-medication. There is also evidence that people with mental illness suffer discrimination in relation to their physical health. They do not get seen as quickly and they do not get treated as well as those in other parts of the NHS dealing with patients who do not suffer from their conditions.
The prescription for Ministers appears to be this: more talking treatments; better physical care; concerted action to reduce stigma; and more direct payments for those who can cope with them, allowing those on benefits to buy their own care rather than relying on social services.
Robert Buckland (South Swindon, Conservative)
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 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 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 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.
Andrew Griffiths (Burton, Conservative)
I too offer my thanks and praise to my hon. Friends the Members for Loughborough (Nicky Morgan) and for Broxbourne (Mr Walker) for securing the debate and for putting mental health at the centre of Parliament and the centre of our thoughts today. I also want to thank my hon. Friend Dr Lewis. Over recent months, he has played Starsky to my Hutch in relation to mental health debates. He also managed to make my speech today in a much more succinct and erudite manner than I could ever hope to do.
I rise today to make a plea to the Minister. He graciously attended an Adjournment debate that I secured on the closure of the Margaret Stanhope centre, a mental health facility in my constituency. It was as a result of his intervention that the consultation was extended, and I was grateful for that. The end result, however, was that the local PCT—South Staffordshire PCT—took the decision to close the centre. As a newly elected Member of Parliament, I assumed that such decisions would be taken based on facts and evidence, and that there would be hard facts to enable the PCT’s claims to stack up. I assumed that its claims about the provision that was going to replace the Margaret Stanhope centre would be demonstrable. As my hon. Friend the Member for New Forest East said earlier, however, the reality was a mind-blowing situation, in which the inability of the PCT to make any of its claims stack up throughout the process became apparent. I was disappointed, but not surprised, that the PCT dismissed the petition organised by my local newspaper, the Burton Mail, to save this much-loved facility, which some 8,200 people signed. The PCT decided to dismiss it because, it said, the petition did not deal absolutely to the letter with all the options that were in the consultation.
Throughout the consultation, the PCT made a number of claims. To start with, it said that it had carried out a pilot scheme and could demonstrate that it could reduce the need for in-patient care by a third. Understandably, we asked for the evidence to back that up. After five weeks of asking, it eventually provided me with some occupancy rates. We then asked for further occupancy rates, because the initial ones did not stack up. We asked for daily occupancy rates. It took a further two months for the PCT to give us that information. When we analysed it, it showed that far from reducing the need for in-patient beds by a third, only stays of more than 90 days—a minute part of in-patient care—had been reduced by a third. The vast majority of the figures had stayed the same and one-day admissions had actually gone up.
We looked further into what the PCT was saying. It had claimed that an independent report by Staffordshire university had said that closing the facility would not have an impact. When we looked at the report, we found that the professor from Staffordshire university who had conducted it was also employed by the PCT. She was on the payroll of the PCT, and yet it was praying in aid her report.
We cited a benchmarking report by the Audit Commission, which demonstrated that the PCT had among the lowest provision of mental health beds in the country. It stated that of 46 mental health trusts, Staffordshire had the lowest provision. Surprise, surprise, the following quarter’s evidence showed that my PCT had the highest provision. It had shot up from the lowest to the highest. When we explored that a little more, we found that the PCT had included beds such as those for eating disorders and drug and alcohol problems. It had lumped them all together to fix the figures.
The most worrying thing for me was that when I attended the final hearing where the decision was made, lay members on the panel were asking basic questions such as how many beds were available and what the occupancy rates were, even after a four-month consultation. They clearly did not have any of the information that was necessary to make such an important decision.
I urge the Minister to think long and hard about how we can bring rigour into such decisions. Mental health issues can affect any family, rich or poor, and are no respecter of intelligence, upbringing or anything like that. It is essential that there is a rigorous, accountable and transparent process before PCTs are able to decide to do away with these vital beds. I urge the Minister to consider how the Government can provide those reassurances.
Andrea Leadsom (South Northamptonshire, Conservative)
I congratulate my hon. Friends the Members for Loughborough (Nicky Morgan) and for Broxbourne (Mr Walker) on what has turned out to be a fantastically refreshing debate, which has been part debate and part group therapy.
I want to add my own personal contribution. Like my hon. Friend Dr Wollaston, I suffered from post-natal depression. It is unbelievable how awful you feel when you are sitting with your tiny baby in your arms and your baby cries and so do you. You cannot even make yourself a cup of tea. You just feel so utterly useless. Looking back on that time, I genuinely agree with my hon. Friend that going through that experience makes you a better person. It also makes you determined to do something for other people in that situation.
Post-natal depression is a key issue for women as individuals. Like many others, I got over it with the help of a good family and husband, and by going back to work. Many people do not get over it. Although the consequences are profound for those women, the consequences for their babies are often even more profound.
I want to talk briefly about the experience of a baby. When babies are born, they are about two years premature. Their brains have barely developed. They have all of the neurones but none of the neural pathways are laid down. That happens only during the first two years of life. The peak period for the growth and development of a baby’s brain is between six and 18 months, and that growth is literally stimulated by a loving relationship with an adult carer—usually their mum, of course. If a baby’s mum has a lovely, smiling face and always picks them up, cheers them up, hugs them, feeds them and changes them whenever they cry, their brain becomes hard-wired to understand that the world is a good place. They will go on to be a person who can deal with life’s ups and downs, and who retains the idea that the world will be good to them.
It is like Harry Potter. He had loving parents until he was two, but then along came Lord Voldemort and murdered them, and he had an unspeakable experience until he was into his teens and escaped to Hogwarts. What kept him on the straight and narrow, and understanding right from wrong, was his secure foundation. I put it to the Minister that that is how to secure good emotional health for our society.
If babies do not have a secure bond—usually with mum, but it can be with another parent or with adoptive parents—their brain develops in such a way that they expect to have to fight or withdraw. Those babies are the people who go on to fail to cope with what life throws at them. They struggle to make friendships, and they are the people who are bullied or become victims, or indeed become bullies themselves at school. Babies at the acute
end, where there is real neglect and abuse, are the ones who go on to become drug addicts or violent criminals. In fact, research shows that 80% of long-term criminals have attachment problems stemming from babyhood.
A sad truth about our society is that research shows that 40% of children aged five are not securely attached. Of course, that does not mean that they all go on to become psychopaths or murderers, but it does mean that we are raising generations of babies and young children who do not have the emotional capacity to meet the ups and downs that life throws at them. They will have a much greater tendency than other people to mental illness. They will struggle to have all the things that we perhaps take for granted, such as a secure family and a decent job, and they will be less robust in their emotional make-up.
There is much that we could do to support people. We heard yesterday in the debate on early intervention about how much more could be done to support social workers and destigmatise going to children’s centres and seeking help. One very good example came from Mr Field, who has talked about it for a long time. Why do we not ensure that people go to a children’s centre to register their baby’s birth, and then to get their child benefit? That would instantly mean that most people would use children’s centres, so it would destigmatise them.
Children’s centres should not just be places where people go for antenatal and post-natal check-ups; people should be able to go there for psychotherapeutic support such as that offered by the Oxford Parent Infant Project, the charity of which I was chairman for nine years. It provides psychotherapeutic support for families who are struggling to bond with their babies. Social workers, health visitors and midwives love it because it is somewhere to which they can on-refer people. We hear a lot of talk about training for health visitors, but no talk about what they should do when they spot attachment problems and what help they should provide to families to turn the situation around. OXPIP has shown how incredibly easy it is to do so, because both mother and baby are extraordinarily receptive to being supported in such a way as to develop the attunement and empathy that they need for a good relationship with each other.
Mums who adore their babies do not allow partners to stub cigarettes out on them. They do not shake them to death or neglect and ignore them when they are crying. It is all about building an early relationship. It is greatly in the interests of our society for sound relationships to have been built by the age of two so that we do not constantly have to deal with the consequences of failed attachment later in life.
James Morris (Halesowen and Rowley Regis, Conservative)
I welcome this important and timely debate. As other hon. Members have said, mental health issues are often marginalised in debates about health in general. Mental health must take centre stage, because mental health problems are widespread across the social system and affect people of all ages.
As Members have pointed out, there has often been a stigma attached to mental illness, but we are beginning to tackle that stigma head-on both here and, increasingly, through other public figures talking about their mental health problems.
As we attack that stigma, we must also examine whether our approach to tackling the problem is fit and appropriate for the 21st century. Our approach to mental illness over a number of decades has been based on what I would call the psychiatric model. The model has medicalised mental illness and treated it as something to be dealt with using drug-based therapies. It is dominated by a concern for short-term relief rather than long-term cure. That approach has dominated our thinking about mental illness in mainstream health. In my view, it needs to change, which is why I broadly welcomed the recommendations in the Government’s “No Health without Mental Health” strategy, particularly its emphasis on improving access to psychological therapies. The Government are investing £400 million over the spending review period, which is a welcome development.
People who suffer from a range of mental health problems need clear access to a range of talking therapies, but it has become fashionable to be sceptical about the effectiveness of long-term approaches such as psychoanalysis and psychotherapy, and we must not fall into the trap, as we do in many aspects of modern life, in focusing on therapies that have a short-term effect. I believe strongly that psychoanalytical and psychotherapeutic approaches can help to treat a range of mental health problems, from anorexia and psychosis to schizophrenia. We should not be embarrassed to advocate the use of such therapies.
At the same time, we need an integrated approach at a local level. I am impressed by the approach taken in Sandwell, part of which I represent. A GP-led approach to mental health care in Sandwell has borne results. The area has high levels of mental ill health, and high social deprivation and unemployment. Local GPs, led by Dr Ian Walton, agreed that depression should be a top priority. They developed an integrated mental health care approach emphasising greater choice, and helping to build emotional resilience and independence. The approach shifts the focus to mental well-being rather than mental illness.
As other hon. Members have pointed out, GPs are an important first gateway into NHS mental health services and the early identification of treatment for mental health problems. Big steps have been taken in Sandwell to improve GP training to deal with patients presenting complex mental health problems, and Dr Walton and his team have invested time in GP training to improve the efficacy of early diagnosis.
Improving early diagnosis of mental health problems is a fundamental part of the integrated model that has been successful in Sandwell. It frees resources in secondary care and allows people to deal with their mental health problems in community and family settings. The Sandwell model emphasises positive self-help, access to appropriate talking therapies and a focus on specialist programmes tailored to the needs of patients, which other hon. Members have mentioned. It also emphasises the importance of partnership working with schools, health, employment and other social providers.
Dr Walton and other local GPs have helped to transform mental health care in Sandwell, with consistently high recovery rates using IAPT of 63%, compared with a national average of just 44%. As we seek to tackle the major problem of mental health across our country, we need that greater emphasis on talking therapies. We need to challenge the psychiatric model of mental health
treatment that has dominated thinking in our health system for far too long. We need an integrated approach at a local level that takes the best talking therapies and gives people access to the treatment they need. As the debate has illustrated, we also need a commitment from the Government to place mental health as a top priority within our health service as we seek to tackle the problem.
John Glen (Salisbury, Conservative)
In the short time available, I wish to address two subjects. First, I shall consider mental health in the military and the excellent progress made since the election, and refer to the work of my friend and constituency neighbour, my hon. Friend Dr Murrison. Secondly, I want to reflect on my experiences dealing with constituents over the past two years. I think that many Members have been surprised by the sheer number of individuals who come to surgeries with mental health problems and associated issues. I want to refer to several of my experiences with constituents.
Soon after I was elected, one constituent told me about the treatment of her brother, who had recently committed suicide. She was unhappy with his experience and that of her brothers and mother during the previous 20 years, so we convened a meeting with relevant health professionals. I sat in the room for an hour and a half, as we went through the history of that poor man’s experience over 20 years. We have had an excellent discussion this afternoon about the different investments, and new policies, resources and approaches, but it struck me in that meeting that the real challenge was to join up all the different components that make for a proper solution for that family as a whole.
We were given an excellent briefing in the run-up to this debate, but one comment, in particular, from Mind and Rethink struck home. They wrote that
“whilst many people with mental health problems receive excellent care, all too often people face barriers in getting the care that they need as people’s journeys to recovery are rarely linear or straightforward.”
That is the key issue. People do not know what to expect, and because many of these conditions are unseen and the future is unknown, a great deal of fear creeps into families doing their best for a struggling relative. That leads to great tension and anxiety, so it is incredibly important that as we move to a new commissioning environment, we give local providers of appropriate support a voice and enable them to be commissioned. These decisions must be based not on numbers and spreadsheets but on the practical experience of local people.
The “Fighting Fit” report was a valuable piece of work commissioned in the first few weeks of the Government taking office. It is important to think about mental health in the armed forces in the same way as in other areas, but it is difficult to do so, given the culture in that environment. We heard some excellent statistics and useful perspectives from my hon. Friend Sir Paul Beresford underscoring the fact that many people in the military suffering from mental health issues do not take their first step towards accessing care until more than a decade—13 years, on average, we are told—after they leave the services.
It is pleasing that progress is being made on the principal recommendations in the “Fighting Fit” report—on increasing the number of mental health professionals conducting outreach work, on the establishment of an online early-intervention service and on a veterans’ information service. That progress is welcome, but much more needs to be done to educate new recruits and personnel throughout their career on the need to be open about their mental health, to admit to it and to seek support from the relevant authorities.
As everyone has said this afternoon, mental health issues do not discriminate by age, background, career or profession. That is the key message that we need to get into every aspect of life in our country. We need to continue to de-stigmatise mental health issues. We need to work for earlier diagnosis and smarter commissioning arrangements, and to invest in preventive measures to ensure that we achieve the maximum benefit to our society—that is, a lower rate of mental illness in the future.
As someone who recently endured the misery of seeing those very close to me suffer when a relative was in and out of mental hospital, I realise that this issue is very painful and difficult to talk about, and I commend those Members who have spoken so openly about their experiences and conditions this afternoon.
Oliver Colvile (Plymouth, Sutton and Devonport, Conservative)
I, too, congratulate my hon. Friends the Members for Loughborough (Nicky Morgan) and for Broxbourne (Mr Walker) on securing this Backbench Business debate in the first place. Indeed, this is an historic moment, for the simple reason that it must be the first time that three former association officers of the Battersea Conservative association have found themselves speaking in the same debate.
Oliver Colvile (Plymouth, Sutton and Devonport, Conservative)
I am sure my hon. Friend is quite right.
I have followed this issue very closely, because in my maiden speech I gave a pledge that I would try to raise the issue of mental health for our veterans during the course of my time in the House of Commons, however short or long that might end up being. I hope very much that I have been good to my word. Only too often when we have had debates on mental health or veterans issues in the House, we have found that it has been the Armed Forces Minister answering, and although he has always done a brilliantly good job of explaining what is going on, the debate has unfortunately never had a joined-up feel about it—for instance, by including Ministers from the Department of Health. That is why I very much welcome this debate.
I congratulate both Mr Jones and my hon. Friend the Member for Broxbourne on their sheer candour in speaking about this issue. If we could capture my hon. Friend’s energy, we would sort out the national grid once and for all.
I recently had a Falklands veteran come to talk to me about how he feels he is being discriminated against in his benefits. That is something we most certainly need
to look at as a House. My interest in this whole matter began in 2000, shortly after I was selected as the candidate in Plymouth, Sutton, when I went out with the people from one of the churches and saw them handing out soup and sandwiches to various people. Plymouth, being a major—indeed, principal—naval port, most certainly has a lot of veterans issues. There was a man on that occasion who had left the Army and was sleeping rough. He had come across real problems because he had taken to drink—he had obviously taken to drugs as well, which was also a very big issue.
Indeed, when my father served in the Navy—he went in as a boy sailor at the age of 14, serving in Dartmouth and subsequently in the second world war—he had the job of picking up the head of a man he was sharing a cabin with and throwing it over the side, into the sea. I think that would most certainly have given me the heebie-jeebies, I can tell you that, although it did not seem to affect him at all.
A number of Members have made a series of points in this debate which I fully agree with. I was going to talk a little bit about the position now, as we commemorate the Falklands war, 30 years on, but my hon. Friend Sir Paul Beresford has already dealt with that. However, we have to recognise that the families are the first people to get to know whether mental health issues are arising and how combat stress affects them. We need to remember that at the time when my father ended up having to deal with these issues, there were no mechanisms in place to look after his mental health or even try to take it forward. As others have said, my hon. Friend Dr Murrison has produced a very good report, which has very much formed the basis of Government policy in this area.
I ended up talking to Mind during the course of the last few days. Alison Seabeck and I are speaking as one, as she made the point that the amount of money devoted to mental health in Plymouth is an issue. It seems that money has been taken away from mental health to be given to those who suffer from physical ailments. I think that we most certainly need to look at that.
Last week, during the jubilee recess, I visited the Glenbourne mental health unit at the Derriford hospital. I was told that it had seen a significant rise in the number of people with mental health issues, especially from the military, and I was told how important it was to ensure that something was done about it.
We must make sure that we adopt a proactive campaign so far as stress and mental illness are concerned, and that we give our support to those organisations that are in the business of delivering it, while also ensuring that we have trained GPs to look after people. The Jesuits have a saying, do they not—“Give me the child until the age of eight, and I will show you the man”? That was very much the issue that my hon. Friend Andrea Leadsom raised in her contribution, for which I was grateful.
Let me finish on a small note. We need significantly more joined-up government between Departments. We should not be talking only about the Ministry of Defence, but about the Department of Health, the Ministry of Justice and the Department for Work and Pensions. If we can do that, we can make real progress.
Nicky Morgan (Loughborough, Conservative)
I am sorry that in the short time available, I will not be able to mention all of the fantastic speeches we have heard this afternoon. We can definitely say that we have considered the motion fully—and we should all be very proud of that achievement.
I shall make a few brief points to draw the issues of the debate together. First, we all agreed that the debate was somewhat overdue and that it was time that mental health was discussed more often in the Chamber. I hope that we have shown the House of Commons at its best. I certainly think we have; I think this is one of the best debates I have attended since I was elected just over two years ago. We were right to hold out for a debate in the main Chamber, which was an important issue.
Secondly, we have shown that Members of Parliament are not immune to mental health experiences. I would like to pay particular tribute to the speeches of Mr Jones and of my hon. Friends the Members for Broxbourne (Mr Walker), for Totnes (Dr Wollaston) and for South Northamptonshire (Andrea Leadsom), who should win an award for bringing the name of Harry Potter into her speech.
We have shown this afternoon why it is so important for my hon. Friend Gavin Barwell to introduce his private Member’s Bill. I am sure that we all wish him well with it and look forward to working with him on a cross-party basis—another significant achievement from today’s debate. I thank both Front-Bench teams for their support for my hon. Friend’s private Member’s Bill.
I think it was the Minister who said that this issue is not about them and us; it is just about us. Mental health affects everybody within society, and it is up to all of us to challenge stigma. Mention was made of media leadership, particularly of the campaign run by the Sunday Express. Mention was also rightly made of the importance of using the right language when we talk about mental health. That is certainly something that I shall take away from this debate.
The point has been made that many different treatments work and that we should respect that. I entirely take the shadow Secretary of State’s point about moving the NHS into the 21st century. His point about the physicality and the separateness of our mental health trusts and buildings was a good one. I had not considered that point before; the right hon. Gentleman was absolutely right.
Heidi Alexander talked about the many challenges faced by local mental health services and those working in them, and her speech perhaps best summed them up. We have also heard concerns about the work capability assessments.
My hon. Friend Oliver Colvile argued that different parts of the Government needed to work more closely together in the sense that a number of different Ministers could have sat on the Front Bench to talk about this issue.
Finally, I want to thank all the speakers, the Backbench Business Committee for securing the debate, everyone who has watched it outside and, as my hon. Friend Dr Lee mentioned, everyone currently working within the mental health system.
Question put and agreed to .
That this House has considered the matter of mental health.