I can inform the House that the amendment has not been selected.
I beg to move,
That this House
believes that mental health should be treated with the same priority as physical health and recognises the importance of promoting good mental health from childhood through to adulthood;
believes that not enough progress has been made in translating this House’s commitment to parity of esteem between mental and physical health into practice;
notes with concern that the King’s Fund has reported widespread evidence of poor-quality care across mental health services, and the latest available figures show a rise in suicide rates and the number of detentions under the Mental Health Act 1983 increasing by 10 per cent in the past year alone;
further notes the delay in the publication of NHS England’s Mental Health Taskforce report;
notes the concerns that have been raised with the Scottish Government regarding the rate of inappropriate admissions of young people to non-specialist facilities for mental health treatment which have increased by 38 per cent since 2011; is concerned by the absence of data on NHS spending on mental health services since 2011-12; opposes the Government’s decision not to enshrine the right to psychological therapies in the NHS Constitution;
and calls on the Government to urgently rectify this systemic inequity in entitlement to treatments, reinstate the annual survey of investment in mental health services and develop and implement in full a new strategy to improve the Government’s cross-departmental response to mental health.
It is a privilege to open this debate as the first shadow Minister for mental health. The fact that we are having this debate is testament to just how seriously the Opposition consider mental health. The issue affects one in four of us every year, yet it has been neglected for far too long. Mental health has come out of the shadows in recent years, and I know that many Members on both sides of the House feel very strongly about this issue. There have been many important steps forward, but talk to anyone with a mental health condition and they will tell you that they still face stigma, prejudice and discrimination. Sadly, there remain many areas in which there has not been the progress for which we had hoped.
Labour Members have deep concerns about our nation’s mental health and the services and support that are available. Three years ago, my Labour colleagues in the House of Lords won the fight to ensure that the Government wrote parity of esteem between mental health and physical health into law. However, the gap between the rhetoric we hear from this Government and the reality for patients on the ground is growing wider.
I am sure Members on both sides of the House have many constituency cases that echo such concerns. In my first few months in this position, I have been struck by the thousands of messages I have received from people up and down the country. They are desperate to see a change in how our society approaches mental health. This strength of feeling is not surprising. On this Government’s watch, there has been an increase in the number of patients who report a poor experience of community mental health care. More patients have to travel hundreds of miles just to get a bed. The number of children being treated on adult wards, which the Mental Health Act 1983 rightly says should not happen, has risen again this year. The number of people becoming so ill that they had to be detained under the Mental Health Acts leapt by 10% in the past year. The level of suicides, particularly among men under the age of 45, has been at its highest since 2001.
Does my hon. Friend share my concern about the scale of the stress—by common agreement, often inappropriate stress—on the police as a consequence of the pressure on emergency mental health services? My local police have advised me that they sometimes spend half a shift with severely mentally ill patients who are queuing for access to acute mental health hospitals. That is bad for the police and bad for the patients, and is a reflection of the terrible pressures on the acute mental health sector.
I thank my hon. Friend for making that very important intervention. There are too many stories of our blue light services—not just the police, but our ambulance and fire services—being under incredible pressure in contending with such issues. I believe that the Government must do more to address that issue.
I am pleased the hon. Lady has called this debate. Does she share my view that yesterday’s report on perinatal mental health makes incredibly disturbing reading? Many women have lost their lives because of the absence of services. We must commit to making sure that every part of the country has good services to ensure people get through such difficult times.
I will come on to the very serious issue of perinatal mental health that the right hon. Gentleman raises. Again, we should all be very concerned about that issue.
I am very concerned that there has been a psychiatry recruitment crisis, with a 94% increase in vacant and unfilled consultant posts. The NHS constitution treats mental health and physical health differently. The Government claim to be increasing mental health budgets, but patients and professionals tell a different story. Ever since Ministers discontinued the annual survey of investment in mental health three years ago, we do not have an accurate picture of spending on mental health in our country.
My hon. Friend is making an important point about the transparency of spending. Last June, I asked the then Health Minister, Norman Lamb, who is in his place, when figures would be published, and he told me that the Government were working with NHS England to provide meaningful data. Last month, Dr Poulter tabled a question for written answer asking when the information would be available. It is still not available. Does my hon. Friend agree that the Government should come clean?
The hon. Lady is of course right that this subject is vital. The Government are working hard on it. Will she join me in welcoming the Government’s promise and commitment to bringing in an extra £600 million for mental health services, as set out in the autumn statement?
My concern partly rests on the fact that, given the cuts we saw during the past five years, we are only returning to the levels of spending on mental health that we had back in 2010. I have asked a number of questions about how the £600 million might be presented, but I am waiting for the answers to see how the Government will allocate that money. I will come on to the pledges that the Government have made and what is actually happening in reality.
I will make a little progress, because I have my speech to get through and I am conscious that many Members on both sides of the House want to contribute to this debate.
We are calling for three things that we believe will make a difference. First and foremost—several interventions have referred to this—we are asking the Government to restore transparency to address the murky picture of mental health funding. Secondly, we are asking Ministers to address the fundamental inequality that currently exists in our NHS constitution. Finally, we are asking the Government to prioritise prevention and to implement a fully cross-departmental plan to prevent mental health problems from developing in the first place.
Does the hon. Lady agree that transparency is known to be a very effective lever for the Government to use to improve quality? Does she welcome the steps taken by the Government to increase transparency in the performance of mental health services?
I do not share the hon. Lady’s view. Just in the last week, I have written down a list of 10 things about which I have asked the Government for figures, but about which I have been told that they do not hold information centrally. Many of the statistics that were available previously are no longer available. The central request we are making today is to restore the transparency, particularly on how much is spent on mental health, which the Government took away in 2011-12. Many Members on both sides of the House would like to know those figures.
My hon. Friend is making a very powerful speech. On prevention, is she as concerned as I am that a recent report by the University of Liverpool has estimated that an additional 590 suicides were associated with the work capability assessment process, a Government policy, between 2010 and 2013?
I am fully aware of the research that my hon. Friend mentions. It was carried out by a number of academics from the University of Liverpool, including one of my constituents. I have studied the research very carefully. It highlights many areas of concern, particularly the changes and reforms made by the Department for Work and Pensions that have had a negative impact. I will address the very point she raises later in my remarks.
Nowhere is this gap between Ministers’ rhetoric and the reality more evident than when we look at investment in our mental health services. Only last year, funding for mental health trusts was cut by 20% more than that for other hospitals. In 2011-12, total investment in mental health dropped for the first time in a decade. Perhaps unsurprisingly, in the same year the Government stopped publishing how much they invest in mental health.
Last year, I had to use freedom of information requests to get to the bottom of how much clinical commissioning groups were allocating to mental health: 67% of those who responded spent less than 10% of their budget on mental health, despite the fact that mental health accounts for 23% of the total burden of disease. This year, the Minister for Community and Social Care promised to do something about this. He said he would ensure that investment in mental health by clinical commissioning groups increased in this financial year in line with the increase in their overall budgets. However, as the Government do not publish a central record of these data, I had to use the Freedom of Information Act to find out for myself. Over the past summer, I found that more than one in three CCGs were not meeting the Government’s expectation. That is just one of many Government pledges on mental health that have not been translated into reality.
The hon. Lady is making an important speech, but may I encourage her to be as bipartisan or as all-party in her approach as possible on this vital issue? It is very good to see the Leader of the Opposition and the Heath Secretary in their places, both of whom have a long-standing interest in this issue. Will the hon. Lady at least accept that the all-party campaign led by Norman Lamb—very substantially assisted by Alastair Campbell, who has some considerable expertise in this area—was successful, beyond the scenes, in persuading the Chancellor to produce an extra £600 million for mental health? All of us will try to ensure that that money is spent well, but let us try to do so with an all-party or bipartisan approach.
I know that the right hon. Gentleman has worked hard on these issues, as have many Members across the House. My job is to hold the Government to account for the promises they have made, and that is what I am endeavouring to do. Where there are opportunities for us to work together we should be keen for that to happen, but the Government have not delivered on their previous pledges. I am keen to know the detail of how that £600 million will be allocated and over what period, and we look forward to that information coming forward.
The spend of clinical commissioning groups is just one pledge on mental health that has not translated into reality, and—unfortunately—another is the commitment to spending £250 million on child and adolescent mental health services this year. In response to a parliamentary question, the Government have admitted that there will be a £77 million shortfall on what they have pledged to spend this year. With those spending promises so far unfulfilled, Labour Members are concerned about the lack of transparency on mental health spending. That is why we are calling on the Government to reinstate the annual survey of investment in mental health services.
It is not only in funding that equality for mental health has yet to be achieved, because a huge disparity remains at the heart of our NHS. The NHS constitution sets out the rights to which patients, the public and staff are entitled, and the pledges that the NHS is committed to achieving. The constitution enshrines our rights to access drugs and other treatments, but it does not extend that right to talking therapies. Recently, the Government consulted on adding a right to psychological therapies to the NHS constitution, but they decided not to include it in its latest version. That decision reinforces the existing bias in the system against mental health, and if the Government are serious about fair access to cost-effective mental health treatment, they must address that fundamental disparity.
I am disappointed with the tribal attacks on the Scottish health service in the motion, and it does not say much for the new politics promised by the Leader of the Opposition. Has the hon. Lady reflected on the situation in Wales—the only part of the UK where the Labour party is in charge—because the Academy of Medical Royal Colleges in Wales, which represents 16 colleges and facilities, said last month that mental health services in my country face significant inequalities? How will the hon. Lady respond to those concerns?
I have heard from my colleagues in Scotland about the challenges that they face with mental health services, and it is right that we should raise that issue during this debate. I have also had the opportunity to meet my colleagues in Wales and see the fantastic work that they are doing. Their pioneering piece of mental health legislation, which came into force in 2012, is the first for any developed country in terms of how it treats mental health, and it ensures that patients have a proper dedicated plan that considers not only their health needs, but their support, personal care, wellbeing, education and training. I look forward to working with my colleagues in Wales and to supporting them in the fantastic work that they are doing.
My hon. Friend made an important point about access to talking therapies. One of the biggest consequences of not having such access is the fact that the only option available to clinicians is medication—often in very inappropriate circumstances—which can lead to people becoming dependent, sometimes for a long period of time. This is not just a minor matter about whether this provision is in the constitution; that lack of access leads to inappropriate intervention that can have a lifelong effect on many people.
I thank my hon. Friend for his important intervention. I am sure that too many of us hear from our constituents about how that sort of experience has been replicated across the country. We know that the number of prescriptions issued for mental health issues has risen exponentially and is into the millions for people who have to access drugs. Sometimes that is because they cannot access talking therapies, which should be of serious concern to us all.
Does the hon. Lady welcome the Government’s commitment to introducing waiting time standards so that patients do not have to wait a long time to get access to a talking therapy? This Government introduced that measure, but the Labour Government did not.
The Labour Government created the services in the first place. In order to introduce a waiting time standard those services have to exist, which was not the case previously. We had to address the chronic underfunding of mental health that existing pre-1997, and we introduced the improving access to psychological therapies programme, of which we are incredibly proud. As things develop, it is right that those waiting time standards come forward. The Labour party had waiting time standards in place for all consultant-led services, which included physical and mental health. I am proud of that fact but disappointed that in too many cases the same equality is not also applied to mental health. If the Government are serious about fair access to cost-effective mental health treatment, they must address that fundamental disparity. That is why we are calling on the Government to commit to ensuring that all patients, regardless of whether they need a drug, a physical health treatment or a psychological therapy, have the same rights.
I hope the hon. Gentleman will forgive me but I will make some progress as I am conscious of time.
Ensuring that people have access to help early on is critical to preventing people from becoming ill, but in recent years, short-sighted cuts to key prevention, early intervention, and community services have been having a devastating impact. When the number of children with a mental health problem who turn up at A and E has doubled in recent years, when one person in prison takes their own life every four days, when a young person who is self-harming is told that because they are not suicidal they do not meet the threshold for help, and when a woman with an eating disorder is turned away from specialist services because her body mass index is not low enough, it is clear that people are not getting the right help early enough.
Too often, mental health problems are ignored, and it is only when they reach crisis point that they receive attention. More and more I hear from mental health professionals across the country that their middle-tier community services, psychologists and counsellors are being stripped out. Apart from the obvious devastating human cost, which impacts on people’s ability to hold down a job, keep a tenancy, pay the mortgage and maintain relationships with partners, friends and family, those decisions will cost our NHS and local authorities more as they struggle to deal with the consequences of serious ill health that could have been prevented. That cost is not insignificant. Recent studies have put the cost of mental ill health to our society at a staggering £105 billion a year. How can the Secretary of State and this Tory Government justify that? Ensuring that people can access support when they need it is an urgent priority, but if we are to ensure that our services are sustainable into the future, we must do much more to prevent people from becoming ill in the first place.
Norman Lamb mentioned perinatal mental health problems, which affect up to 20% of women at some point during pregnancy and/or the year after the birth of their baby. Left untreated, perinatal mental health problems cost our economy £8 billion a year. Is it not appalling that even if those women seek help, they are not always guaranteed the specialist support they need? The number of mother and baby units has dropped since 2010. The Government’s pledge to spend £15 million on perinatal mental health this year was welcome, but as of this month— according to an answer I received to a parliamentary question—the Government have spent just one fifteenth of what they promised. That is a bitter disappointment because intervening early in perinatal mental health does not just help to improve the health and wellbeing of the mothers affected, but it also improves that of their children.
May I take the hon. Lady back to her point about the IAPT programme that was introduced by the previous Labour Government and is an illustration of where both parties have delivered success? It may be good to enshrine psychological therapies in the NHS constitution, but we need to build more capacity in the system to deliver on access standards. This is not something that we can just write into the constitution; we need to increase choice and access to psychological therapies across the country.
I do not think it is an either/or situation; it is about how we do both, and I will come on to that in the rest of my remarks.
We know that 75% of people who have mental health problems in working life first experienced symptoms in childhood or adolescence, yet only about 6% of the mental health budget is spent on child and adolescent mental health services. We need to do more to focus attention on children, young people and, crucially, prevention, and here we must look to our places of learning, our workplaces and our communities. We need schools and colleges that promote good mental health. We need to ensure that all children have access to high-quality social and emotional learning so that they acquire the skills to express how they feel and develop an understanding and awareness of good mental health. We were concerned to read the 2013 Ofsted report on personal, social, health and economic education, which stated that mental health education was often omitted from the curriculum owing to a lack of teacher training. The Government have funded the PSHE Association to publish guidance and lesson plans to support teaching about mental health, but how are the Government ensuring that schools are actually using it?
We need communities that promote good health and wellbeing. Poor housing, fuel poverty and neighbourhood factors, such as overcrowding, feeling unsafe and a lack of access to community facilities, can have a harmful impact on mental health. These, along with abuse, bullying, trauma, deprivation and isolation, are just some of the levers of mental distress in our communities that we must address.
I congratulate my hon. Friend on setting out such a strong case. Does she agree that the pressure on local government over the last few years has had a negative impact on community cohesion in relation to mental health and led to a growth in loneliness and other such things that spawn mental health problems?
My hon. Friend’s intervention brings me neatly on to my next remarks. I am enormously concerned about the impact of the Government’s deep cuts to local authority budgets over the past five years, of the additional £200 million in-year cuts to public health and of the cuts coming further down the line. I am concerned about their impact on our communities and the services that serve them, such as our libraries, drop-in centres, leisure centres, befriending services—my hon. Friend talked about loneliness—children’s centres, which support parents and young children, and citizens advice bureaux, which support people early on. They are the glue that support and keep our communities together, and I am concerned about what might happen over the next few years.
We need a social care system that is integrated with our physical and mental health services, and we will continue to push the Government to address the fragmentation across these systems. Billions have been slashed from social care budgets and the number of people receiving social care support for mental health has fallen by a quarter since 2009-10. This is seriously impacting on mental health trusts’ ability to discharge their patients. I hear that time and again when I visit mental health trusts across the country. They have patients they cannot move out because the social care is not available for them to move into.
We need workplaces that promote a good work-life balance and where mental health is recognised, understood and supported. Some 70 million working days are lost every year owing to stress, depression and other mental health conditions. Mental health problems cost employers in the UK £30 billion a year through lost production, recruitment and absence. As the chief executive of NHS England has rightly pointed out, the NHS has to get its own House in order. Across the health service, staff tell me they are concerned about their wellbeing and that of their colleagues. Longer hours, fewer resources, greater demands and an incredible amount of goodwill are creating a perfect storm within the NHS. The figures from the NHS staff survey show that the proportion of staff reporting work-related stress has increased from 29% in 2010 to 38% in 2014.
In the spirit of bipartisanship touched on by my right hon. Friend Mr Mitchell, will the hon. Lady accept the clear evidence showing a link between good mental health and employment and comment on the number of jobs created over the past five years, which, I have no doubt, has helped to promote good mental health?
I am interested in the hon. Gentleman’s intervention as I am about to talk about employment and unemployment support. I am concerned by the number of constituents coming to see me about the increase in precarious employment and their ability to budget and sustain themselves from week to week.
For those who are unemployed or lose their job because of their condition, the hope of getting back into work under the Government is unjustifiably slim.
The latest statistics reveal that fewer than 9% of people with mental health conditions receiving employment and support allowance have been helped back into work by the Work programme. In fact, 83% of people surveyed by the charity Mind reported that the Work programme had made their mental health condition worse. How can it be right that programmes that are supposed to help people into work are doing the opposite?
These issues alone cover the work of at least five Departments, and it does not stop there: the arts have long played an important role in helping people with mental illness; the Ministry of Justice must do much more on mental health in our prisons; and all front-line professionals, especially those in our police and emergency services, need training and support in how to respond to mental health issues.
I come now to our third and final call: we urge the Government to implement a truly cross-departmental plan to improve their response to mental health issues within our society. “No Health Without Mental Health”, published in 2011, promised to be a cross-Government outcomes strategy for people of all ages, but we are fast approaching its fifth anniversary and progress has been limited. We need a new strategy with teeth that will co-ordinate work across all Departments and set priorities, measure progress and evaluate success. We have been eagerly awaiting NHS England’s taskforce report, which was due to be released his autumn, yet we heard the other week in the Chancellor’s autumn statement that it has been delayed until next year, when the NHS England planning guidance will already have been issued. What influence or impact do the Government hope the report can have if the NHS guidance for the coming year will not take it into account?
In conclusion, mental health matters—in our schools, our workplaces and our communities. It matters to our fulfilment as individuals and to the economic success of our society. There have been important strides forward, which we welcome, but we are also concerned that too much is at risk. We hear too often that our mental health system is in crisis. We are concerned that the right help and support is not there for people when they need it; we are worried that not enough is being done to prevent people from having to turn to these services in the first place; and we are anxious that, in some areas, changes taking effect across Departments are making things worse for our nation’s mental health. Much needs to change, and we are asking for three things that will make a difference. I commend the motion to the House.
I congratulate the shadow Minister on securing this debate. She spoke powerfully about the shortcomings in mental health provision, and although she was reluctant to recognise the progress being made, she deserves credit for having secured her first debate on her new portfolio.
President Obama recently talked of the need to bring mental health out of the shadows, and I would like to start by congratulating hon. Members on both sides of the Chamber on their bravery in doing exactly that. I recognise the bravery of my hon. Friend Mr Walker, who has spoken powerfully about his obsessive compulsive disorder and its impact on his family life; of John Woodcock, who has talked about his treatment for depression; of Mr Jones, who has also spoken bravely about his battle with depression; and of my right hon. Friend Mr Mitchell, who is part of the new cross-party campaign, and who opened up about his mental health challenges during a difficult period in his life.
I also thank my hon. Friend Gavin Barwell for his private Member’s Bill, supported by the Government, that repealed the laws preventing people with mental health conditions from being Members of Parliament, jurors or company directors. I also thank my hon. Friends the Members for Vale of Clwyd (Dr Davies) and for Eastleigh (Mims Davies). I thank Gloria De Piero for her leadership of the all-party group, and I thank Norman Lamb—no one has done more in the House to campaign for mental health. In particular, I would like to recognise the bravery of his son, Archie, who spoke about his mental health challenges. Anyone who saw the joint interview on ITV News will have been extremely moved. I would also like to recognise someone who is not a Member and is not usually praised by Conservative Members: Alastair Campbell is a very powerful advocate for mental health; his bravery and openness is a reminder to us all that depression affects people in all walks of life.
Hon. Members have sent a strong message to the public: when it comes to mental health conditions, you are not alone. One in four adults experiences mental health problems every year. They affect everyone, including our elected representatives. By speaking out, hon. Members send a message to other parliamentarians who may be suffering in silence. Despite the incredible privilege of working in this place, public life can be incredibly stressful. It can destroy not just people’s hopes but their marriages, relationships and families. Being an MP does not make us immune to the pressures that affect everyone. With the support of wonderful campaigning organisations such as Mind, Rethink, the Samaritans and Young Minds, this kind of courage has made a real difference.
In the past couple of years, we have seen huge determination from those on both sides of the House to improve mental health provision. One reason for that is that society’s understanding has improved a huge amount in the past decade. We should celebrate the fact that we know much more than we ever did before about the workings of the brain, the causes, treatment and prevention of mental ill health, and links to other societal issues, such as debt, unemployment and family breakdown. As a result, between 70% and 90% of those treated for serious mental illness see a reduction in their symptoms and an improved quality of life. That percentage is even higher if the illness is caught earlier. The best example is early intervention for psychosis, which can reduce suicide risk from 15% to just 1%.
We should also recognise the progress made on depression. The World Health Organisation describes depression as more disabling than angina, arthritis, asthma or diabetes, but we know it can be treated as successfully as any of them. The BMJ’s research, published today, mentions that talking therapies for moderate and severe depression can be as effective as drugs. Our own programmes of talking therapies have a 50% recovery rate, post-treatment.
I appreciate the way the Secretary of State is addressing this subject. We are all on a journey on this. He will remember that last October we published a document that painted a vision of achieving genuine equality by 2020; that was not rhetoric. Central to that was introducing comprehensive waiting times standards, so that there was a complete equilibrium of rights: the same right to access timely treatment for both physical and mental health problems. Does he remain committed to that absolutely critical principle?
I am committed to that principle. As the right hon. Gentleman knows—we have discussed this many times—access to treatment is vital, but so, too, is the quality of treatment at the start of the process. We need to make sure that we keep a close eye on both. I think it was right to ask Paul Farmer of Mind to lead an independent review of the best way to make progress towards parity of esteem during this new Parliament. I want to wait and see Paul Farmer’s recommendations before we decide how to implement the vision that the right hon. Gentleman played such an important part in developing.
We all know that one Department’s policy can cause pressures on another area. I read today that the Secretary of State for Justice is announcing a reduction in prison sentences, with more people perhaps serving their sentences in the community. I would not necessarily disagree with that, but will there be discussions with the Department of Health about what pressure that would put on community mental health services? Mental health issues, as well as addiction issues, are often behind offenders’ criminal behaviour. I implore him to look at how one Department’s policy will have a knock-on effect on an already pressurised mental health service.
The right hon. Lady makes a very important point. I reassure her that there are very good and close ongoing discussions with the Ministry of Justice. The mental health of the prison population is another area in which we have failed to do as much as we need to. There are so many obvious things that we could do that would be of huge benefit, not just to the individuals concerned, but to the rest of society through reducing reoffending rates. We are absolutely committed to making real, tangible progress on that.
Set against improvements in the potential of mental health treatment are troubling societal changes that increase the demand and need for mental health support. Globally, there has been an 80% increase in those living alone since the turn of the century. In the UK, the percentage of households in which people live alone has risen to nearly a third. For children and young people, there is not just exam pressure and insecurities around body image, but the risks of social media. The Office for National Statistics found a clear association between more time spent on social networking sites and child mental health problems. Children who spend more than three hours a day on social media are twice as likely to suffer poor mental health.
The Secretary of State talks about the pressures on children. One in five children is in need of treatment and is being turned away, including from A&E. There is a real crisis in service provision, with £200 million reduced from the mental health budget. As he reflects on how big a challenge this is, does he not think his Government’s response is completely inadequate? That is not good enough, despite the good efforts being made. He needs to step up and improve the situation, particularly for young people.
I accept that we need to improve the provision of mental health services for children, but I do not accept the hon. Lady’s characterisation. She will know that in the final Budget before the general election, the previous coalition Government committed £1.25 billion over this Parliament to improving child mental health provision and perinatal mental health support. That has been honoured by this Government, and we are in the process of working out how to roll that out. It is something that the Minister for Community and Social Care, my right hon. Friend Alistair Burt, spends a lot of time thinking about.
Before we discuss precisely what things need to happen—I think they should be done in a bipartisan spirit—we should recognise that really important progress has been made in recent years. I want to start with some of the achievements made by the previous Labour Government, who increased funding for the NHS and, within that, for mental health services. They oversaw a significant expansion of the mental health workforce and big improvements in in-patient care, with 70% of mental health patients being seen in private rooms. They increased the use of new drugs and therapies, including psychotherapy. Those were important steps forward.
Under the coalition Government in the previous Parliament, we saw a record investment of £11.7 billion in mental health services at a time of huge pressure on public finances. We passed the parity of esteem clause in the Health and Social Care Act 2012, something we Conservative Members are incredibly proud of. The first access targets were set for talking therapies for psychosis. We are starting to end the distortion that the right hon. Member for North Norfolk talked about, which saw targets for physical health access sucking resources away from local mental health provision over a sustained period.
We have seen particular progress in two areas. It is important to mention them; it provides encouragement that when we decide to focus on improving specific areas of mental health provision, we can make real progress. First, on talking therapies, the NHS is now recognised as a world leader. The number of people getting help from talking therapies quadrupled from 182,000 people starting treatment in 2009-10, to 800,000 starting treatment last year. The total number of people helped in the previous Parliament was 3 million, compared to just 226,000 people helped in the Parliament before that—a thirteenfold increase.
We are hitting the new access target to reach 15% of those needing it, although we are not quite hitting the recovery target; I hope we can put that right soon. That model is being looked at very closely by Scandinavian countries, and a pilot, based on what we have done here, is starting in Stockholm. We can be very proud of that important progress.
The last Parliament saw a 50% increase in dementia diagnosis rates, up from 41% at the start of the Parliament to 67% at the end of the Parliament—the highest dementia diagnosis rate in the world. We have 1.3 million dementia friends and 120 dementia-friendly communities. We have seen a doubling in funding for dementia research, with a new ambition to find a cure or disease-modifying therapy by 2025. In the spending round, the Prime Minister announced funding for a new dementia research institute; that will be another important step forward.
The Secretary of State talks about the amount of money put into dementia research for very good reasons, but is there not a strong argument for building a research and evidence base around mental health? We need a commensurate investment in research on mental health, so that we can understand more about prevalence.
My hon. Friend is absolutely right, and I commend him for the work he does on the all-party group. The truth is that it is still early days when it comes to a proper understanding of mental illness. According to the latest Times Higher Education league table, this country has five of the top 10 health research universities worldwide, so we have a huge contribution to make to that research; he is absolutely right to make that point.
I have already mentioned the 590 suicides associated with the work capability assessment. In addition, the Royal College of Psychiatrists has raised concerns about the cut to the employment and support allowance work-related activity group, given that many of those affected have mental health or behavioural disorders. According to the RCP, there is potential for exacerbating mental health issues and self-harming, and even for people to take their own lives. Will the right hon. Gentleman meet the Secretary of State for Work and Pensions to deal with this matter?
We have close working relations with the Department for Work and Pensions, which I shall come on to explain. I would urge caution, however, on the issue of suicide rates. The BMJ study said that no conclusions could be drawn about cause and effect from it. When it comes to work, we need to remember the many studies that talk about the improved health and wellbeing that comes from being in work, and the tremendous progress made, with 2 million additional jobs created over the last Parliament.
I acknowledge the progress made, but let me tell the Secretary of State that what really winds up people outside this place is the rhetoric-reality gap. When they hear politicians on all sides making grand statements about access to treatment, but the reality is different, it damages the integrity of politics. There are two options for the Secretary of State. The first is using political will at a national level to say to local commissioners that they have to prioritise mental health and close the gap in terms of parity of esteem. The second is to address the fact that commissioners on the ground do not have adequate resources; they have to make impossible choices because sufficient resources are not being made available.
If the hon. Gentleman has listened to what I have been saying, he will know that I have been very honest about the problems and about the gap between what we want to deliver and what we are delivering. I shall come on to talk about some solutions, but it is important that Opposition Members recognise that we have had a real and specific focus on mental health over the last five years, during which very important progress has been made. If we continue to broaden out our focus, we hope we can make progress in other areas as well.
Let me talk openly about where more progress needs to be made. First, we have far too much variation in the quality of services across the country, and opacity about where services are good and where they are unsatisfactory. It is wrong that I, as the person responsible for the health service, cannot tell people in simple terms the relative quality of mental health provision in North Shropshire versus South Shropshire or in Cirencester versus Sheffield. We need to know that. We know from other areas of the health service that once we can be transparent about the variations in care, people will measure themselves against their peers and huge improvement can be made.
My right hon. Friend deserves great praise for not only the content but the tone of his speech. Further to the point made by Mr Lewis, does my right hon. Friend agree that while any gap between reality and rhetoric is to be regretted, what really irritates our constituents is the making of bogus party political points on the subject? I hope that he will ensure that his tone and his content are reflected by his Department. I wish him every success in working with Luciana Berger, who clearly cares deeply about this matter, to ensure that we have an all-party approach to it.
My right hon. Friend is, of course, absolutely right, and I think we do a great disservice to the many people suffering from mental health conditions if we allow this to become a partisan issue. Of course Oppositions must hold Governments to account for their promises, but we should never try to suggest that one side of the House cares more about this issue than the other or that the efforts on one side have somehow been compromised by a lack of interest in or commitment to the issue. It is clear from the number of Members of all parties speaking in today’s debate that the determination to improve mental health provision is shared right across the House.
We urgently need to address other issues, including the increase in eating disorders such as anorexia, which can be a killer. Between 5% and 20% of anorexia sufferers tragically die, and we have to do something urgently about that. We need to deal, too, with the pressures on child and adolescent mental health services, with which all Members will be familiar through their constituency surgeries. Referrals were up 11% last year, and we need to make sure that CAMHS is able to deal with that extra demand, as well as looking at what can be done to improve early intervention so that we reduce the increase in those referrals.
Let me make some progress, and I shall give way later.
We need to look at the use of police cells, which has often been spoken of here. We have seen a 55% reduction in the use of police cells over the last three years, but they were still used 4,000 times last year. Particularly for children, that is totally inappropriate, and it is often inappropriate for adults, too. Out-of-area placements for non-specialist care are another issue, and the Minister for Community and Social Care, my right hon. Friend the Member for North East Bedfordshire is working extremely hard and is committed to implementing a plan to turn this around by March next year.
The Secretary of State talked about cross-party support for action to tackle suicide and related issues. In our debate on assisted dying, there was a lot of support for doing more to tackle the problems of anyone who suggested that they wished to commit suicide. Why, then, does the right hon. Gentleman refuse to acknowledge the impact of benefit cuts and changes in assessment processes, as mentioned by my hon. Friend Debbie Abrahams?
The British Medical Journal was very clear in saying that conclusions about cause and effect should not be drawn, but let me make a broader point about suicide. Suicide rates—under the last coalition Government and the previous Labour Government—have been above and below the 20-year long-term average, but I think they are an important bellwether of the effectiveness of mental health services. I think we should be bold and ask whether we could have a zero suicide ambition. No country in the world has delivered that, and it would require a big rethink of the way we approach mental health services. Nevertheless, I think that we should be bold and ambitious and think in terms of that objective, and then think about all the factors that may contribute to people being in a highly distressed state and unable to get the support that they want.
I thank the Secretary of State. What assessment has he made of the effect of the changes in employment and support allowance, particularly those relating to the work-related activity group, on those who suffer from mental ill health?
We are working very closely with the Department for Work and Pensions to improve mental health provision for people who are looking for work—not just those who are experiencing difficulty in finding work because of stigma and bias among employers, but those who are in work but may fall out of the work force because of a mental health condition.
We cannot do everything, in this area of health provision as in others, but that does not mean that we should not make tangible and measurable progress towards the ambitions that are shared by Members in all parts of the House. The first important step involves funding. The Chancellor delivered a record settlement for the NHS in the recent spending review, confirming a £10 billion real-terms increase in its funding over the course of this Parliament. That is very significant for mental health, because not only will there be a rise in the baseline funding of the clinical commissioning groups that hold local health budgets, but those CCGs are committed to increasing the proportion of their funding that goes into mental health.
I will proceed with my speech for a little longer, if I may.
We are seeing the prospect of very real progress, and we as a Government need to give careful thought to which areas to prioritise. We do not have a monopoly of wisdom in this area, which is why we set up the independent mental health taskforce that is led by Paul Farmer, the chief executive of Mind. We will receive its report early in the new year. It will follow a successful independent report produced by the cancer taskforce, chaired by Harpal Kumar. I think that it is a good way of uniting the Government, Members in all parts of the House, and the mental health campaigning charities, so that we can decide together on the key areas that we want to transform in the coming years.
We are still working on the detailed planning, but we have already announced the provision of £2 billion of additional mental health funding over the course of this Parliament, which will benefit CAMHS, perinatal mental health treatment, the treatment of eating disorders, and talking therapy. Some of that funding is a result of promises made by the coalition Government which we have said we will honour, and some is a result of promises that we ourselves have made.
I agree with the hon. Member for Liverpool, Wavertree that as we increase investment in mental health, we need greater transparency in respect of the way in which that money is spent. I am pleased to say that next June, following consultation with the King’s Fund, there will for the first time be independently assured Ofsted-style ratings that will tell us very simply, CCG area by CCG area, whether mental health provision in the health economy as a whole is outstanding, is good, requires improvement, or is inadequate. As far as I know, ours is the first country in the world to do that. The hospital sector underwent the same process in the wake of mid-Staffs, and, on the basis of that experience, I believe that it will lead to a dramatic reduction in variation and an improvement in care as people are given independent information about how their services compare with those of their peers. That increased transparency will also mean the development of a new mental health data set, which will enable us to collect more and better data and then share them with the House, debate them, and learn what needs to be learnt.
I recognise the thoughtful case that the Secretary of State is making in saying that things are not good enough but they are getting better, but I must say to him—in a non-partisan way—that when it comes to funding, the stories about funding in my area do not match what we are hearing from him today. There is a story on the Manchester Evening News website about a £1.5 million cut in Greater Manchester.
We, as a Government, make commitments and choices in terms of where we want resources to go, and we then have a duty to ensure that they are followed up locally. As we know from our experience of the health service, sometimes—under all Governments—that advice is followed, and sometimes it is not. The introduction of proper independent ratings, area by area, will enable us to expose the areas that are not making the commitment to mental health that they should be making. As has been pointed out many times by Members in all parts of the House, failing to invest what is needed in mental health is a false economy. It stores up problems for accident and emergency departments and for the providers of mental health services, because late intervention means more expensive intervention, and it is of course a very real human tragedy for the individuals concerned.
I believe that we will be able to do that, but I will write to the hon. Lady to clarify exactly what we think we are able to do. I am certainly committed to ensuring that the House is given information about the quality of provision throughout the service, and investment is a factor in determining whether the standard of that provision can be as high as we want it to be.
The hon. Lady rightly spoke of the importance of cross-Government work. We have established an innovative unit with the Department for Work and Pensions, and have set up a series of pilots to help people with mental health conditions to get back to work. We urgently need to do more to reduce the stigma perceived by employers. According to the findings of one survey, up to 40% of employers would avoid hiring someone with a mental health problem. We also want to help those who are at risk of leaving work because of mental health problems. We are working closely with the Department for Education as well. We have launched a pilot programme to create a single point of contact for schools that are concerned about pupils with mental health challenges. It now covers 22 areas and 27 CCGs.
If we are to tackle this issue, however, we need to achieve something that the Government alone—indeed, the House alone—cannot deliver. We need further progress throughout society in reducing that stigma. Bill Clinton once said:
“Mental illness is nothing to be ashamed of, but stigma and bias shame us all.”
Let me end by paying tribute to the Time to Change movement, founded by Mind and Rethink, and the Dementia Friends movement, led by the Alzheimer’s Society. I also pay tribute to Members in all parts of the House who have participated in mental health campaigns, and reassure them that they have the Government’s full support as we try to change attitudes on this vital mission. Someone once said that the greatest cruelty was our casual blindness to the despair of others. Let us resolve today that when it comes to mental health, no one can ever say that about the House of Commons.
I congratulate Luciana Berger on initiating such an important debate. It is a privilege to contribute to it.
I must begin by declaring a professional interest, having worked as a forensic and clinical psychologist for 20 years in the NHS and beyond, specialising in mental health, at consultant level for 10 of those years. I continue to maintain my skills and engagement in line with the professional requirements of my registration with the British Psychological Society and the Health Care Professions Council. Earlier in the year, I had the privilege of contributing to the evidence taken by the Youth Select Committee during its inquiry into child and adolescent mental health services.
I want to say a little about three topics: the adult mental health service and strategy, child and adolescent mental health services, and mental health services for veterans. Mental health is an extremely wide field, ranging from major mental illnesses such as psychosis and depression and anxiety disorders to trauma and eating and adjustment disorders. Developmental disorders such as attention deficit hyperactivity disorder and autistic spectrum disorder are also sometimes included in the sphere of mental health, and I would welcome future debates about those important conditions, because I fear that we shall not have time to do them justice today.
The British Psychological Society has reported that one in four people in the UK will experience a diagnosable mental health problem, with mental health problems accounting for up to 23% of all ill health in the UK and being the largest single cause of disability. In Scotland the figures are currently one in three. Mental disorders are strongly related to risk of suicide, and it should be known that high levels of comorbidity with substance disorder and physical ill health are prevalent.
Mental health services across the UK are not the finished article wherever you go. We are continually striving towards improvement, and that should always be guided by patient need and by research underpinning most effective clinical practice.
When I started practising in the 1990s in Scotland, the funding of mental health services severely lagged behind other areas of NHS funding. That resulted in far too few practitioners and what seemed to be never-ending waiting lists for both patients and clinicians. At the start of my career, patients routinely waited to see psychologists in mental health specialties for six to 12 months, and in some areas for over a year. That was clearly ineffectual, often meaning that problems were exacerbated over time and that a mainly medical model persisted. That is not what patients wanted, nor did it fit with best practice; evidence indicates that patient recovery is improved with access to talking therapies alongside medical management. That is evidenced clearly in National Institute for Health and Care Excellence guidelines.
In 2014, the HEATs—health improvement, efficiency, access targets—were adopted in Scotland and across the UK, meaning that patients should be seen from referral to assessment in 18 weeks. In Scotland in 2014, 81.6% of patients were seen in 18 weeks and the number of people seen was 27% higher than in the same quarter the previous year. Demand is increasing, which is a good thing: it means that we are starting to tackle stigma and that access is improving.
Matched stepped care involving psychological therapies and practitioners at differing levels, depending upon clinical effectiveness of therapy type for different disorders, was rolled out in all boards within NHS Scotland, and NHS Education for Scotland took a primary role in workforce capacity modelling and training. Use of self-guided help has also been developed. Technological advances are important in terms of access for patients in this modern world and in relation to early prevention. Suicide rates have been brought down and the target met of training high levels of front-line staff in suicide prevention and risk identification. Quality ambitions have also been developed as benchmarks in relation to person-centred, safe and effective care.
I fear, however, that demand on mental health services will continue to increase dramatically. Evidence suggests that recession increases mental health problems, including depression, suicidal behaviours and substance abuse. Unemployed individuals, particularly the long-term unemployed, have a higher risk of poor mental health compared with those in employment. Stress is now the most common cause of long-term sick leave in the UK and the more debt an individual has the more likely they are to suffer a mental health problem. A social and policy climate of austerity, affecting the most vulnerable to a greater degree, is a likely aggravator of mental ill health.
I welcome pledges from both the Westminster and Scottish Governments to increase spending on mental health significantly: the figure is £100 million in Scotland. Mental health services, however, have not achieved parity with physical health services over the decades since I started in the field and we need to be clear that much more is needed to fill the gap. I commend Ministers and MPs to visit mental health services and spend quality time with clinicians on the front line. Managerial statistics often occlude a multitude of issues and it is only with that front-line insight that the true patient journey and daily clinical barriers can be identified. Those often include excessive paperwork, repeated reviews and service changes that diminish morale.
Mental health problems in childhood are extremely serious. They can destroy educational potential at worst and impede it when problems are less severe. Difficulties must be assessed and recognised at an early stage. HEATs for child and adolescent mental health services were set at 18 weeks as of December 2014. NHS Scotland data suggested a significant reduction from 1,200 waits of over 26 weeks in 2008. In the quarter ending June 2015, 76.6% of CAMHS patients were seen in 18 weeks and the average wait was nine weeks. In the past two years, there has been a 35% increase in demand due to productive work completed on stigma and in improving access, and since 2009 £16 million has been invested in the CAMHS workforce; it is at its highest ever level. To improve waiting times further, £15 million more has been pledged to CAMHS in Scotland. Widespread staff training has been undertaken in modalities such as cognitive behaviour therapy, family therapy, interpersonal therapy and specialist interventions such as for eating disorders, with a focus on seeing patients as close to home as possible. More progress is required across the UK and in Scotland to meet the 90% target.
I must say that in-patient treatment for children and adolescents should be a last resort. It takes children away from family and pathologises their difficulties. Best practice highlights intensive outreach approaches enabling children to be seen at home and treated in their natural environment, so maximising key family and peer supports. Children who need in-patient services suffer psychosis, intractable eating disorders, severe obsessive compulsive disorder and a variety of neurological conditions and neuro-developmental disorders. Currently there are 48 beds available in Scotland and this year £8 million was pledged to build a unit for children and adolescents with mental health problems in Dundee. My clinical experience suggests a lack of available beds in forensic and in learning disability child and adolescent mental health services. Constituents who have contacted me have also suggested that further work needs to be done to improve access to specialist eating disorder in-patient care outwith the private sector.
Increases in the number of children presenting with self-harm and receiving brief overnight admission have been high. Clinically, this is quite a difficult decision. Often, clinicians are faced with the issue of sending adolescents for a brief stay miles and miles from their home—which makes it difficult for carers and parents to visit them—or admitting them briefly overnight. Surely the optimum treatment would be to see and assess them and to ensure that children are safe and able to go home with the strongest possible package of care as quickly as possible.
I value greatly the contribution from the hon. Lady, who has huge expertise. I get the feeling that there is much medical expertise to come from the paper she may have been citing a lot in her speech. As the Front-Bench spokesman for her party, could she explain whether she thinks the points made in amendment (a) were valuable? In the absence of that, does she support the motion as it stands? How does she urge Members to vote today?
I do not support the motion and how it reflects Scottish Government care. As I have said, for children who have mental health difficulties, clinicians have to make a sensitive judgment regarding the length of potential stay, and whether the problems are intractable and the children should be admitted to a specialist unit, which can often be some miles from their home. Many of cases of self-harm attempts require psychiatric assessment and monitoring, overnight care and monitoring, and then a package of intensive home care to try to reduce the chance of another such incident. I hope that answers the hon. Lady’s question.
Recommendations, however, do have to be made in relation to CAMHS. They include having a wider appreciation of children’s mental health beyond any problems, providing education and awareness in schools, and having access potentially to mental health clinicians in school settings and not just clinics. As with diet and exercise, good mental health should be normalised. Those are all fundamental living skills that impact on all aspects of functioning and deserve more of a health and well-being slant, rather than a pathologising label.
Does my hon. Friend agree that it is invaluable to have these services in schools as that normalises the feelings of low self-esteem that many of these young people are experiencing, and does she also agree that to have counsellors based in the school is very important for young people’s mental health?
Yes, access to such mental health services in schools is certainly merited, as well as mental health awareness and training, and particularly training for staff in schools so they can pick up at a very early stage if someone is experiencing a mental health problem and then try to access services at that very early stage. Specialist training for teachers would be a positive step forward so that they recognise the signs of mental distress in children. We also need to modernise our approaches to mental health for children and adolescents and embrace the IT and social media method of communicating with young people, because that is the modern world and that is often where they communicate from.
There is a project in Scotland called SafeSpot, an application, website and school intervention to promote positive coping skills, safety planning and access to information about mental health services for young people. The project is going very well and the app is freely available on iTunes and in Android stores. The SafeSpot app and website will be used within Greater Glasgow and Clyde health board, and Dundee health board is also looking at access to it. It was designed by a clinician, Dr Fiona Mitchell, specialist registrar in child and adolescent psychiatry, and I commend her on her innovative work in that regard.
There remains a lack of empirical data regarding effective interventions for young people with co-morbidity issues, by which I mean mental health coupled with learning difficulties or substance use, and that requires to be built upon. Looked-after and accommodated children are some of the most severely disadvantaged in terms of services and magnitude of difficulties, particularly those who also may have violence-risk needs or self-harm needs. Further service provision for specialist groups and underpinning research will be crucial.
Given that the weight of evidence for child and adolescent mental health services is in favour of psychological, rather than pharmacological, interventions for the majority of child mental health presentations, clear structures should be in place to support the delivery of effective, evidence-based psychological therapies for children and adolescents. Those from socially disadvantaged backgrounds have always tended to have a poorer uptake of CAMHS. An assertive outreach may be required so that some of the most vulnerable and disadvantaged children and families do not slip through the net.
Specialist service delivery in areas of developmental disorder such as autism, children in the criminal justice system, and children with co-morbidity requires to be thought through and planned, so that those children and their families are able to access facilities without feeling they are being passed from pillar to post. It is extremely difficult for families in particular to access early diagnosis of developmental disorders such as for those with autistic spectrum disorder, which means that their needs can go unmet for years and their attainment may diminish.
I continue to believe that the mental health of veterans is an area that is underfunded across the UK and that those who have been willing to lay down their lives for their country should have consequent health, including mental health, needs prioritised. The Minister agreed a few months ago during my Adjournment debate that much more would be done. I would like to have a statement on what more is being, and will be, done, particularly as we are now in a new conflict and the numbers of those in our armed services who witness or experience trauma will increase.
As a clinician in mental health, I make the following plea to the House. To me, mental health services are beyond party politics and it is crucial we tackle this meaningfully in a cross-party manner that brings about real continued progress on the ground for service users and staff, and that we share best practice across the UK and a “what works” philosophy.
I welcome the announcement of improved access to data, which is also crucial in terms of taking forward and ensuring best practice. I say in conclusion that I sense a real note of collegiality across the House and a will to take this important issue forward. I look forward to fully partaking in that, and my party wishes to see mental health services continue to improve in Scotland, the UK and beyond.
One of the ways in which we can measure how civilised a society we are is how well we deal with our most vulnerable citizens, and there are few groups more vulnerable in our society than those who suffer from mental illness, yet from when I began working in the health service as a doctor back in the early 1980s to right through my time as a Member of Parliament, mental health services have been the Cinderella subject in the national health service. Let us be very frank: we would never accept the level of care in cardiac disease or orthopaedic disease or cancer for our constituents that we are forced to accept in terms of the treatment for mental illness.
There can be few areas where our advocacy role as Members of Parliament is more important than mental health, because the people involved are very often among the least able and least willing to stand up for themselves in the debate about how the NHS cake is going to be divided out.
We have a role, also, in dealing with what the Secretary of State and the Opposition Front Bencher, Luciana Berger, talked about as the last taboo. We do have to make societal changes and we can be instrumental in that, and I pay tribute, as the Secretary of State did, to our colleagues in this House who have used their often painful personal experiences to give colour to our debate and to take this issue forward. In all 23 years that I have been in the House of Commons, I cannot remember an attendance as high as that today for a mental health debate. That is indicative of how far we have come.
I very much welcome the Government changes both in terms of the funding they are proposing and the attitudes that have been fostered in recent years, not least, I have to say, during the coalition Government—it was one of the great achievements of that coalition Government that they put mental health much further up the agenda. I am particularly pleased at the announcement the Secretary of State has made about transparency on clinical commissioning group outcomes, because it is not the spending that we need to see, it is the outcomes. That is the crucial element, and I look forward to the details he will be bringing forward on that.
However many rights we give patients, it is the capacity-constraints that will ultimately determine what those outcomes are, and I want to deal with just two or three of them. The Government’s IAPT—improving access to psychological therapies—programme is a great programme. Getting access to talking therapies is, as Dr Cameron said, extremely important, but I was asked to do a short piece for the “Victoria Derbyshire” programme on the BBC and we looked at the difference between the best and the worst in the provision of talking therapies.
It is unacceptable, in a national health service that is funded from the single basis of taxation, that in some parts of the country 100% of patients are seen within the Government’s target time, whereas at the other end of the scale, in East Cheshire, which is the worst area, only 4.6% of patients are seen within that time. We can accept something of a discrepancy between the best and the worst, but we cannot accept that level of discrepancy in a health service that is supposedly funded on an equal basis across the whole country.
As the hon. Member for Liverpool, Wavertree and others have said, experience suggests that when there is better access to talking therapies, doctors are less likely to prescribe medication, including antidepressants. That is an extremely positive development, because one thing that has worried me about the lack of capacity in mental health services is what I would describe as the medicalisation of unhappiness. Because medical professionals simply do not have the time to talk to patients about the causes of their symptoms, they deal with the symptoms themselves. That is not good medical practice.
The second area that I am concerned about is child and adolescent mental health services. In the 23 years that I have been in the House of Commons, Government after Government of both political persuasions have told us that those services will improve, but I have seen very little sign of it. That matters because about 70% of adult mental health problems will have presented by the age of 17. One would have thought that, knowing that, we would prioritise healthcare early on to minimise the damage that is caused by untreated illness, yet we are still not fulfilling our duty on that front.
The biggest problem we face is that of in-patient capacity. When we debated the closure of the old Victorian asylums, it was very personal for me because I worked in one of those old hospitals. It was genuinely a Dickensian nightmare. There was a great fashion, which was supported right across the House, to move towards care in the community. However, the consequence of not having adequate capacity in the community was that a lot of patients fell through the net. The point has already been made about the large population of those with mental illnesses in our criminal justice system. In effect, we closed one type of inappropriate institution and ended up with patients in a different type of inappropriate institution, and called it progress. That is simply not good enough and we need to do much more to prevent patients who are mentally ill from being incarcerated in our criminal justice system, when they should be treated appropriately for their illness.
We also see patients being put in police cells because there is inadequate capacity in in-patient care. How would we feel if women with breast cancer or diabetic patients were put in police cells because we could not find beds for them? It would be on the front page of every newspaper and lead every news bulletin in our country.
No, I will not.
I would love the money that is being made available for mental health by the Treasury to be ring-fenced in CCGs. If that money is not ring-fenced, it will go elsewhere, for the very reasons I have set out. We need to ensure that the money that is rightly being made available for mental health treatment ends up there and is not siphoned off into areas where the voice for spending is stronger. I would love us to give more support to the wonderful mental health charities out there, such as Marjorie Wallace’s SANE and Mind. All those charities are hugely important.
In closing, I ask the Secretary of State to look at one thing: the incipient crisis of suicide among men in the United Kingdom—a subject that is not hugely talked about. The culture of our society often makes it difficult for men to admit that they are unable to deal with the stresses of life, anxiety and depression. The statistics relating to the worst manifestation of that—suicide—are deeply worrying. British men are three times as likely to die by suicide as British women. Suicide remains the most common cause of death in men under the age of 35. More than a quarter of the 24 to 34-year-old males who die take their own lives, compared with 13% among women. That is a huge national scandal and we need to give priority to it.
Success or failure in dealing with mental illness in the 21st century in the world’s fifth richest country is not just a judgment on the Government or the NHS, but on our society as a whole and on our basic humanity.
I am sorry to have to say, not for the first time in this House over the last few years, that in spite of all the warm reassurances from the Government that our mental health services are getting better, the experience of my constituents as users of the service, people who work in the service and those who manage the service is completely different.
It is extremely welcome that mental health has risen up the political agenda in recent years. I pay tribute to the many people outside and inside this House who, by speaking of their own experiences, have helped to achieve that. However, the higher public profile has not yet translated into delivery on the ground. In my area, the public are still experiencing services being cut and are still having to wait an unacceptably long time for talking therapies and other treatments.
In spite of the repeated warnings about the scandal of people being sent out of area in recent years and the assurances we have received, there was a 23% increase in the number of patients sent out of area last year, taking it up to more than 500. In Devon, which is one of the worst performing parts of the country, 45 patients were forced miles away from their friends and families.
I recently experienced that problem for myself, when the bright and previously happy teenage daughter of a close friend of the family had a crisis. While on the waiting list to receive treatment, her crisis escalated rapidly and she had to be admitted. There were no suitable beds at all in London, where she and her family live. She was first sent to Southampton, only for the unit there to be deemed unsuitable. She was then sent to Manchester.
In my area of Kirklees, some children and adolescents wait up to two years for out-patient talking therapies. Does my right hon. Friend agree that that is appalling and completely unacceptable? Does he also agree that early intervention is very important to ensure that people do not suffer too much in later life?
My hon. Friend is absolutely right. As she clearly articulates, the picture on the ground is very different from the one that is so often painted by the Government.
The House may remember a case that caused headlines a couple of years ago when I raised it in another debate. A 16-year-old girl in Devon was kept in a police cell for two nights because no bed could be found for her anywhere in the country. Her case is not unusual. As we have heard in this debate, more than 6,000 people with mental illnesses were held in police cells last year.
Does my right hon. Friend agree that the provision of tier 4 CAMHS beds is a national commissioning issue? Those beds are commissioned by NHS England, not by the CCGs. I think that that is a problem. The Government need to focus on the nationally commissioned beds. Many young people who have eating disorders get to the stage where they need such beds.
My hon. Friend is absolutely right. I hope that the Minister heard her intervention, because I will leave that bit out of my speech. I was going to raise the ongoing problem of the interface between mental health services for young people and adolescents and those for adults. A lot of people are falling through the gap.
There has been a lot of talk, including from the Government, about parity of esteem, but there is scant evidence of it on the ground at a local level. I ask the Minister to explain when he responds to the debate why, if the Government are serious about parity of esteem, NHS England has removed it from this year’s NHS mandate. That is the important document that the NHS publishes every year to tell local health services what they have to deliver. Why has parity of esteem been removed?
Why are the Government cutting so drastically the funding for public health, which delivers many preventive services, such as alcohol and drug treatments and psychological support for young people in schools, that prevent people from getting ill in the first place, saving money and lives.
As we have heard, after years of falling, the rate of male suicide is on the increase again. Suicide is the main cause of avoidable death among young males.
Would my right hon. Friend like to attend a meeting held by the all-party parliamentary group on suicide and self-harm prevention and the all-party mental health group, at which Dr Robert Colgate will address us on the subject of triaging? By that process, mental health nurses, social workers and GPs can triage a patient for whom they cannot get an immediate appointment and enable appropriate care plans to be put in place while they wait for the next-stage appointment. The meeting is on
I am sure that hon. Members will be grateful for that public invitation in spite of the pressure on their diaries from numerous all-party parliamentary groups.
Yesterday, the Health Select Committee was told that, whereas the vast majority of acute hospital trusts were expecting to run deficits this year—a big increase— the figure for mental health trusts was much lower. We might think that that is a good thing, but the reason that acute trusts are running such big deficits is that they are giving priority to ensuring safe care. So, if far fewer mental health trusts are running deficits, is that because they are simply cutting services? I should be grateful to hear the Minister’s view on the difference between the deficits being run by mental health trusts and those run being by general acute hospital trusts.
I shall close now, because many people want to speak in the debate. There is probably no one here or outside the House who has not been affected, or whose family has not been affected, by mental illness. We have been hearing warm words from the Government for several years about how things will improve. Indeed, we have heard today that they are improving, but that is not the experience of people on the ground. So I hope that, when the Minister responds, he will focus on action and delivery and not just on words.
Several hon. Members rose—
Order. The House will be aware that a great many Members wish to speak, so I will now have to impose a five-minute time limit on Back-Bench speeches.
It is a pleasure to follow Mr Bradshaw. Like him, I want to talk about concerns raised by my constituents. However, I also welcome the £2 billion of extra funding that the Government have put into mental health, and the fact that we have put parity of esteem into law. My right hon. Friend Dr Fox made a powerful case for the need to invest in in-patient capacity. In Worcestershire, I welcome the improvements made in the Holt ward in Newtown hospital, but there is clearly a need for more investment of that kind. It is also essential that we take on the remaining stigma around mental health, and I echo the words of support for brave colleagues who have spoken out on this issue.
Members of the Worcestershire Youth Cabinet have, over the last year, set themselves the challenge of raising awareness of mental health issues, combating stigma and providing better signposting and co-ordination for young people with mental health problems, and I commend their collective effort in this regard. In particular, I commend the passion with which my young constituent, Darian Murray, has spoken out on this issue, and the leadership he has shown in bringing together different groups from around the county.
I agree with my hon. Friend. The way in which young people have spoken out about these issues is very impressive. As in many other areas, perhaps they are showing us the way in relation to taking on that stigma.
In that vein, I also welcome the excellent work done for people with learning difficulties by members of the Worcestershire People’s Parliament. In the hustings they organised during the general election, and in their subsequent campaigns on mental health, they have attracted cross-party support in Worcestershire. Attitudes towards mental illness have changed for the better in recent years, and I hope we will see further progress in the years to come.
I welcome the fact that the Under-Secretary of State for Disabled People, my hon. Friend Justin Tomlinson, has held a reverse jobs fair in his constituency to help people with disabilities of all kinds, but particularly with mental health issues, to find work. I am planning to copy his idea in the new year, and to work with local charities and businesses to promote opportunities for people with mental health and learning difficulties.
I have some concerns about a recent consultation carried out by the Worcestershire Health and Care NHS Trust on vocational centres for mental health. In Worcestershire, we have three such centres providing therapeutic support, re-enablement and support to people who might otherwise have difficulty getting back into work. One of the centres is in my constituency at the Shrub Hill workshop. Another is in the constituency of my hon. Friend Harriett Baldwin at Link Nurseries. The third is in the constituency of my hon. Friend Karen Lumley at Orchard Place. Earlier this year, the trust launched a consultation on the future of those services, saying that the commissioners were reducing their budget by a third and implying that they were considering moving from three centres to two.
Many of my constituents contacted me to express their strong support for Link Nurseries and the Shrub Hill workshop, and a number of people gave examples of how the services had helped them to turn their life around. I have no doubt that my hon. Friends in neighbouring constituencies will have heard similar stories from their constituents. It became apparent that it was not necessarily the best use of resource for the trust to run the centres itself, and that there were many charities doing excellent work in that space that it could commission to do that. My hon. Friend the Member for West Worcestershire has been working with staff and supporters of the very popular service at Link Nurseries to see whether the service could be taken over as a social enterprise by staff, who could continue to deliver the service that has been offered with such success.
That is an approach I would support, and I have written to the trust and spoken to local commissioners to encourage them to explore it. I was pleased to see in an update from the trust today that the matter is under active consideration. It is, however, a matter of great concern that although the initial consultation suggested a move from three centres to two and a greater focus on outreach, the trust’s latest thinking appears to involve closing all three of the centres and replacing them with a single one as part of a hub-and-spoke model. It is small comfort that the proposed single hub would be in my constituency. We all recognise the benefit of having more outreach, but I have to question the whole approach of a consultation that appears to be cutting back on an important service, valued by service users, at a time when demand is apparent and the overall budgets of health commissioners are being increased. I urge the Minister to look into this matter and see whether he can do anything to encourage the commissioners to have another look.
Another aspect of mental health provision in Worcestershire that causes me concern is support for A&E. We piloted 24-hour mental health liaison for the A&E at the Worcestershire Royal hospital, and the acute trust and the health and care trust found it incredibly helpful. At the end of that pilot, both trusts asked for that support to continue. I note that the crisis care concordat calls for people to be given access to support 24 hours a day before crisis point, and to be given urgent and emergency access to mental health care. As the Secretary of State said, it is welcome that, since the concordat, the number of people going through mental health crises who are held in police cells has halved nationally. However, I am afraid that in south Worcestershire, the commissioners decided early in 2014 that the 24-hour cover was to be withdrawn, and replaced with a specialist nurse during the daytime and access to telephone support overnight. The Minister has given a helpful reply to written question on this matter.
My hon. Friend mentions psychiatric liaison in A&E. Does he agree that it is incredibly important for hospitals to have a comprehensive psychiatric liaison service, so that when people go to A&E, there is a specialist capable of giving them the right help?
I wholeheartedly agree with my hon. Friend. The provision of specialist care in those situations is vital.
“at all times as accessible, responsive and high quality as other health emergency services.”
Does this mean that he has the power to mandate that mental health support to A&E services be provided by practitioners, rather than merely through phone support? I urge Ministers to consider the case for all emergency departments, especially those as busy as the one at the Worcester Royal hospital, having 24-hour access to mental health experts.
I draw the Minister’s attention to the case of a constituent who, as a result of the absence of this support early in 2014, went through an acute episode, having left A&E without receiving the help she needed. This involved the calling of multiple police cars and ambulances. That use of the emergency services incurred far greater cost than simply having the support in place would have done. Any savings made from the failure to commission overnight cover would, in my view, be a case of being penny wise and pound foolish. As the Secretary of State said, not investing in mental health can sometimes be a false economy.
Overall, however, I welcome the progress made. I welcome the additional investment, including in my constituency. I hope that the Minister can respond to my concerns.
It is a pleasure to follow Mr Walker. I am very grateful for this debate, as the issue is very close to my heart. It is vital to ensure that everyone has access to the best mental health services. As the Secretary of State pointed out, one in four of us will face some form of mental illness over the next year, but figures from the mental health charity Mind suggest that 75% of those with anxiety or depression get no treatment at all. It is vital that we start taking mental health more seriously, starting with adequate funding and giving mental health the parity with physical health that it deserves.
I wholeheartedly support a protected NHS budget. The most effective treatment of mental health issues, however, is seen at local level in communities. A protected budget means little when funding to mental health services at local level is being slashed. Those in need reach first for their local services, yet the scale of cuts, particularly to local councils, is having a direct and detrimental effect on services that are crucial to helping many people deal with their mental health problems.
The Royal College of Psychiatrists states that a key part of mental health services is good public health funding, yet only 1% of public health spending is focused on mental health. That will be compounded by the fact that the money given to councils for public health will fall by 3.9%, year on year; that will be an 18% fall by the end of this Parliament. If we are committed to ensuring parity of esteem between mental and physical health, that is simply not good enough.
My hon. Friend may be aware that last year the all-party group on suicide and self-harm prevention conducted a survey of local authorities to see how many had suicide prevention plans and suicide action groups in place. A large proportion did not have any action plan or any groups working on suicide prevention. Is that not something the Government must address if we are to move forward?
My hon. Friend makes a really important intervention on an issue that I was not aware of. The Government should impress on local areas the need to ensure that those things are put in place.
I want to discuss suicide. I pay tribute to Dr Fox, who is no longer in his place, for making an excellent speech, not least as regards suicide. It is a particularly important issue in Rochdale, where suicide rates continue to remain above the national average. In our town, the rate is 11.8 per 100,000 people per year; that compares with a rate of 8.9 per 100,000 for England as a whole. The male suicide rate in Rochdale is 18.6 per 100,000, which dwarfs the 14.1 per 100,000 for England as a whole. Those figures show a large rise from 2010, when they were 14.7 in Rochdale and 13.3 in England. Put simply, more people are killing themselves in Rochdale.
Our council, like many others up and down the country, is faced with daunting cuts to its budget. The result in Rochdale is that the council is considering removing funding to the tune of just £20,000 for the award-winning Growth Project. This project works to provide a safe and supportive haven to those with mental health issues on a number of allotments. The work done by the Growth Project has a proven track record of improving individuals’ wellbeing. It promotes good mental and physical health through outdoor activity in a green environment, and participants can literally see the fruits of their labour. To date, the project has 88 beneficiaries, and it embodies the essence of equality for mental and physical health. Although the project is run by a voluntary organisation, fighting mental health issues must not be seen as an act of charity; it is about justice and necessity.
If we are truly to achieve parity of esteem for mental and physical health, it is exactly projects such as the Growth Project in my constituency that will need funding. They do not need to be cut because of pressure on council budgets.
It is a pleasure to follow the thoughtful speech made by Simon Danczuk. The issue of mental health is such an important one, and it cannot and should not be swept under the carpet any longer. I pay particular tribute to Norman Lamb for his work in this place during the last Parliament—he has definitely left a legacy.
How people talk about the issue of mental health is similar to how we spoke about cancer a few years ago. People did not talk about cancer because they hoped it would go away. Similarly, people have not been talking about mental health—they were hoping it would go away, but it has not done. Mental health, sadly, is not going away and the sooner that is recognised, the better. Putting mental health on a level playing field with physical health means that people are now talking about it. The issue of mental health and its impact has recently been recognised by an important group of young people. For the past seven years, Girlguiding UK has carried out a girls attitude survey, which canvasses the opinions of more than 1,500 girls and young women between the ages of seven and 21. As year-on-year surveys can be compared, it is interesting to note that five years ago the area of most concern to those surveyed was alcohol and drug abuse, whereas in the 2015 survey, published in early October, today’s cohort of girls and young women has changed that to mental health. I stress that those surveyed were not just girl guides, but a much wider audience of young ladies and girls across the country. That gives the survey validity and it needs to be taken seriously. What was concerning was that the survey showed a mismatch between what concerns young people and what parents think concerns young people. The girls taking the survey feel that their parents are worried about what they perceive as traditional risks such as smoking, drug and alcohol use and unplanned pregnancy, whereas their own top concerns are mental health and cyber-bullying. As we heard from my hon. Friend Mr Walker, those young people are definitely not sweeping the issue under the carpet.
Further information coming out of the survey indicated that fewer than half the girls surveyed have talked about mental health in lessons at school, despite the majority saying that that is where they would most like to get information about it. In my short time as a Member of Parliament, I have had a number of cases in my advice surgery relating to mental health issues in young people, and this problem is not going away. Headteachers at my local schools have also highlighted to me the problem of mental health issues starting at a very young age. That is why I am planning in the new year to convene a round-table meeting with headteachers, the police, the local clinical commissioning group, charities and other interested parties. I want to find out what more can be done locally and what more should be done to help prevent mental health issues from arising, and I want to see whether there are any grass-roots solutions to the existing problems.
As constituency MPs, we have our own role to play. People turn to us for help on a daily basis, often as a last resort. Their issues vary, with some easier to resolve than others, but these issues can all cause a great deal of stress and pressure, which in turn mounts up and can be, for want of a better phrase, the straw that breaks the camel’s back. We may not have all the answers or be able to secure the right outcome for every constituent, but often we are the only people fighting their corner and we should do everything in our power to avoid situations deteriorating to such an extent that they could have a significant impact on a constituent’s mental health. At this point, I wish to take the opportunity to pay tribute to all our casework staff, who go above and beyond for local residents on our behalf, often with little recognition of their efforts.
Mental health is not exclusively a health issue. It crosses so many boundaries, including education, employability and family life—the list goes on, as we have heard from other hon. Members. Today’s debate, yet again, has served to keep mental health high on the political agenda. But along with the words, we must continue to take action, and I commend the Government on the work they are doing to ensure that we do have that action.
I welcome today’s debate. We are doing a very simple thing today, but it is very effective: we are again talking about mental health in this Chamber. Both the Secretary of State and my hon. Friend Luciana Berger talked about a change in attitudes and said that things are changing. I agree totally that things are changing for the better, not just in this place, but in the media and in society. Sadly, in my own party there are some parts that still need to go a bit further in understanding mental health, but we are making great strides and they should be recognised. That is down to the great work that is being done by Rethink, Time to Change and other charities, which are not only those individuals who work for those organisations, but the thousands of volunteers behind them.
I thank the hon. Lady for her intervention. I have a simple view on mental health, which is that we need to talk about it more, because that will change attitudes.
What do we do next? Well, we need to hardwire mental health and mental well-being into public policy and society. To those who ask why that is important, I say that not only is it the right thing to do, but, even in these times of austerity, it makes economic sense. It saves money as well as lives. We need a system in which every single Government policy is road-tested against mental health and mental well-being.
The Secretary of State accused my hon. Friend Luciana Berger of being political on this matter. Well, I am sorry, but the Government cannot escape from some of the things that they are doing in this area. It is the Opposition’s job not only to question the statements they make, but to look at the facts. The Chancellor announced an investment of £600 million in talking therapies, which I welcome, but that is set against a cut of almost 8.5% in the previous Parliament. The money will do nothing to replace the beds that have been lost in psychiatric wards. As Norman Lamb has said, there are people who have to travel ridiculous distances around the country to access those beds. What is the root cause of that? Is it a shortage of beds? Yes, it is in some areas, but another root cause, particularly in London, is the shortage of available housing. Our housing policy has a direct effect on the problem.
Another area of concern relates to the back-to-work interviews and the work capability assessments. My hon. Friends and I have raised that matter on numerous occasions, but the Department for Work and Pensions is not listening. People are still being put through that tortuous process, which is neither good for the taxpayer nor good for the individuals concerned. A 56% cut in the local government budget will have a direct effect on the delivery of mental health and support services. At the moment, a consultation exercise is out on the formula for allocation of public health funding. On that basis, County Durham will lose £20 million a year.
People might say that all those policies have nothing to do with mental health, but they do have a direct impact on the services that we deliver. We need to hardwire mental health and mental well-being into all those areas, whether it be schools, society, the family or the criminal justice system.
Many issues face people with mental illness. Personally, I have been to some very dark places, but the most tragic and darkest place is faced by those who commit suicide. We are talking about not just a life being cut short, and the opportunities that are missed in terms of the fulfilment that that person could give both to society and their families, but families being left bereft and in a very emotional state. In this country, three times more people commit suicide every year than are killed on the roads. We had a great road safety campaign, which addressed the problem of people being killed on our roads. We need the same campaigning zeal to attack the suicide rates in this country.
My own region in the north-east has an unenviable suicide record. We have the highest rate of suicides in the country, with 13.8% per 100,000 individuals taking their lives. Such rates are related to the economic situation. People may try to gloss over that fact, but economic situations do affect people’s lives. We must also address the fact that 78% of that figure are men. Men are terrible at talking about mental health. So, yes, progress is being made, but we do need to have mental health and mental well-being running through all Government policies.
I welcome the debate today, because it provides us with another opportunity to talk about mental health on the Floor of the House, which must be a good thing. Now is the time to change those words into action.
Several hon. Members rose—
Order. We have less than an hour for Back-Bench contributions in this debate, so I will have to reduce the time limit to three minutes, which makes life a little difficult for Mr Julian Sturdy.
I will focus my brief contribution on the mental health services in York and in my constituency.
The Minister is aware that Bootham Park hospital, a mental healthcare facility in York, closed on
The facility had been part of the Leeds and York Partnership NHS Trust, and concerns had been raised about it since 2013, when the CQC inspection declared that the hospital did not meet the required safety standards.
Although improvements were made at a cost of £1.7 million, the CQC visited again and expressed its continued concerns about the safety of some of the wards. As a consequence, significant improvements were called for in January, and the money was made available. However, when the inspectors returned nine months later, in September, no improvements had been delivered. No one denies that there were problems with the facility due to its structure and age. I visited the hospital and saw for myself the problems that were raised by the CQC.
The trust had nine months to rectify those well-known and well-documented problems, yet it did nothing, which led to this important facility being closed, with staff and patients being given just five days’ notice, which is unprecedented and which caused an immense amount of stress and anxiety for patients, families and the hard-working staff.
Things were further complicated when the Vale of York clinical commissioning group chose to transfer York’s mental health services from the Leeds and York NHS Trust to the Tees, Esk and Wear Valley NHS Trust. That was due to allegations that a disproportionate amount of funding was being allocated to Leeds, with York missing out. Was that because Leeds had been prioritised over York? Well, Leeds and York NHS Trust has many questions to answer, and I wish to know who will bring it to account over a situation that never should have arisen. There were plenty of opportunities to solve the problem and the trust had enough warnings. Sadly, action was not taken and the facility was closed.
Finally, in this very brief contribution, let me say that, in the long term, we hope to see a new purpose-built facility in York. From my meeting with the Minister, I know that he feels the same way, and I am confident that he will deliver it, but I want to hear him say it today. We also must deliver parity of esteem across the board, because, at the moment, York is not getting that parity of esteem.
Let me say at the outset that I strongly support the motion and I think the whole House should unite behind it. Although Members may disagree with aspects of the motion, it is really important that we send out a united message that we are all agreed on the imperative of achieving equality for mental health. Self-evidently, we still have a long way to go, and we should be impatient for change.
The sentiments in the motion were at the heart of the cross-party campaign that I launched with Alastair Campbell and Mr Mitchell. We managed to get more than 200 leaders from across society to come together to make the united case for equality for mental health and for extra investment. Why is it that so many leaders agreed to join that cause? Is it because there is now a growing recognition that we must end this absolute historic injustice and ensure equal access to treatment?
I commend the right hon. Gentleman for his work. Does he agree that those leaders now need to translate that action into policy, both at a national and a local level?
I totally agree. We have to set the framework, put the funding in place and deliver services on a local basis. How can anyone in this Chamber possibly justify this: if someone has suspected cancer, they have a right to an appointment with a specialist within two weeks of referral by their GP, but a youngster with an eating disorder has no such right, yet we know that their condition can kill? That is a scandal and an outrage and it must change. There must be equality of access.
When someone does get access to treatment, too often it is a lottery. As we discussed last Friday, we have the continuing scandal—Mr Jones referred to this earlier—of people being shunted around the country in search of a bed. That would never happen to someone suffering from a stroke or a heart condition. It is inequality of access to treatment, and it is a complete scandal.
There is an issue with the number of beds, but does the right hon. Gentleman also accept that one of the problems is that people are in those beds for far too long? One of the crisis points in London is access to adequate housing so that people can be discharged into the community.
I was so pleased that the hon. Gentleman made that point in his speech, and I pay tribute to him for the work he has done. The answer is not simply to have more beds; we should also be reducing the length of stay, which often is not therapeutic for the individual. Getting them into secure housing is central to their health and wellbeing.
I am afraid that I cannot give way, as I have very limited time.
At the heart of that inequality is the stigma that still attaches to mental health. We have made real progress in combating that stigma, but we have a way to go. My message to the Government is that the inequality of access is morally wrong. We cannot begin to justify one person not getting access in the way that somebody else does in our publicly funded NHS. I am pleased that the Secretary of State has acknowledged that that is a scandal, but the Government now have to deliver that equality of access. We have to deliver by 2020 the vision that he and I set out last October.
That inequality of access is not only morally wrong, but economically stupid, as many Members have mentioned. The Centre for Mental Health reckons that neglecting mental ill health costs us about £105 billion a year, so continuing to neglect it is stupid and completely counterproductive. If we make the investment up front, we will achieve savings further down the track. I therefore welcome the £600 million that the Chancellor indicated in the spending review would be made available over this Parliament for mental health. That is real progress, but it is not enough. We have to keep arguing the case for genuine equality.
We need to do two things. First, we need to spend the money differently. Many hon. Members have made the point that we need to shift resources away from containing people, often in long-stay, secure settings, to early intervention, recovery and ensuring that there is proper crisis support in the community to stop hospital admissions, which can be so damaging to someone’s wellbeing.
Secondly, up-front investment is needed to fund a programme for comprehensive maximum waiting time standards, including for children and young people, so that there is a complete equilibrium, with equal rights of access to treatment. We published that vision last year, and I hope that the Secretary of State will deliver it. If we give up on the right of equal access, if we give up on ending that discrimination at the heart of our NHS, and if we do not end this historic injustice, we will let down countless families across the country, and that would be an utter disgrace.
I thank Luciana Berger for bringing forward this debate. I truly believe that mental health is the social challenge of our generation. Suicide is now the biggest killer of young men under 50 in Britain. Today, 17 of our fellow men and women in this country will take their own lives. This year, thus far, has seen the greatest number of male suicides ever. Suicide kills more young people than any physical illness.
I am currently trying to visit every school in my constituency before the end of the academic year, and the teachers I speak with have been genuinely struck by the dramatic increase in mental health problems in our young people, even since I left school some 15 years ago. With all those statistics, there is also the classic issue of underreporting of mental health conditions, given the stigma surrounding the whole issue, so the real extent may, if anything, be worse.
I believe that how we deal with this challenge will define the future of communities such as mine in Plymouth. I genuinely believe that our approach to mental health is that important. I am determined to win that battle for those in Plymouth who do not have the strength to fight for it themselves. What do we do? It requires a genuine shift in our attitudes—that most difficult of changes to achieve—and a cultural change in how we view and consequently deal with mental ill health.
As the Secretary of State suggested, interventions in mental health can produce the most brilliant results, whether it is the inspirational staff at Marine Academy Plymouth making talking about mental health a part of the school day; South West Trains employing staff specifically to look out for people on the network who are in that 10 to 15-second trance before they throw themselves in front of an oncoming train; or the Royal Marines in Plymouth taking responsibility to talk about mental health away from the medical chain and putting it with the main chain of command in order to totally de-stigmatise talking about post-traumatic stress and other prevalent mental health conditions in young men.
In any of those examples, early intervention and talking about mental health can have dramatic effects, but even that is not enough on its own, and that is the nub of the problem. The interventions that really work are early interventions, so last weekend I started an executive mental health group in Plymouth to determine a way of producing a project similar to one running in Trieste in Italy. Now, city council chiefs, commissioning group heads, police chiefs and healthcare providers will get together every month in the local police station until we have a 24/7 mental health capability in Plymouth to match our 24/7 capability for dealing with physical healthcare.
My hon. Friend is making a brilliant speech. Does he agree that local commissioning group spending should reflect commitments made at a national level on parity of esteem for mental and physical health?
I completely agree, and I draw my hon. Friend’s attention to the comment made by our right hon. Friend Dr Fox on how important it is to ensure that CCGs ring-fence the funding so that we get the parity of esteem that I am trying to establish in Plymouth, and which I know the Government are committed to establishing across the country. It might take five months or five years in Plymouth, but I and the others will keep going until we get there, because this problem is actually too big to fail at.
We must be the Government who turn the corner on this. If we are to be so—rightly—fixated on a healthy economy to deliver our manifesto pledges, we must be equally as committed to our less high-profile commitments to those who will not make as much noise if we fail but whose need is of equal, if not greater, importance.
I want to make some brief remarks in support of the motion and, just as importantly, to welcome the opportunity to talk about this issue. I do so as someone who, like many Members of this House, and many millions of people across the country, has had my life affected by mental ill health. I grew up in a home where a very close family member suffered from severe depression and had a number of breakdowns. I experienced how it affected the whole family over many years, and not just individual suffering, but the effect on everyday family life of regular hospitalisation and the need for other family members to be home carers. Like most of us probably, I have a number of friends who have been affected by mental ill health, and some years ago a close friend committed suicide as a result of her depression.
I have my own personal experience of mental ill health. Like other Members of the House—I think that there are probably a number of us—I have suffered from depression. As a result of these depressive episodes, I know how it feels to be unable to function normally, or to perform even the most basic everyday tasks, because the weight of the depression is so overwhelming. I know how debilitating depression and other mental ill health can be. It is quite difficult to explain to people who have not experienced that just how debilitating it can be.
I am really heartened that mental health is increasingly being not only recognised, but acknowledged and spoken about. People increasingly accept that it is an illness that should be without stigma or taboo. The more that mental health is discussed, the clearer it becomes that it is something that affects people in huge numbers from all walks of life, all backgrounds and all ages. More and more I think my experience is not unusual.
As a councillor for many years before coming to this House in May, I noticed an increase over the years in the number of people coming to advice surgeries with serious mental health problems. Most of us will have stories about how constituents with mental health problems have been failed by the system. We need to treat those people with more sensitivity and understanding. It is the right thing to do not only for the individual, but for society and the economy.
With regard to addressing constituents’ needs, the hon. Gentleman might have seen that I have a private Member’s Bill on perinatal mental healthcare. The aim is that mothers should be able to get that healthcare at that most vulnerable time within a reasonable distance from home—75 miles—because at the moment we have a postcode lottery on where they can get it.
That is a very important issue, and I thank the hon. Gentleman for bringing forward his private Member’s Bill.
A person recently came to my surgery who had some very difficult personal circumstances that left them unable to work due to mental health issues. They were told by an official at the jobcentre that in order to maintain their benefits they were required to take part in telephone counselling, without reference to their GP. That turned out to be an extremely detrimental experience. It brought up episodes from the past that meant that my constituent was set back in their recovery and is now even further away from the ability to regain confidence and rejoin the workforce.
Because of my personal experience, I understand how depressive illness can blight the life of an individual, but it blights our society too. It is difficult to measure the cost of mental ill health to society, but it clearly runs into several billion pounds each year. That is why cuts to mental health services, particularly preventive services, are a false economy, as the Secretary of State acknowledged in his very good words earlier. We are all seeing the effects of the cuts to social care budgets, to wider council support budgets, and to mental health trust budgets. That is a bad thing at a time when demand is growing and we can finally acknowledge the need for concerted action to tackle this issue, and that is why I am supporting this motion.
I have experienced how medication and physical treatment can make a difference—medication worked for me—but I know that psychological therapy can also make a big difference. It is illogical that the right to one of those can be enshrined in the NHS constitution but not the other. We are making progress on parity of esteem, as I think we can all acknowledge across the House. We now need to go beyond that ambition and that rhetoric and match it with action.
I congratulate colleagues on their contributions and welcome familiar faces from past mental health debates.
This is obviously a massive subject, and it is impossible to cover it in three minutes. I am struck by the number of different specialties and different problems within mental health that have already been touched on, be it addiction, dementia, depression, stress-related illness, or eating disorders in the young—the list goes on and on. Sadly, all these things are increasing in frequency.
Next week and over Christmas, I will be working as a doctor, and I can guarantee that I will be seeing people with mental health problems during that period. We have talked a lot about service provision; in fact, I think that every contribution so far has dealt with that.
We might want to reflect on our society and ask ourselves the difficult questions as to why we are seeing an increase in depression, stress-related illness, eating disorders and the like. I would say that it reflects what is sick in our society. There are the drivers towards excess consumption that we can afford neither financially nor physically. There is the breakdown of the family, with people not taking their parental responsibilities as seriously as they should on every occasion. There is the retreat of the Church, to be replaced by what, exactly? I am not sure that anything has come forward to replace the Church in providing from within communities and not necessarily from government a community hub and support for people in distress. We should all reflect on that. We should spend a few weeks or a few months thinking about it, and ask ourselves how we can pass legislation here, how we can perhaps lead different lives as role models, and how we can encourage people to seek a life that is better in terms of the quality of life and also physical and mental health.
I want to mention something specifically with regard to forensic psychiatry. My constituency is proud to host the pre-eminent high-security hospital, Broadmoor. Broadmoor hospital is widely renowned internationally. It is being redeveloped over the next few years. This redevelopment was based on a Care Quality Commission report commissioned under the previous Labour Government, and the decision was made by the coalition Government. It provides £250 million for 210 to 220 new beds and is designed around new clinical models. Broadmoor is not a prison, but if its recidivism rate was replicated across the prison service, we would all be extremely happy. Its 420 nurses and 12 consultants do remarkably good work. It is challenging work dealing with some very difficult cases—the type of cases we see in our newspapers. I am very proud that that hospital is based in my constituency, and I am particularly proud of a society that places such emphasis on treating people as patients, not as criminals.
I, too, want to talk about Bootham Park hospital, which closed suddenly, in just under four working days. We must remember the impact that that closure had on patients—the confusion, the fear and the anger, with some withdrawing and some wanting to die. We must also sing the praises of the professionalism of the staff in dealing with it. However, the closure was avoidable. There were too many people involved in decision making—commissioners; providers; Historic England; Prop Co, the owner of the buildings; and others. That is one of the failings in what happened at Bootham. With the change of provider, politics and blame ensued, and that must be investigated, because it had an impact. We must also look at the role of the CQC, which has acknowledged that its role in having to inspect the building before registering it with the new provider had an impact on patient safety.
It is therefore absolutely vital that we have an independent inquiry, as I, and 8,000 people in my constituency, have requested. I want the Minister to say that we can have that public inquiry, which is needed to ensure patient safety for the future. It might be an embarrassing situation, but we have to push on to make the service safe. Patients were scattered across our city for their out-patient appointments, and scattered across our region, travelling miles in a crisis. That is unacceptable.
It is not only essential that we have answers on what happened at Bootham Park hospital, but that we look back at the Health and Social Care Act 2012, which lies at the heart of the problem. Because of it, there is nobody with overarching responsibility for patient safety in the NHS. Different jurisdictions and different regulators have different responsibilities, and there are no mechanisms for responding to such situations. There is also the role of the Secretary of State in now having a duty to promote the NHS, and no longer to provide and secure it. That has an impact, because people can point a finger but do not have to lift a finger. We need to look at that, and also at the role of the CQC.
My second plea is that we have clarity about a replacement for Bootham Park hospital. When the Chancellor gave the autumn statement, he said that three new hospitals would come to fruition, but one for York was not mentioned. Was that because mental health is not getting parity of status, or because we are not getting a hospital? We need that clarity today. I trust that we will start to have some answers on those two points—the need for an independent inquiry and a new hospital.
If I may, Madam Deputy Speaker, I would like to ask you to cast your mind back to the summer. As a new MP, I was sitting on the grass on a Sunday reading through my casework. There were many of the usual items of correspondence on housing, planning and so on, and then a letter, and a moment I will never forget. It was from a constituent, Steve Mallen, telling me about the tragic suicide of his 18-year-old son—a brilliant, gifted young man with grade 8 piano, straight A*s at A-level, and a place reserved at Cambridge University. Ten months ago today, Edward Mallen took his own life in front of a train. “Mental health”—they are not dirty words. We all have a state of mental health, just as we all have a state of physical health. We have good days and we have bad days. We all have them, every one of us. For most of us, the good days follow the bad days and overcome them, but tragically this did not happen for Edward.
Today I want to talk about what we in this Chamber can do to make sure that there are no more Edwards. Members will know that I want this House to work together to resolve problems, not to point fingers at failure. So I urge those in all parts of the House to recognise the good work that has been done so far and to commit, from this day, to working together to achieve more. I believe that we are building on the foundations laid by the tremendous work of Norman Lamb and the Health and Social Care Act 2012. We have seen investment of £1.25 billion to help deliver the Future in Mind Initiative, the appointment of Sam Gyimah, and the appointment of Natasha Devon as the Department for
Education’s first schools mental health champion—and boy, what a fireball she is! Only this week, we had the announcement of a £3 million pilot programme to support mental health leaders in schools across the country. Given that 10% of children under 16 have a clinically diagnosable mental health problem, and 75% of all mental illness predates higher education, we are focusing on the right things.
Prevention is far better than a cure, because by the time a cure comes, families, communities and the wider economy have been devastated. Ask Steve Mallen, his family and the village of Meldreth, because they know. We could argue all day about whether the Government are spending enough on the cure, but I do not want us to do that.
The hon. Lady is making a passionate case, particularly in relation to the tragic case of her constituent. Does she agree that we need to get the whole of the NHS to sign up to a commitment to a zero suicide ambition? That is not about setting a target, but about changing the culture so that everyone focuses on saving lives.
That is fundamental and there should be no alternative. The right hon. Gentleman is absolutely right.
Nobody doubts the need to improve mental health care or the fact that money does not grow on trees. Investment is increasing, but I fear that the scale of the problem is far greater than any Government chequebook. It is so much bigger than that, but the good news is that we are capable of being bigger than that, too. Let us cast aside party politics and make this our issue, not just the Government’s issue.
In South Cambridgeshire, we are pooling together the resources of schools, world-leading academics, mental health charities, business, local authorities, politicians and parents—everyone—to do things differently. With Steve and the memory of his son, Edward, at the helm, we want to roll out a timetabled early intervention and prevention programme in every single one of our schools. We are trialling and developing it, and in March next year we will launch it at an international conference in Cambridge, which Alistair Burt has kindly committed to attend.
Order. The hon. Lady must refer to Members by their constituency name. Twice now she has referred to people by their names. It is simply not done in this Chamber.
Forgive me, Madam Deputy Speaker—I was genuinely unaware of that.
I have no doubt of the personal dedication of our Ministers, for they have proved it to me and, more importantly, to Steve Mallen. If Members are undertaking similar work in their constituencies, or if they want to join our project, I urge them to talk to me. If we have learned one thing about mental health, it is that we need to talk about it. The answer is simply not about cash; it is about partnership working, and I urge every Member of this House to join in this fight together. Let us take the responsibility.
Several hon. Members rose—
Order. If hon. Members wish to be kind to their fellow Members, they will now take three minutes or less and no interventions. If that does not happen, several people will not get to speak at all. It is up to Members how they wish to behave.
In Salford and Eccles, we know only too well about the urgent need to provide better mental health services, but I want to focus specifically on children’s mental health services. As we have heard, a significant proportion of lifelong mental health problems start in the teenage years, yet only 6% of the mental health budget is spent on child and adolescent services. YoungMinds, a leading mental health charity, has confirmed that, due to local government cuts, 60% of local authorities have either cut or frozen their child and adolescent mental health services budget since 2010.
Research has shown that early intervention is of paramount importance, with one in 10 children encountering a mental health problem, which, without early intervention, is likely to become a more chronic problem in later life and thus a greater burden on the NHS. Early intervention is also key to ensure that an issue does not escalate to the stage where hospitalisation is required. One in-patient bed costs a staggering £25,000 a month. It is perfectly clear that adequate investment in the lower tiers of CAMHS provision is not just a question of social conscience, but a matter of economic common sense.
I must also address the systems in place for ensuring that children who present with mental health issues receive the requisite help at the earliest opportunity. GPs play an incredibly important role in early intervention, as they are often the first point of contact for parents whose child is experiencing a mental health problem. GPs have, however, voiced the concern nationally that they are not sufficiently equipped to deal with children with mental health issues and their training does not prepare them adequately for such situations.
Time and again, I am made aware of cases in my constituency where a child did not present symptoms clearly enough to a GP, a referral was not made and the problem, which could have been dealt with relatively easily, escalated to the point where the child became seriously ill and required hospitalisation. Other barriers to referral include the body mass index limits in relation to eating disorders, which my hon. Friend Luciana Berger highlighted earlier. What further support and guidance will the Government provide to GPs in order to address the issues?
The case for effective early intervention in Salford becomes even more convincing when we consider the shortage of in-patient beds in Greater Manchester. I have been working with a family in my constituency whose child desperately needed urgent treatment but who, due to the lack of available beds, was admitted to a general paediatric ward, where they waited for months until a child mental health bed became available. Although the staff on that ward were amazing and did all they could, the simple fact remained that this child was not on the correct ward and was therefore not receiving the psychiatric treatment that was immediately required.
Although I appreciate some of the measures that the Government have taken, I have serious concerns that they will barely begin to address the issues that I have raised today.
I want to consider mental health in the justice system, and will draw my remarks quite widely to include the police. I am very pleased that we have made progress in this area. In my county at least, police cars are no longer used to transport mental health patients; ambulances are used instead.
NHS England has been charged with developing better healthcare services for people in the criminal justice system, and the National Institute for Health and Care Excellence has also been asked to develop guidelines on improving mental health for those in prison. The need is to identify those who have mental health problems and to support them, as the Government have recognised. The choice is for the prisoner either to have support for their mental health issues as they move along the criminal justice pathway, or to be diverted into treatment—or, indeed, social care. The integration of social care and the NHS can contribute a lot to that process.
The service provided to prisoners needs to be consistent across the UK, and I was pleased to hear the Secretary of State’s remarks on the involvement of the King’s Fund in that. There is a great need for prisoners to have the same access as non-prisoners to mental health services. It is also necessary to ensure continuity of treatment across the prison estate and through to the non-prison environment. That continuity is crucial to the provision of better facilities for those prisoners with mental health issues.
That takes us back to the crisis care concordat and the need for good access to support. Prisoners need to know that their problems are genuinely taken seriously, and that they can get help when they need it. That could help tackle the issue of the huge number of men who commit suicide, which my right hon. Friend Dr Fox has mentioned. That has to be acknowledged.
I congratulate the Government on the progress they have made, and on recognising the need for parity between mental and physical health services. I am also extremely grateful for the £600 million of additional funding for mental health that the Chancellor put into the system in the recent autumn statement and spending review. The Royal College of Psychiatrists was also pleased with that commitment, and said that it was good news.
I am proud of the work that the Labour campaign for mental health has done to highlight many of the issues that have been raised today. In particular, I congratulate my constituent, Victoria Desmond, on her work.
I want to raise the case of one of my constituents. I have briefly outlined it before in this House. Kane was only 18 years old—the same age as my eldest son—when he took his own life. Kane had grown up in care, in foster homes and in institutions, and he had a history of mental health problems, but those difficulties were compounded by the problems that society threw at him. Already extremely vulnerable, his unemployment benefits were suddenly stopped after he missed a doctor’s appointment. He was one of many people with mental health issues who are increasingly being sanctioned through no fault of their own. Then Kane was hit again when the moneylender Wonga, from which he had taken out a payday loan, cleared out his bank account in one fell swoop as part-payment of his debt. Kane was left absolutely destitute, literally, without a penny to his name. Hours later, Kane hanged himself.
That is a shocking story about a young boy who had already had more than his fair share of problems in life being left penniless by a payday loan company. After being penalised by the state, which withdrew his benefits, it must have seemed like he had nowhere to turn to for help, support or a little human understanding.
Of course Kane is not alone. He is one of 16 men, on average, who commit suicide every year in my constituency. Many more attempt to take their own life. It is a miserable fact that men are three times more likely than women to take their own life. It would be wrong to speculate on the reasons, but it seems irrefutable that economic circumstances play some part. I try to be non-partisan, but that is difficult after my experience and that of my mum, who suffered from bipolar disorder for many years. The Government shout about their long-term economic plan, cut taxes for the richest in the nation, and then tell my mum, “You’ve got to move because of the bedroom tax. You’re having your benefits cut, and we’ll cut funding to local authorities and charities.” Charities such as Mind that look after people like my mum can no longer offer the support that she once had.
Economics plays a huge part in the treatment of people with mental health problems. The number of mental health beds in Greater Manchester has been cut by 5.9% in the past five years, despite increasing demand. My hon. Friend Jonathan Reynolds mentioned that the regional press in my area today reported the start of a consultation on cutting £1.5 million from Manchester Mental Health and Social Care Trust. More than 600 patients are set to be hit by these proposed cuts.
If people listening to this debate need support, I commend the services out there run by the voluntary sector and charities, including the Samaritans, of which I used to be a member.
It is important to reflect on whom this debate is about. It is about the thousands of people across the country who may have woken up this morning feeling that they might not be able to get through the day. It is for the young boy, perhaps aged 14, feeling confused and depressed at school and not knowing where to get help, and the young girl prepared to starve herself potentially to death because of issues to do with body image. This debate is for the middle-aged man of 40 who may be contemplating suicide because of a sense of a loss of his identity. It is about the older person, perhaps the 75-year-old woman who has just suffered a bereavement and feels isolated and depressed, not knowing where to go for help. Those are the people whom we are speaking about today.
In my role as the chair of the all-party parliamentary group on mental health, I am aware that the public debate about mental health has changed radically over the past decade. Celebrities and Members of Parliament talk about their mental health. That has created a unique context in which we can talk about mental health policy. This Government have an historic opportunity to make a genuine difference to the direction of mental health policy in Britain.
As part of the £14 billion that we spend on mental health services in Britain, it makes sense to move resources to tackle the issue at its source, whether through the Government’s commitment in respect of perinatal mental health, or by radically transforming our child and adolescent mental health services so that we get rid of the tiering system that is more suited to the commissioners than to service users. We need radical change in that area. We need a crisis care system in which, if an individual rings up and says, “I am having a crisis”, they get compassionate help. Overall, we need a vision for mental health policy that achieves a situation in which talking about mental health—about an individual’s mind and their place in their family and in their community—is thought to be entirely normal in society. We have that opportunity and we as a Government need to take it.
I congratulate Luciana Berger on securing the debate, in which it is a great privilege to speak.
If David Beckham had suffered mental health issues which prevented him from training or playing, would we have tracked his progress and well-being with such careful attention? Would he even have admitted to having had a mental illness? I am speaking hypothetically, but for a variety of reasons we often treat mental health completely differently from physical health, and there is no good reason or explanation for that. How we frame the debate is hugely important. According to the charity Mind, which surveyed almost 6,000 people in January 2015, over a third of people—40%— come up against stigma and discrimination on a monthly and weekly basis, and over half the people surveyed said that stigma and discrimination were as bad as or worse than the illness itself.
In Scotland we are proud that the early introduction of targets for child and adolescent mental health services has supported substantial increases in the CAMHS workforce. The Scottish Government are investing over
£100 million over the next five years to ensure that our health service is equipped to train the workforce that offer these vital services. I pay tribute to the great work of organisations such as the Scottish Association for Mental Health, which recently launched its “Give mental health a sporting chance” campaign. In partnership with Chris Hoy, SAMH is building on the success of sport in Scotland, such as the 2014 Commonwealth games. Its chief executive says:
“The time is right for sport to use its collective power to tackle the stigma and discrimination around mental ill health.”
It is important in a debate such as this to recognise the root causes of mental ill health and how we can ensure that every child and young person gets the very best start in life. That is why I find it incredible that the UK Government are choosing to continue with their austerity agenda, when a recent report by Psychologists Against Austerity called “The Psychological Impact of Austerity” states:
“It’s now well established that austerity has hit the poor much harder than the wealthy: we have indeed, been ‘balancing the books on the backs of the poor’”.
The report goes on to say:
“What has not been sufficiently highlighted is the psychological price people have paid.”
In closing, I would like to read the last two verses of a poem that a constituent who has suffered mental illness sent me:
“I know we’ve had this conversation before
But this time I’m throwing you out of the door
I tried in the past but I didn’t want to be rude
For after all you’ve done me such good.
I appreciate that you’ve been my friend
But now I’m afraid it has to end
I cannot keep you by my side
There were times you almost let me die.”
People deserve better service. For too long some constituents have battled to get the care they need. Many do get excellent care, and I pay tribute to the staff of the Norfolk and Suffolk mental health foundation trust, who dedicate their lives to caring for thousands of patients successfully. I am pleased to see Clive Lewis and Norman Lamb here. I hope they will work with me and meet the trust here next week.
What we should be debating today is how to complete the job of bringing mental health into the light, into equality with physical health and into an era where the norm is of a better service, with every patient getting the treatment they need. I am currently helping constituents who have lived with seeing someone they love go down in a spiral—fast, sudden, out of control and finding it too hard to know what to do. I am concerned about continuity of care, the role of GPs and out-of-county beds. Poor provision of services is not acceptable or just: people deserve a better service.
I want to say three things: first, funding matters; secondly, equality matters; and thirdly, good management matters. On funding, I welcome the steps that the
Government are taking to increase investment. The Norfolk and Suffolk mental health foundation trust has been open about the funding shortfall it can see in its books compared, for example, with the Norfolk and Norwich hospital down the road. The chief executive has called for the same system of funding for mental health compared with physical health.
Of the seven CCGs in the region, Norwich devotes the highest proportion of its budget to mental health. Although the overall budget for this year rose by just over 6%, spend on mental health increased by just over 4%.
I am afraid that I cannot take an intervention.
Norwich CCG notes that its
“spend on mental health has increased significantly in real terms, by almost £2m.”
It believes that
“access to mental health care is consistent across the county in line with demand.”
I welcome the announcement today of transparency measures, which will help us to understand such a statement.
On equality, we need proper parity of esteem between mental and physical health to be made a reality through funding. It is welcome that, in the planning requirements, commissioners are required to invest additionally in mental health.
Finally, good management is also needed, as the Minister for Community and Social Care recently argued in the Eastern Daily Press. By the way, I pay tribute to its campaign on mental health. My trust is in special measures and subject to an improvement plan. We must work with the trust to help it to get better. The staff have made very clear the pressures that they perceive; I also pay tribute to them. The CCG found that the trust was good at caring, but inadequately led. Monitor found that its financial management was lacking. Patients deserve better and other trusts are doing better: Norwich deserves better.
Several hon. Members rose—
Order. If every speaker is to get in and we are to finish the debate on time, we must now have a limit of two minutes.
Thank you, Madam Deputy Speaker.
“There they stand, isolated, majestic, imperious, brooded over by the gigantic water-tower and chimney combined, rising unmistakable and daunting out of the countryside—the asylums which our forefathers built with such immense solidity to express the notions of their day.”
The proposals will set the country on a path of integrated community services for people with mental health issues, with an emphasis on the hospital as the place of last resort. No one doubts the complexity of the issue, but there is a real danger we will have a system that does not do one thing or the other. On the one hand, mental health hospitals are struggling to cope with demand for in-patient beds; on the other hand, community services are also straining to cope. There is a symbiotic relationship that feeds off the gradual inability of the other to cope with demand, despite the best efforts of the staff in those services, such as my colleagues in the 5 Boroughs Partnership NHS Foundation Trust, the staff of Mersey Care NHS Trust in my area, and charity and local authority workers.
What would happen if we did not have carers? We need to give them more support—concrete support—not warm words. I am not pointing the finger at the Government. We have gone beyond that. We genuinely have to get down to the issue. However, they are the Government, and they have a significant responsibility to get to grips with this burgeoning and growing crisis. I hope that the Minister has the vision to do so.
May I join many other hon. Members in what they have said about the courage and bravery of Members standing up in this Chamber to speak about their own mental health issues? They are no longer in their places, but I refer in particular to my right hon. Friend Mr Mitchell and my hon. Friend Mr Walker. Listening to their speeches has given me enough confidence to think about my own mental health issues. I have to admit that trying to confront those issues was difficult in my first couple of months as a new Member of Parliament, but with the help and support of people in this place and in my constituency, I am managing to get through this period.
When someone comes to my constituency surgery to talk about their mental health issues, I completely understand the difficulties they face in finding the correct signposting. I completely agree with hon. Members who have said that we have a responsibility as MPs to be advocates for our constituents and to speak about mental health in this place. I have decided to hold a regular constituency surgery to work on mental health with Sirona Care and Health in my constituency. I will also hold hearsay information hubs, as I have done recently. I must admit that I have been pretty startled by the number of people coming forward to my surgeries with mental health issues during the past six months. I am at the very end of the journey on mental health: they should have been picked up well before they come to my office.
I have, however, seen a radical improvement during the past five years, having worked alongside the NHS for the past seven years. Avon and Wiltshire Mental Health Partnership NHS Trust in my constituency has Hillview, which is an excellent facility. It is increasing the number of psychiatric beds, which is definitely a benefit. We also have a range of community organisations and charities such as Bath Mind, which the Secretary of State visited just before the general election. I will never forget some of the work that it is doing, and I am currently helping it out. We play a vital role in this debate, and hopefully we will be able to signpost more of our constituents to the right place.
I want to focus on attitudes towards, and the prevalence of, mental health problems among young black men, which I believe is important. Although the prevalence of mental health conditions among young people is often discussed in Parliament, it is less often discussed in the House in terms of race. Black men in Britain are 17 times more likely than their white counterparts to be diagnosed with a psychotic illness. Studies carried out in 2014 in Lambeth, an area with a black population of 26%—the largest in the country—found that 70% of the borough’s residents in secure psychiatric settings are of African or Caribbean origin.
The majority of people enter the mental health services via primary care, but young black African people are more likely to enter via the court or the police. According to a report by Mind in 2013, in a survey of black people’s experiences of the mental health services, 46% had been restrained by mental health staff. Of those, 79% thought that restraint was aggressive, and 34% had been physically injured.
We must listen to and act on reports such as that of Healthwatch Enfield, which surveyed 77 people in the community. The majority of those were young people and their parents, and they found—among many conclusions—that there were cultural, language and access barriers to services for black and minority ethnic communities. That needs to be considered by the Government. We need a comprehensive investment in mental health that takes racial differences into account. That will be one step forward to ensuring that we have an adequate service that helps all those in this country who suffer with mental health issues.
It is an honour to follow Kate Osamor who made some important points.
I will focus my brief remarks on young people with mental health issues. Every year I am privileged to bring about 10 young people into Parliament for a parliamentary induction day, and during a question and answer session I asked what were the biggest challenges facing them and their generation and peers. I thought that the answer would be about how to get into, and fund, a place at a decent university, but all 10 of them said in unison that mental health was the biggest challenge they faced.
I found that staggering, and given the various cases that I have had to deal with as an MP, I have taken a much closer interest in the subject and worked hard to find out more about the issues relating to young people. Clearly, the challenge is increasing. In the Cheshire and Wirral Partnership NHS Foundation Trust alone, referrals have gone up by 25% over the past couple of years. There is growing awareness of the issue, which in many ways is a good thing.
It is also clear that social media amplifies those challenges, and I ask those who have brought the likes of “Assassin’s Creed”, and other weird-sounding computer games, to the young people we work with, to please use that creativity and ability to communicate with young people to develop digital approaches that will help them to feel more comfortable about who they are, and about their place in the real world and the digital space. There is a responsibility there.
I am pleased that we will hear from the Minister for Community and Social Care, who takes a keen interest in this area. Extra funding is being used to tackle issues on the ground, and we are seeing best practice with young advisers in our area helping to youth-proof local services. Our Emotionally Healthy schools programme is bringing together an integrated approach to that vital part of our community.
The Norfolk and Suffolk NHS Foundation Trust was the first mental health trust in England to be placed in special measures, where I am afraid it still languishes. Let me praise the staff who have held that trust together, and kept it going throughout this tough time. Despite that, throughout the coalition years, we heard—and still do—much about parity of esteem between mental and physical health. Unfortunately, the reality is very different. Unison members in my constituency worked out that if my local mental health trust were funded using the same formula as my local acute trust, it would have an additional annual income of about £69 million. Instead, however, it was cut by £30 million. Ultimately, were parity of esteem a reality rather than empty rhetoric, those cuts would not have been made.
In the face of severe financial constraints, my trust has been forced to cut services such as early intervention in psychosis, assertive outreach and the specialist homeless teams that were once in place. Each and every cut was a false economy. The impact has been catastrophic. People in crisis in my constituency have been left without access to a local NHS bed. Instead, they have been sent hundreds of miles from Norwich, separated from their families and care teams, to places as far away as Harrogate, Bradford, London and Brighton.
Forgive me, therefore, if I do not sound too excited by the announcement in the Chancellor’s recent autumn statement of an additional investment of £600 million for mental health services. An investigation by the BBC and the Community Care magazine in March found that £600 million had been cut from mental health services since 2010. It is therefore an affront to call this £600 million an investment. In reality, it is barely a replacement. Unfortunately, it is too late for those in my constituency who have lost their lives or suffered life-changing injuries because help was not there when they needed it. The Government have failed patients, failed their families, failed staff and ultimately failed my community.
I want to highlight the importance of preventive work in dealing with mental health issues. I am not saying that my constituency does not need more funding or resources for preventive work or the acute mental health setting, but I want to highlight some good work happening locally already.
In my constituency, Sussex police were, until recently, at the forefront of dealing with those in mental health crisis. For those who do not know my constituency, it is on the beautiful Sussex coast, and I have the picturesque spot of Birling Gap lying right next door to Beachy
Head, both of which are suicide hotspots. Until recently, the police, along with the Beachy Head chaplaincy team, had to deal with people standing or sitting on those cliffs contemplating suicide. Since last year, mental health nurses have been out with Sussex police on these and other calls to ensure that people suffering acute mental health crises get the help they need when they need it. Previously, Sussex police were detaining more people under the mental health legislation than any other police force. They had no other way of looking after those people. That was far from ideal, because a prison cell, rather than a hospital bed, is not conducive to supporting vulnerable adults.
I ask Opposition Members, therefore, to look at some of the great work being done. I am not saying we do not need more funding and resources, but there is some great work being done in the field of mental health.
We have heard in this important debate from an astonishing 27 speakers, in addition to many interventions during the opening speeches. I welcome the involvement of all those who have taken part. In particular, I would like to thank Dr Cameron, Dr Fox, my right hon. Friend Mr Bradshaw, Mr Walker, my hon. Friend Simon Danczuk, Maggie Throup, my hon. Friend Mr Jones, Julian Sturdy, Norman Lamb, Johnny Mercer, my hon. Friend Jeff Smith, Dr Lee, my hon. Friend Rachael Maskell, Heidi Allen, my hon. Friend Rebecca Long Bailey, John Howell, my hon. Friend Angela Rayner, the hon. Members for Halesowen and Rowley Regis (James Morris), for Livingston (Hannah Bardell) and for Norwich North (Chloe Smith), my hon. Friend Peter Dowd, Ben Howlett, my hon. Friend Kate Osamor, David Rutley, my hon. Friend Clive Lewis and Maria Caulfield. It is a remarkable number.
The Secretary of State was right to thank Mr Walker and my hon. Friends the Members for Barrow and Furness (John Woodcock) and for North Durham for talking about their personal experiences. My hon. Friend the Member for Manchester, Withington also spoke about his experiences today. We should always thanks hon. Members who speak from their own personal experience. I also want to mention the leadership of the all-party group on mental health and the commitment of the right hon. Members for North Norfolk and for Sutton Coldfield
(Mr Mitchell) and Alastair Campbell, who have formed a group arguing for equality for mental health and an increase in funding.
I want to thank my hon. Friend Debbie Abrahams for her persistence in raising issues relating to suicide and the work capability assessment, and on the impact that changes to social security programmes can have on people with mental health problems. If we are to have a zero suicide ambition, as the Secretary of State mentioned, we must do more work on that particular issue, and on the crisis of male suicide, which was raised by the right hon. Member for North Somerset and my hon. Friends the Members for Rochdale and for Ashton-under-Lyne.
Right hon. and hon. Members have spoken with knowledge about mental health services around the country and about the excellent work being done in their own constituencies, often by charities and voluntary projects. Many speeches illustrated the fact that our mental health services are under intense pressure and in urgent need of improvement. In the previous Parliament, we heard much from Ministers on parity of esteem, but we saw little progress. I think all the speeches today have shown us that things have got worse. The independent King’s Fund commented recently that parity of esteem for mental health “remains a long way off.” The hon. Member for York Outer said exactly the same thing and the right hon. Member for North Norfolk called the current situation “morally wrong and economically stupid”.
Mental health services have faced cuts and Government promises on spending have not been kept. We focused on that in this debate. In 2012, the annual national survey of investment in mental health services found that spending on mental health had been cut for the first time in a decade, but rather than take action to put it right Ministers discontinued the survey. As my hon. Friend Luciana Berger said earlier, since then it has been very difficult to make an accurate assessment of the level of investment in mental health services. Indeed, we have to rely on freedom of information requests and on expert analysis by charities and independent bodies. The King’s Fund found that about 40% of mental health trusts experienced reductions in income in both 2013-14 and 2014-15. The charity Mind reports a real-terms reduction of 8.25%, or almost £600 million, in the funding of mental health services at the same time that referrals to community mental health teams have risen by nearly 20%. Labour’s own analysis by my hon. Friend the shadow Minister found that one in three clinical commissioning groups was not increasing its spending on mental health in line with the growth in their budget allocations, despite an explicit promise from Ministers that that would be the case. If Ministers have the determination to change that, we would welcome it.
The suggestion made by the right hon. Member for North Somerset of ring-fencing extra funding for mental health was very welcome and was supported by a number of hon. Members. The Secretary of State admitted earlier that he just did not know by how much standards and investment varied across the country. The lack of information is simply not good enough. I urge the Minister to reinstate the national survey of investment in mental health. That is the way to go.
One area on which we have accurate information is funding for social care. Social care services play an important role in supporting people with mental health problems. Cuts to social care services have a serious impact on people with mental health needs, as do other issues raised in this debate such as housing. A report on mental health care from the Health Foundation found that the number of people receiving social care support for mental health problems has fallen by 25% since 2009-10. A recent survey of NHS mental health trusts found that cuts to social care budgets were having an adverse impact on their services. Indeed, as my hon. Friend the Member for North Durham said, we need to road-test policies from other Departments for their impact on mental health.
The recent spending review will surely go down as a missed opportunity to do something about the desperate funding crisis in social care, which does affect people with mental health problems. The Chancellor’s proposals on social care funding are woefully inadequate. They will leave a black hole in care services for older people and for people with mental health problems. To cite a local example, Government cuts to Salford City Council’s budget have caused budgets for adult social care to fall from £76 million in 2010 to £61 million this year—a cut of £15 million. However, the 2% council tax precept will raise only £1.6 million. The King’s Fund warned this week that the decision to use council tax rises to offset cuts in social care will widen the gap between richer and poorer areas but will raise less than half the £2 billion the Chancellor predicted.
Older people are not just being hit by cuts to social care; they are also being hit by cuts to mental health services. The Secretary of State said that depression was more debilitating than angina, asthma and diabetes, but depression affects 22% of men and 28% of women aged 65 or over—some 2 million people in England. In the UK, mental health problems present in 40% of older people attending their GPs, 50% of older people in general hospitals and 60% of older people in care homes.
The Secretary of State also said that talking therapies are more effective than drugs, but Age UK tells us that older people are six times as likely as young people to be on tranquillisers or equivalent medication, but only a fifth as likely to have access to talking therapies. While 50% of younger people with depression are referred to mental health services, only 6% of older people are. The Royal College of Psychiatrists estimates that 85% of older people with depression receive no help at all from the NHS. The Government are letting older people down by reducing their access to the services they need.
There is also a need for better emotional and psychological support for carers. Caring for a spouse or family member is more common in older age, and there are nearly 1.2 million carers aged 65 plus. Levels of stress and psychological distress are higher in carers who look after people living with dementia, and studies show that rates of depression can range up to 85% for carers of people living with dementia and up to 45% for carers of people living with anxiety.
The motion before us makes three clear calls, and I hope Members of all parties will join us in voting for the motion today. Good mental health is an issue for our schools, our workplaces and for our care homes, as well as for all our health services. I hope that Members on both sides of the House will join us in voting for the motion, which I commend to the House.
I thank Barbara Keeley for her remarks. I thank colleagues for a remarkable debate, to which I shall return in a few moments.
Less than a week after being appointed, I made a visit to the Maudsley hospital in south London. I met a parent who had an eight-year-old little girl and told me of her two-year struggle in her home county some 200 miles away to find information on what would be best for her daughter—until, by her own efforts and through the internet, she had hit upon the Maudsley. On the same visit, however, I met a team working in primary schools to introduce children to mental health difficulties, giving them the understanding that just as they would look after one of their classmates who took a tumble in the playground and grazed their knee, they would look after a friend with a hurt mind.
I went to Derby and sat round a table for a meeting organised by my hon. Friend Amanda Solloway. I met and was inspired by Sarah Eley, who had set up Borderline Arts to promote awareness and combat stigma against borderline personality disorder, from which she suffers and about which she is up front with great bravery. At the same time, I heard once again a familiar refrain from those around the table and from mental health sufferers in too many places, especially at crisis times—that “no one listened to me”. That is how it is with mental health issues in this country—a pattern of light and shade, good news and bad.
So I welcome this debate, which has given us such an opportunity to raise a number of the issues that reflect that light and shade—issues raised in powerful and personal speeches that reveal the depth of pain that mental ill health can cause. Through those expressions we can provide a sense of the urgency and purpose with which Parliament as a whole now addresses and will continue to address such matters. There is a sense that progress is being made—and I mean real progress, not “political-speak” progress—in areas ranging from therapy to crisis care. There is, however, still too much variation in the delivery of services; there are areas of unmet need; there is much more to do. More than ever before, though, there is a belief that those of us here are listening and acting on what we are hearing.
I cannot cover everything in the time available, and I will answer by letter colleagues who raised specific questions. Let me say that we heard powerful speeches, often about local issues, from my hon. Friend Mr Walker, Simon Danczuk, Mr Bradshaw, my hon. Friend Maggie Throup, the hon. Members for Livingston (Hannah Bardell) and for Salford and Eccles (Rebecca Long Bailey), my hon. Friend Chloe Smith and the hon. Members for Norwich South (Clive Lewis) and for Bootle (Peter Dowd).
I am grateful to Dr Cameron, who represents the Scottish National party, for offering her support for a consensual process. I look forward to visiting Scotland to see what is going on there, as I think there is much that we can share. I greatly valued the hon. Lady’s contribution.
Strong personal statements were made by colleagues who know about these things, and I particularly thank the hon. Members for North Durham (Mr Jones) and for Manchester, Withington (Jeff Smith), as well as my hon. Friend Ben Howlett. Kate Osamor bravely raised the issue of recent ethnic minority issues in mental health. That needed to be raised, and I am very pleased that she did so. We do not concentrate nearly enough on that issue, and I am sure I will come back to her on that.
Norman Lamb, who grappled with these difficulties himself so well and is so well regarded, spoke of the matters that he wanted to be dealt with more urgently than had been the case since he left office. I assure him again that we will do that.
I can tell Rachael Maskell and my hon. Friend Julian Sturdy that a letter is on the way to them. It will not give the hon. Lady quite the assurance that she wants in regard to the inquiry that she requested, but it will move matters on a little further. She knows that my door is open, and, indeed, I shall be happy to see both Members whenever they wish.
My hon. Friends the Members for Bracknell (Dr Lee) and for Henley (John Howell) raised the issue of mental health in the law and justice system. That is sometimes another less regarded area, but, as my hon. Friends pointed out, mental health issues matter there as well.
My right hon. Friend Dr Fox, my hon. Friends the Members for Plymouth, Moor View (Johnny Mercer) and for South Cambridgeshire (Heidi Allen), Angela Rayner and my hon. Friend Maria Caulfield raised the important issue of suicide. I take that issue extremely seriously, and I think that we have not done nearly enough to deal with it. I shall say something about my ambition in that regard towards the end of my speech.
The concept of parity of esteem was also mentioned, and Members wanted to know where it was in the mandate. The new NHS England mandate will be published shortly, and it will refer to that concept.
This is an Opposition day debate, involving a motion and a vote. Just as it is the right of the Opposition to press the Government to do more, and to level criticism where it is due—and occasionally where it is not due—it is the duty of the Government to explain what they are doing, and, in this instance, to ask for the House’s support for our response to the mental health needs that were set out earlier by my right hon. Friend the Secretary of State. However, I do not want the message of today’s debate to be in our procedure and our vote. I want it to be in the speeches that we have heard, in the words that have been quoted from our constituents and others, in the recognition that our Parliament and its Members have “got it” in terms of mental health, and in our assurance that the progress that has been made by successive Governments over a number of years will not stop, but will be accelerated.
We will point to our world-leading IAPT programme, and to the work of Richard Layard and David Clark in that connection. We will point to the inspiration in our local areas for our Crisis Care Concordat work, to the appointment of the first Minister for Education with whose remit includes tackling mental health issues in schools, to the improvement in the diagnosis and treatment of dementia, and to our determination to see the £1.25 billion investment in children and young people’s services deliver a sea change in what were previously undervalued services.
However, I want more. I want our ambition and our vision, building on all that has been done so far, to be recognised as providing the world’s best mental health services, and I want us to be really close to that by 2020. I want to see the inevitability of suicide to be challenged and rejected as we do more to combat the scourge of too many suicides. I want a national campaign against loneliness and isolation, and the mobilisation of the millions in clubs, faith groups and associations around the country, to bring more people in, and to let no one go.
I want to see a step change in perinatal mental health recognition, and urgent work to improve the services involved. Like my hon. Friend David Rutley, I want our children’s mental health—which is now at the mercy of a social media whose effects are as yet not fully calculated—to be protected by young people themselves through their own use of new technology and ingenuity, with the assistance of teachers and mentors everywhere. I want the mother whom I mentioned at the beginning of my speech to be reassured that others like her will know who to turn to quickly. I do not want anyone suffering from mental ill health ever again to feel that no one is listening.
Whether or not Members join my right hon. Friend and me in the Lobby this afternoon, I know that each and every one of us in the Chamber shares that vision and ambition, and I look forward to working with colleagues on both sides of the House to pursue it relentlessly.