Access to Mental Health Services

Part of the debate – in the House of Commons at 1:33 pm on 10 September 2013.

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Photo of Mike Thornton Mike Thornton Liberal Democrat, Eastleigh 1:33, 10 September 2013

I beg to move,

That leave be given to bring in a Bill to provide for establishing maximum waiting times and establishing standards for access to evidence-based psychological therapies for those with mental health problems;
and for connected purposes.

This Bill is about ensuring that those with mental health issues get access to the treatment they need when they need it. I have always known that mental ill health is a fact of life, but the figures surprise me. One in three families—that is, parents and their children—includes someone who is mentally ill. In people under 65, mental illness accounts for nearly half of all ill health. The economic cost amounts to over £100 billion a year, but the human cost—the suffering—is intangible. Many mental health problems, if untreated, can shatter lives.

Despite the obvious scale of the problem, only in the past few years have mental health issues started to emerge from the shadows of our society. Mental health is often a problem that people feel they need to hide, cover up, or excuse—and for far too long, Governments and society have felt as though they needed to do the same. I therefore welcome recent significant and major advances in the provision of mental health services. One of those is the pioneering IAPT—improving access to psychological therapies—programme, designed significantly to increase the availability of National Institute for Health and Care Excellence-recommended psychological treatments for depression and anxiety disorders. This has been particularly successful and is now in its fifth year, having treated over 1 million people. In addition, the Government’s commitment to embed parity of esteem for mental health in their mental health strategy and in the NHS mandate marks a significant shift in national attitudes to mental health.

However, a major disparity continues to exist regarding access to mental and physical health services in the NHS, and that is what the Bill seeks to address. Astonishingly, it remains the case that people with mental health problems do not have the same rights to timely access to treatment as those with other types of ill health. Despite the fact that the NHS constitution embeds the right to access certain services commissioned by NHS bodies within maximum waiting times, this excludes anyone who is waiting for psychological therapy. That means that at present there is no statutory maximum waiting time for mental health treatment of this type. In contrast, according to the NHS constitution, patients with a physical complaint have the right to be seen within 18 weeks.

There is also a disparity in relation to accessing the right services. The constitution states that

“you have the right to drugs and treatments that have been recommended by NICE for use in the NHS.”

Yet while patients have a right to demand NICE-approved drug and medical treatments for mental health issues, psychological therapies fall under a separate category. That means that patients do not have a right to these treatments—the very treatments that often result in the best long-term outcomes.

What does the status quo mean for my constituents in Eastleigh and people elsewhere with mental health issues? If somebody goes to their doctor seeking support for a mental illness and they are referred for treatment, they could be waiting two weeks, two months or even two years for treatment that sometimes may not be suitable for their condition anyway. In fact, it is entirely possible that they may never receive any effective treatment at all. Put simply, it is appalling; it is a lottery.

Lack of treatment and long waiting times have a huge impact on people’s lives. People are being forced to live with debilitating mental health problems day in, day out. Relationships can break down and many people are forced to take time off from work or give up a job completely. Children with mental health problems, unable to seek appropriate treatment, miss out on months of vital schooling, disrupting not only their education and their social development but their whole future. Perhaps most importantly, early treatment prevents later mental health crises. Rates of detention under the Mental Health Act 1983 are increasing year on year. They currently stand at 42% of all admissions to hospital, suggesting that people are not able to access the early support and treatment that are so vital to prevent major crises later on. One sufferer testified to Mind:

“I had a complete breakdown, was unable to work and was hospitalised. If therapy had been available when I needed it, I believe I could have been helped to manage the illness and not reach the stage where everything fell apart.”

Providing better and more timely access to treatment is not only the right thing to do but makes sound economic sense. The Centre for Mental Health estimates that, as I said, the economic and social costs of mental health problems amount to over £100 billion a year. In comparison, the wider annual UK cost of obesity is £15 billion. Let us take one example, among many, of where savings could be made: depression. Extending NICE-recommended treatments to all those with depression could deliver £1 billion in economic benefits each year, with treatment costs vastly outweighed by higher Government revenues and reduced welfare payments, as well as wider social benefits.

Given the disparity in waiting times and patchy access to services, hon. Members may ask how many of the people diagnosed by their doctor with mental illnesses are languishing on waiting lists waiting to receive treatment. Believe it or not, the answer, quite simply, is that no one knows. Few reliable figures exist for how long people have to wait for psychological therapies, and this further compounds the problem. Indeed, my hon. Friend the Minister of State, Department of Health himself admitted, during the debate on mental health on 16 May this year, that it was

“a bit shocking that we do not know the figures across the country for the number of people waiting and how long they are waiting.”—[Hansard, 16 May 2013; Vol. 563, c. 818.]

Without a mandatory maximum waiting time there is, of course, no consequence for trusts that do not provide timely treatment.

To get a better picture of current provision, it is necessary to turn to anecdotal evidence and estimates from charities that have surveyed those waiting for help. In 2010, a report entitled “We need to talk” was published by a coalition of mental health charities. It found that one in five of those surveyed had been waiting more than a year to receive treatment, and that one in 10 had been waiting more than two years. That is wholly unacceptable. We need better data in order to gain a better understanding of access and outcomes. I therefore urge the Minister to ensure that there is appropriate investment in the welcome mental health intelligence network currently being developed.

Let me emphasise that NICE recommended that psychological therapies are proven to be effective, so there is no basis on which to contest their use. According to experts from the LSE, after undergoing psychological therapies:

“A half of all patients with anxiety conditions will recover, mostly permanently, after ten sessions of treatment on average. And a half of those with depression will recover, with a much diminished risk of relapse.”

Such therapy is literally a lifesaver—a point particularly important with today being World Suicide Prevention Day. I am sure hon. Members will agree that when such effective treatments exist, it is a scandal that they are not consistently available, within a reasonable time, to sufferers of mental illness.

In conclusion, I recognise the immensely valuable work that the my hon. Friend the Minister of State has done, and continues to do, to ensure we work towards parity in this area. He has long argued that we must have access standards in mental health, and I am aware that his Department is starting to look at those issues, specifically through the NHS mandate “Refresh” document, currently out for consultation. I also welcome increased investment for IAPT in the recent comprehensive spending review, which I am sure he fought hard to secure. The Bill would ensure that that momentum is not lost. Over the past 10 years, much has been achieved and we have made enormous strides. However, achieving parity for mental health is a monumental task, and although we have made tremendous progress, the job is far from finished.

If someone is ill, they are ill. Let us remove the artificial, anachronistic and absurd distinction between so-called mental and physical illnesses. I commend this Bill to the House.

Question put and agreed to.

Ordered,

That Mike Thornton, Stephen Gilbert, Simon Wright, Sir Andrew Stunell, Sir Bob Russell, Mrs Annette Brooke, Sarah Teather, Steve Brine, Dr Alan Whitehead, Ian Swales and Paul Burstow present the Bill.

Mike Thornton accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 29 November, and to be printed (Bill 106).