Autism Community: Mental Health and Suicide

Point of Order – in the House of Commons at 3:30 pm on 30th November 2017.

Alert me about debates like this

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health) 3:30 pm, 30th November 2017

I beg to move,

That this House
has considered the support available for autistic people experiencing mental health problems;
calls on the Government to ensure that the NICE-recommended indicator for autism in GP registers is included in the Quality and Outcomes Framework;
and further calls on the Government to ensure NHS England works closely with the autism community to develop effective and research-based mental health pathway.

I thank everyone across this House, no matter what side of the Chamber they sit on, who supported the application for this important debate to the Backbench Business Committee. It is truly a cross-party endeavour to raise the profile of this issue, awareness of mental health issues within the autism community, difficulties regarding access to services, the importance of funding adequate support, and the progress we all must make across the UK for this population.

I thank the many autism charities, mental health charities and research groups that have reached out to me over the past few weeks.

Photo of Paula Sherriff Paula Sherriff Shadow Minister (Equalities Office) (Women and Equalities)

Will the hon. Lady join me in thanking the Whole Autism Family, a charity run by Anne-Marie and Martin Kilgallon in my constituency, who have two autistic boys and who do so much to support other families, who can find it difficult to access medical and other healthcare?

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

I thank the hon. Lady for her important words. The bedrock of much of the work undertaken across the UK is such small charities, often run by those who have personal experience and know what works and what needs to be done.

The level of interest in this debate shows the importance of the issue. It is important to so many across the UK, including charities such as those already mentioned. Many charities have contacted me with important recommendations, including Autistica, the National Autistic Society, the Royal College of Psychiatrists and the British Psychological Society.

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

I congratulate the hon. Lady on securing this debate. Will she join me in congratulating women’s organisations in Coventry that are very much involved in mental health issues among younger people and older people in particular? What help can they get? Often, women act as carers and the Government should do something about that and give proper grants to those organisations.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

That is an extremely important point. We must ensure that, when we consider young people with autistic spectrum disorder, we think about a family-systemic approach. Carers are at the forefront of providing support and they need the best resources possible.

I also thank the many citizens from across these isles who have contacted me to give their own poignant personal accounts. These accounts have been harrowing to read—and more harrowing for them to experience—and make us realise just how absolutely vital this debate is.

I also want to extend a personal warm welcome to the youth patrons up in the Gallery today representing Ambitious About Autism. Their recent campaign and research project, “Know your normal”, has been helping many people and raising important awareness. I pay specific thanks to Heidi Allen and Mrs Gillan, who have worked tremendously hard on this debate, on behalf of people with autistic spectrum disorder, through the all-party group over many years.

As a psychologist, I know that progress has been made on autism and mental health over the many years since I started in 1990, when waiting lists were extremely long—possibly a year and more—and services were very limited. However, much more must be done across the United Kingdom.

Photo of Kevan Jones Kevan Jones Labour, North Durham

I accept the point that the hon. Lady is making, but I have to tell her that waiting lists in Durham are still two years long.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

That is an excellent point, and that situation is clearly unacceptable. The Scottish Government and the United Kingdom Government are introducing waiting times initiatives across the United Kingdom. We are finding that the experience on the ground for young people with autism and their families, and indeed across the lifespan, is that, despite the waiting times initiatives, the waiting times that are expected to be in place are not the reality. We need to address that issue seriously.

Photo of Kevin Brennan Kevin Brennan Shadow Minister (Digital, Culture, Media and Sport) (Arts and Heritage)

Does the hon. Lady agree that mental health issues for adults with autism can arise out of the way in which they are treated when they encounter the criminal justice system? The behaviours that sometimes accompany autism can be misinterpreted by people in the criminal justice system. Does she agree that we need not only to get the health provision right but to ensure that the people working in the criminal justice system understand about autism and take it into account when they meet adults with the condition?

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

Yes, I wholeheartedly agree with that point. I have personal clinical experience of that through working across a variety of secure hospitals and prisons in my practice with the NHS. People with autistic spectrum disorder often find themselves caught up in the criminal justice system, which has little awareness of their needs or of the support that they require. When they get caught up in the system, it is difficult for them to move on and rehabilitate because the provision simply is not there.

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

Following on from the point made by my hon. Friend Kevin Brennan, there is an argument that the police lack the training to handle some of these young people because they do not understand the nature of their mental illness. Does the hon. Lady agree that something needs to be done to provide the police with the necessary training?

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

I agree. Our police are on the frontline and they deserve the utmost respect for the work they do, but yes, it is correct to say that they require further training and also further support. There requires to be a clearer pathway when people exhibit challenging behaviours in the community, from the point at which the police are put into contact with them right through to the provision of adequate support in the health system, without their being caught up in the criminal justice system in between.

Photo of Madeleine Moon Madeleine Moon Chair, Defence Sub-Committee

The hon. Lady will be aware that the societal body that is most likely to come into contact with someone who is likely to take their own life is the police. The police, and particularly the British Transport police, are doing critical work in assessing how staff can be trained to identify potential suicides and to take action to take people back at a time of crisis in their life in order to prevent them from taking forward a suicide. We should not knock the police too much. They are doing fantastic work in this area.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

I wholeheartedly agree. As I said, the police are on the frontline. They face the crux of the matter when it comes to matters of life or death. They are doing their very best with the training and resources that they have, but there requires to be a clearer pathway so that people who are at that crisis stage can access health services—and probably crisis health services—and so that the police have somewhere to ensure that the clinical needs of those people are met. It is unfair for our police to have to take care of people’s clinical needs when that is not what their training provides for.

In 2016, an academic study in Sweden, which was published in the British Journal of Psychiatry, found that people with autistic spectrum disorder were nine times more likely to die by suicide than the rest of the population. The latest research indicates that people with autistic spectrum disorder account for a harrowing proportion of suicides in the UK. There is a 16-year gap in life expectancy between people with autistic spectrum disorder and the general population. To put it all very bluntly, people with autistic spectrum disorder are 28 times more likely to consider suicide than the average population —28 times. The statistics make one thing abundantly clear: what we are doing now to support people with autistic spectrum disorder is not working and is not enough. Research shows that almost seven in 10 people with autistic spectrum disorder experience mental health issues, including anxiety and depression. Services must be in place to ensure that people are cared for holistically. We have to meet all their clinical needs, which may mean their autism or their learning difficulties, but they will almost certainly have mental health issues. Quite frankly, we do not have services in place today that take account of the complexity of such needs.

What types of things are going wrong for people at the frontline? It is difficult for people with autistic spectrum disorder to access mental health support through the usual routes. For most of us, that might mean going to our GP as a first point of contact for primary care for mental health problems, but a GP practice is a daunting, unfamiliar place for people with autistic spectrum disorder. One young man wrote to me and described a recent trip, saying that it was

“quite hard for me to access the GP anyway. The whole environment is difficult. It’s noisy, there’s often children, it’s very hot. There’s also a loud beep when they call the next person that I find really quite painful. When you’re feeling emotionally poorly that becomes almost impossible.”

GP surgeries make reasonable adjustments for wheelchair users every day—simple changes that make the life of the patient easier—so the same policies should be implemented for people with autistic spectrum disorder. We need training to raise GP awareness. Access needs to be easier. We need to ensure that GPs know who on their register has a diagnosis of autistic spectrum disorder.

If an autistic person bypasses the GP and goes straight to mental health services, they may face unprecedented waiting times or they may simply be refused treatment. When individuals do attend services, they may find that they are discharged without any follow-up. At the Health Committee last week, we heard how a young autistic boy was turned away by child and adolescent mental health services four times, despite feeling suicidal, because he had not yet attempted to take his own life. Things have hit crisis point, and we need to ensure that we engage in prevention. When someone attempts to take their own life should not be the point at which they receive treatment. We need early intervention to pinpoint the symptoms of difficulty and where we should be aiming the treatment.

Photo of Luciana Berger Luciana Berger Labour/Co-operative, Liverpool, Wavertree

I thank the hon. Lady for securing this very important debate. We both sit on the Health Committee, and during the inquiry into suicide prevention we heard that the point at which someone is most likely to take their own life is, tragically, when they are discharged from in-patient care. The Committee’s recommendation was that everyone should be contacted within at least three days, and we are waiting for the Government to respond that. Does she agree that everything should be done to ensure that the most vulnerable, including people with autistic spectrum disorder, should be supported in that period when they are extremely vulnerable to ensure that they do not take their own life?

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

I agree. That is an extremely valid point. If people arrive at A&E for crisis intervention and are admitted for a period of time, it is important that they are discharged with some follow-up. People often return to the same circumstances that led to the difficulties in the first place, and if they do not have some support to deal with those difficult circumstances, they may be in a vulnerable situation and may try to self-harm or take their own life once again.

If a person with autistic spectrum disorder feels unable to go to the GP or to reach out to services in their local community, they might try to ring a suicide helpline. However, that can be extremely difficult in itself for a person with autistic spectrum disorder who finds communication and social interaction difficult. They might be able to verbalise only some of their difficulties, and they may then find there is no follow up from that service, either. Early access points and early intervention are crucial to preventing suicide and preventing mental health problems being exacerbated. Much more has to be done at that critical early intervention stage to ensure access to services.

If a person with autistic spectrum disorder reaches a health professional, they often find that their mental health problems are overlooked or misdiagnosed, which might be because they present an extremely complex case. They might also have concomitant learning difficulties, and they might not present the symptomatology that would usually be expected for anxiety or depression per se because their symptoms are complicated by their autistic spectrum disorder. It is extremely important that mental health practitioners have training in autistic spectrum disorder, in the types of presentation that they might need to identify and, particularly, in risk issues.

Diagnosis is still a postcode lottery. I hope to continue working with the Minister on that issue, because we need an understanding of who is appropriately trained in diagnosis of autistic spectrum disorder and of what level of specialty we have in different professions. What is the workforce plan to ensure that this very great need is addressed across our society? This is so important. People with autistic spectrum disorder say they do not know where to go locally. As a member of the Select Committee on Health, I have asked services about that, and they say, “We don’t really have a map of who can diagnose and who can provide specialist intervention in a given area of NHS England.” Streamlined services would make it so much easier for people to gain that initial access.

I do not want to take up the whole debate, so I will provide a brief overview before letting others speak. Many Members want to contribute to this important debate, but I wish to touch on a few other important issues.

I request that the Minister look at what mental health therapies work specifically for people with autistic spectrum disorder who have concomitant mental health difficulties. There is no adequate research base yet, but we know it is critical—it is lifesaving—so we need to prioritise funding. Traditional mental health therapies might not work in the same way for people with autistic spectrum disorder. If one of us presented at a GP surgery, we might be offered cognitive behaviour therapy, but we do not know whether that is the best option for a person with autistic spectrum disorder, or whether some kind of adapted therapy would be more appropriate. That important work should be undertaken, and undertaken quickly, to engage people in appropriate therapies and save lives.

I have been contacted by a couple of individuals whose poignant accounts have struck me. One is an individual from my constituency who says that she has continually tried to access CAMHS for her daughter, who has been repeatedly self-harming. It has placed the family in such a stressful situation over a lengthy period that the family, including the mother and carers, now feel that their own mental health is under stress.

It is extremely important that we ensure not just that individuals can access the system but that we preserve family life, that we support carers and families, and that we do not place an additional burden on the NHS and other services. Families and parents may go on to develop their own depression and anxiety when dealing with an intractable situation because they do not know how to cope. If we do not address the problem at its root, we will multiply the problem for services across the UK.

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

I met a number of carers some months ago, and one thing that struck me was that from time to time they were extremely distressed. Some of them could not afford a holiday and they do not get very much help, to say the least,—they are not even paid as carers—so there is an effect on the mental health of the carers sometimes as well.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

Yes, that is exactly the point I am making. We are exacerbating the problem for families, and they are at grave risk of having their own mental health difficulties or separations if placed under significant stresses over a period of time. Such things can be avoided if supports are put in at an early stage, and we can address the difficulties and give them they help they need in that way.

The other case that struck me this week was that of an individual who contacted me last night to say that they hoped this debate would make a difference. They had been struggling for a long time to access services for their daughter, who had been self-harming over many years and in the past few weeks had tried to throw herself on to a dual carriageway under a number of cars. She had been feeling at crisis point—breaking point—and had been feeling isolated, having a lack of peer support and of clinical help at the time of need. This individual had been discharged from CAMHS a number of times after referral for assessment. I understand that if an individual comes to a CAMHS service and does not fit a diagnosis initially, it can be difficult to think of the types of services or follow-up they need, and they may be discharged. However, that has to be looked at, because young people in this situation have grave clinical need. They might not fit a clinical or diagnostic box, but they do have clinical needs that require following up. These young individuals are falling through the gaps, and this family was concerned that their young person would literally be falling under a car and they would be losing them for good. That just cannot be something we allow to happen in today’s society. As I say, this is a crucial issue—it will be life-saving if the Minister can show the leadership that we need today.

The five year forward view for mental health recommends that NHS England should develop a referral-to-treatment pathway for people with autistic spectrum disorder. That would be a vital step, as things are too complicated; people do not know where to access services and they do not know where to go. Even the services themselves do not know the best route forward for people after they present, so this has to be streamlined and we need to see progress in this regard.

As has been mentioned, we also need to look not only at children with autistic spectrum disorder but across the lifespan, at adults. It is very important that adults who may have autistic spectrum disorder have access to a diagnosis in the first place, and that if they present with mental health issues they are able to receive the support they need. This care pathway has to straddle the lifespan, so that none of our constituents, right across the UK, fall through these gaps.

It will be important to ensure that we undertake the GP registers, which are recommended by the National Institute for Health and Care Excellence, whereby individuals with autism are highlighted to GPs on these registers so that they can signpost them to correct supports. That is an extremely important issue. Last time this issue was debated, the Minister at the time said that the Government were “open” to these suggestions about the registers, and it would be important to hear an update on that today.

The Scottish Government have launched their own Scottish strategy for autism in 2011, declaring autism a “national priority”. I concur with that, as it is a national priority. This means more than simply diagnosing autism; it means that we must think about people with autistic spectrum disorder right across our communities, and about their access to services, to community services and to shopping centres—their access to society at large. This is bigger than just health, so I would like to know how the Minister is going to liaise with other Departments to make sure that we do not leave people with autism behind and to ensure that that message is embedded in all Government policy.

I have written to the Scottish Government to ask for an update, because I have read their policy thoroughly and it is extremely good, but constituents still contact me to say that, with respect to the implementation on the ground, they are having the same difficulties accessing services and that things are not working as they should. Perhaps the Scottish, Welsh and UK Governments can work together to ensure that best practice is in place for people with autism right across the United Kingdom.

I really hope that the Minister will listen to at least some of the recommendations raised in this debate. Other Members from all parties will have extremely important accounts to give. I welcome all the accounts given and interventions made. This is a vital issue of concern, so it is important that we work together, across party lines, to ensure that people with autistic spectrum disorder and mental health problems do not fall through the gaps but have the services they deserve.

Several hon. Members:

rose—

Photo of Eleanor Laing Eleanor Laing First Deputy Chairman of Ways and Means

Order. As the House knows, we have limited time this afternoon, so we have to start with a time limit of seven minutes for Back-Bench speeches.

Photo of Anne-Marie Trevelyan Anne-Marie Trevelyan Conservative, Berwick-upon-Tweed 3:55 pm, 30th November 2017

It is a pleasure and honour to speak in this debate, secured by Dr Cameron, because it is such an important issue. It is critical to make sure that those on the autistic spectrum are absolutely wrapped up in our mental health and medical services so that we no longer need even to raise this issue in the House. To that effect, the Government have put mental health on the political agenda as no Government have before. We have invested more in mental health than any previous Government, hired tens of thousands of staff and, most importantly, enshrined the parity of esteem of mental and physical health into law. The Prime Minister took a big step forward last month by opening a review of the Mental Health Act 1983, because too many people are still suffering discrimination.

Photo of Luciana Berger Luciana Berger Labour/Co-operative, Liverpool, Wavertree

I do not seek to be partisan in these sorts of debates, but it is important to note for the record that the amendment to introduce parity of esteem for mental health into the Health and Social Care Act 2012 was tabled by Labour peers in the House of Lords, and unfortunately Tory peers voted against it. I would not like the Government to seek to claim credit for the fact that parity of esteem is now enshrined in law.

Photo of Anne-Marie Trevelyan Anne-Marie Trevelyan Conservative, Berwick-upon-Tweed

I thank the hon. Lady for her comments.

Despite the cross-party efforts of all those for whom this is a passionate policy area—for 18 years I have cared for my son, who is now a young adult with autism—there are some people who are having a miserable time in the mental health system and are not yet benefiting from improved access to core therapies and services: men and women throughout the country on the autistic spectrum. We must do better.

Across the board, a quarter of us will experience mental ill health during our lives, but within the autism community that rises to eight in 10—of those diagnosed as autistic, eight in 10 suffer from mental ill health. To those of us familiar with autism, that is sadly not a surprise. Society is designed for us neuro-typicals, as my son likes to call me—I am not sure it is meant as a compliment—so almost everything designed for us can cause stress or worry for those who are wired differently. A different perspective on the world has huge potential benefits for our society and economy, and we fail all those on the autistic spectrum to the detriment of not only the individual but society more widely.

We are failing these individuals. When I did some research for this debate—as I always do, if I can, for anything relating to this subject—I was appalled to discover the scale of suicide across the autism community. Autistica, the UK’s autism research charity, revealed international findings that autistic people without a learning disability are nine times more likely to die by suicide than the rest of the population. The charity’s research is now beginning to uncover almost identical rates in the UK as it starts to build the research database. As a parent, that is just awful to hear; but as an MP, it is a rallying cry. The exact causes are still being researched. We live in a complex environment and people are complex anyway. If we stick them in an environment that is often alien, it is not surprising that it is sometimes too hard to cope.

There are three clear ways in which our mental health services are letting our autistic citizens down now, and we have a duty to address them. First, we know that autistic people’s mental health problems are often misdiagnosed or missed completely. Despite mental health problems being the norm, there are no systematic mental health checks for autistic people. These problems can often present very differently, partly because so many become practised at masking their feelings to fit in. If someone is severely autistic, it is perhaps almost easier to identify them as sufferers, but those who are managing to live in a mainstream environment have learned some extraordinarily clever, adaptable ways to cope with our neuro-typical world and to their own very severe mental ill health. What is truly traumatic for one autistic person might not be for another, so when they do seek help, as the hon. Member for East Kilbride, Strathaven and Lesmahagow highlighted, autistic people can often find that their worries are dismissed out of hand. They are missed or misunderstood.

The NHS Five Year Forward View for mental health recommends the development of autistic-specific care pathways for mental ill health. That work, as I understand it, is supposed to begin in 2018, but we have heard nothing about it since February. Perhaps the Minister will be kind enough to update us on the project: is it still taking place; who is leading it; what is its scope; and how will autistic people be involved in helping to design it to make sure that we are not missing some very obvious things? Those things might not necessarily be obvious to those of us who are neuro-typical, but we must think in the different way that our wonderful autistic community so often does. This is a crucial opportunity to begin transforming care for autistic people, but we must get it right.

Secondly, we know that autistic people can struggle to find the support that works for them. It is assumed that what works for us neuro-typicals will also work for them. Autistic people may benefit from cognitive behavioural therapy but, as the hon. Lady who is an expert in providing such support says, being made to group work with strangers can be entirely counter-productive. We need to think about how we can adjust that support. The idea that someone who has issues with understanding, with being able to read faces, with processing information would in any way feel supported when they are in a state of deep stress shows a complete gap in understanding. The stresses and the symptomatic problems of people with autism make it more difficult for them to cope.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

The hon. Lady is making an extremely powerful speech, as she is speaking from very personal experience, which is extremely valuable in this Chamber. I have also heard some disturbing accounts in the past few weeks of people with autistic spectrum disorder being referred to group-based therapies, which also shows a lack of awareness of symptoms, as they have issues with being able to interact socially and to communicate. That would place an individual with autistic spectrum disorder under even greater stress than if they underwent a different form of therapy.

Photo of Anne-Marie Trevelyan Anne-Marie Trevelyan Conservative, Berwick-upon-Tweed

I absolutely agree. I work closely in my constituency with the families who are supporting their autistic children. Clearly, dealing with strangers, with the unfamiliar, and with group dynamics is possibly one of the most difficult things to ask an autistic young person—or indeed an older person—to take on.

We have for too long neglected the research into mental health therapies for our autistic community, even though that tops the list of research priorities if we ask those in that sector. I very much hope that the Government will look to support those who are doing this work. In our manifesto, we said that we

“will address the need for better treatments across the whole spectrum of mental health conditions”— by—

“making the UK the leading research and technology economy in the world for mental health, bringing together public, private and charitable investment.”

I support those words wholeheartedly and hope that the Minister will be encouraging and will help us to do much more.

Thirdly, let me mention NHS data gathering—this is an issue that comes up in any number of NHS-related debates, but it is critical in this one. GPs are so often the first port of call for those with mental ill health. Going to a GP can be really, really difficult for autistic people. It is an environment with unfamiliar lighting, sounds and rules that cannot be escaped. The hon. Lady’s example of a bell going off is a classic one. It is the unfamiliarity and the pitch of the unexpected sound. There is a lack of understanding by neuro-typicals about what certain pitches of sound can do to those who have hyper-sensitivities. To an autistic young boy or girl, it can be like a bomb going off. We need to consider the impact of such things on those with these heightened sensitivities, especially when they are in a strange place and already in a state of anxiety. Strip lighting in public spaces is another thing that creates enormous tension.

Photo of Paula Sherriff Paula Sherriff Shadow Minister (Equalities Office) (Women and Equalities)

The hon. Lady is making an incredibly powerful speech. Some supermarkets, including Sainsbury’s, do an autism hour—every month, I think—which is great, as it provides literature in store for people, and staff also gain a better understanding. If a child or young person is having a meltdown, people should not think automatically that they are naughty but consider that they might be experiencing difficulties relating to their autism.

Photo of Anne-Marie Trevelyan Anne-Marie Trevelyan Conservative, Berwick-upon-Tweed

The hon. Lady is exactly right. I have experienced many times the meltdown of a small child in a supermarket aisle and had people either offer a word of support or—usually—criticise me for being a bad parent. The line I always used was, “You tell me when you have an autistic child and take them shopping, and I’ll tell you what the problem is”. It is very difficult to understand. We need to provide places of calm. Cinemas do it, and we can do it too. I ask that the Minister take this forward and take on the challenge of getting those quality and outcomes frameworks to work so that our GPs can provide the support that people need.

Several hon. Members:

rose—

Photo of Eleanor Laing Eleanor Laing First Deputy Chairman of Ways and Means

Order. I do not criticise the hon. Lady for having taken interventions—that is the stuff of debate, and a lot of people want to intervene—but it means we now have to go down to five minutes per person.

Photo of Thangam Debbonaire Thangam Debbonaire Opposition Whip (Commons) 4:06 pm, 30th November 2017

I thank the Backbench Business Committee for bringing this debate before us and the hon. Member for East Kilbride etc. for leading on it. I also wish to say a special thank you to Mr Speaker and Mrs Bercow, who have done so much to support autism awareness in the House and beyond, particularly through their support for the National Autistic Society.

I should make a declaration of personal interest: I have a young cousin on the autistic spectrum, and I am married to someone who runs a special educational school for people with autism. My constituency team has also prioritised making Bristol an autism-friendly city. We have made a start, but we have more to do. We have held a training event for employers on how to make reasonable adjustments in recruitment and employment practices, and have had training for my team and made some adjustments ourselves.

That matters because unemployment is unacceptably high among people with autism, which contributes to mental ill health. According to the National Autistic Society, only 16% of adults with autism are in full-time paid work, and only 32% are in some kind of paid work, compared with 47% of disabled people and 80% of non-disabled people, and we know that unemployment affects mental health and self-esteem. The Government have committed to halving this autism employment gap by the end of this Parliament. In the interests of the mental health of people on the autistic spectrum, I urge the Minister to urge her colleagues to do everything they can to meet that much-needed target.

I have heard from schools in my constituency that funding pressures are affecting their specialist provision for children with special educational needs and mental health problems. Some families have told me that they have experienced effective or partial exclusion from school because of a lack of understanding of autism or of specialist support. That in turn leads to further mental health problems and is exacerbated by a lack of autism-focused specialist mental healthcare and high demand for mental healthcare generally. They have also told me of brilliant support and help from some teachers and schools, but they have fears about staff changes and worries about funding.

I have talked to public venues about what they can do with the help of the National Autistic Society and others to make themselves more autism-friendly. It cannot be acceptable that, according to the Royal College of Psychiatrists’ briefing for this debate, autistic people are more than seven times more likely than non-autistic people to commit suicide and that so many young people on the spectrum have at least one anxiety disorder. None of us wants to accept this, and we do not have to, and there is much we can do.

As I have said, my team has made autism a priority. In association with the fantastic Bristol Autism Support service and the local branch of the National Autistic Society, we recently held what we think was the country’s first MP constituency surgery specifically for adults with autism and parents of children on the autistic spectrum. I encourage all colleagues to do likewise, and I am happy to talk to them about how we did it. It meant that adults with autism and the parents of children with autism could come and tell us about challenges they faced with simple things such as transport and public spaces, as well as housing and employment, all of which affect mental health.

I am not going to repeat things that hon. Members have already said, particularly the hon. Member for East Kilbride, Strathaven and so on—I am so sorry, I cannot pronounce the last bit.

Photo of Thangam Debbonaire Thangam Debbonaire Opposition Whip (Commons)

Thank you, Madam Deputy Speaker.

The hon. Lady comprehensively listed recommendations that I urge the Minister to follow. I will finish by recommending two things. First, I suggest that hon. Members who care about autism and the 1% of our population who are on the autism spectrum consider, as I have done, asking a member of staff to champion that cause. I work closely with my member of staff, Councillor Mike Davies, who is our local autism lead on the council and within my own team. He has patiently taught me a great deal about how to make Bristol a truly autism-friendly city. We have a lot more to do, but I know that, with someone like Mike, I will be able to do much more than I would otherwise have done.

Secondly, I would like us to take a leap. In the House restoration and renewal programme, we could decide to work with the National Autistic Society to make this place autism-friendly. Doing so would help not just people on the autistic spectrum, including children and their parents, but all of us. It would make the place calmer, more welcoming and truly more accessible for everyone. It would be the mother of Parliaments leading by example to the rest of the country so that we can truly make the United Kingdom autism-friendly and address the chronic levels of mental ill health and suicide risk for people on the autism spectrum. I recommend that colleagues consider the suggestions that have been made by me and my team, and by others in this House.

Photo of Huw Merriman Huw Merriman Conservative, Bexhill and Battle 4:11 pm, 30th November 2017

It is a pleasure to follow Thangam Debbonaire. She talked of having a constituency surgery exclusive to those who are on the spectrum. I actually had that pleasure last week, although it was not something that I fixed. It was just that everyone who booked an appointment had issues and was on the spectrum. That is telling about how much pressure MPs rightly face from our constituents who have such huge challenges.

I thank the hon. Member for East Kilbride and other parts of her constituency that are harder to say for securing this debate. It is a real pleasure to have the debate, because it is timed very well, coinciding with a report that has been published by the all-party parliamentary group on autism entitled “Autism and education in England 2017”. The report is particularly relevant because, when it comes to mental health and those on the autism spectrum, I am afraid to say that much starts to go wrong in schools, which are still not equipped to deal with the many people who face complex issues that arise from autism.

It was a pleasure for me to co-chair the parliamentary inquiry that led to the report with my constituency neighbour, my hon. Friend Maria Caulfield. We had three inquiries in Parliament, and we heard from young people on the spectrum, parents and educational experts about where things were not working and where they could work better. The report is a positive one that discusses what could be done better, and that is not just down to money; it is a question of sharing best practice. Unfortunately, the reality of the current situation in schools is that less than 50% of the thousands of people who responded to our request for information felt happy at school, which meant that they felt uncomfortable at school. Fewer than 50% of teachers felt that they were equipped to deal with pupils who have autism. A lot of this comes down to a lack of training that many teachers have.

It is fantastic that the Government will ensure that initial teacher training includes autism awareness, but there are many teachers—including headteachers—who have already been through teacher training and are now teaching in schools but do not have sufficient understanding of the needs of autistic children. That can go wrong for the autistic child, and indeed their parents, by leading to exclusion. Of course, exclusion then leads to isolation, and isolation leads to mental ill health and, dare I say it, suicide. That is where we can do better. Unfortunately, an autistic child at school is three times more likely to be excluded than those who are not on the spectrum.

We need more training in schools and better sharing of good practice. It should not just be the case that specialist schools have all the expertise. If 70% of all pupils who are on the spectrum are in mainstream schools, we need the specialist schools to share what they know with the mainstream schools. Only when we start to tackle that will we actually do better.

I was delighted that the Government welcomed the report. We are now very much looking for them to support the recommendations in it. It will be launched by the all-party group at the beginning of next year, and I very much hope that all right hon. and hon. Members who are here today will come along and support us.

In the time I have left, I want to touch on the many challenges faced by those who have left the school system and are now in the workplace. One of the people who came to my constituency surgery last week wanted to talk about the struggles he has connecting with his jobcentre. I have committed to go along with him, meet the new work coaches we have through the roll-out of universal credit, see the application process and see how he can follow it through.

I am particularly pleased that the Government are now looking at tailoring support for those struggling to enter the workplace, recognising that those left seeking jobs have individual needs, and are looking to ensure that individual specialists are in place in jobcentres, including those ready to help people with mental health difficulties.

I want to again ring the bell for what we can do better in schools, so that we can support them to make sure that the issue of mental health for those on the spectrum is recognised. We must also absolutely believe that we can all do better, across parties.

Photo of Liz Twist Liz Twist Labour, Blaydon 4:15 pm, 30th November 2017

First, I thank Dr Cameron—sorry for my pronunciation—for her thoughtful and comprehensive speech, and for setting out the difficulties that people with autism face. I am tempted to say, “What she said,” but I do not think that does justice to the situation.

I just want to touch on a few points. Earlier this year I met Autistica, a charity that does research into autism. If other hon. Members have not seen its report “Personal tragedies, public crisis”, which looks into why people with autistic spectrum disorders die early—up to 16 years early, as the hon. Lady said—I would encourage them to do so. It makes shocking reading. The key points include the point that autism in itself is not a mental health problem, but that eight out of 10 autistic people will face mental health difficulties, such as anxiety and depression. Four out of 10 children with autism have two or more mental health problems. The research also shows that suicide is a leading cause of death among people with autism. Autistic adults without a learning disability are nine times more likely than others to die by suicide, and autistic adults with a learning disability are twice as likely to be die by suicide. Those are shocking figures. Suicide is preventable, and we need to do much more to reduce those figures.

We also need to recognise some of the specific problems people face. As other Members have said, many mental health problems can look different in autistic people. We need to recognise that and make sure that the issue is addressed, and that people have the appropriate treatments and are dealt with properly.

Photo of Barry Sheerman Barry Sheerman Labour/Co-operative, Huddersfield

My hon. Friend is quoting from an excellent piece of research, but is she aware that the autism commission I chair has conducted a piece of work about the spectrum of obstacles and the difficulty that people with autism face in getting through to the right people in the health service? Those two pieces of research are so powerful.

Photo of Liz Twist Liz Twist Labour, Blaydon

I thank my hon. Friend for that intervention, and I absolutely agree that the two pieces of work go together and can help us to improve services for people with autism spectrum disorders.

As others have said, it is becoming increasingly obvious that some mental health therapies are not right for people with autism and do not work in the same ways that they do for other people, and we need to do more research into those areas.

It can be difficult for autistic people to approach services for support, and we have already heard about the issues with going to a GP surgery. Autistic people and their families are also left fighting the system too often, because information is not shared.

We need to do a number of things. First, as others have said, we need to diagnose autism much earlier so that appropriate interventions may be offered to people with autism and their families. Secondly, we need to record people who have autism on GP records and collect data so that we can identify the issues and develop appropriate services. It is good that, in the Westminster Hall debate in September, the Government committed to gathering data. I hope the Minister can update us on progress on that.

Next, it would be useful to hear from the Minister what progress is being made on developing the autism care pathway proposed in the “Five Year Forward View for Mental Health”, and whether it will address suicide specifically.

There is concern that suicide prevention measures are not well designed for autistic people. I hope that the Minister will look at what needs to be done differently to reach and support autistic people in crisis.

Finally, none of the recent cross-Government suicide prevention strategies makes reference to autism. Given that we now know that the risk of suicide is so high in the autism community, and that there are very different issues to be considered, as we have heard, will the Minister commit to ensuring that the next strategy looks directly at how to help autistic people in crisis?

Photo of Kevan Jones Kevan Jones Labour, North Durham 4:20 pm, 30th November 2017

I join right hon. and hon. Members in congratulating Dr Cameron on securing the debate, and thank the Backbench Business Committee for granting it. The hon. Lady pointed out, as did my hon. Friend Liz Twist, that the percentage of people who take their own life is nine times greater among people with autism than the general population. As my hon. Friend said, autism is linked to depression and anxiety.

I welcome the debate because it is another example of this House talking about mental health. People know that I think the more we talk about it, the better the debate gets. I think people should be congratulated on that. I place on the record my thanks to the charities and the army of volunteers who work with adults and children with autism, because they are unsung heroes.

I want to raise two points. One is about waiting times; the other, which the hon. Member for East Kilbride, Strathaven and Lesmahagow raised, is about how we develop pathways. In Durham, we currently have a two-year waiting list for autism diagnosis. I have tried to get to the bottom of why that is. It is only when you meet some of the parents of the young people that you see what a tragedy it is. The pressure on those families is so great that I suspect some are developing mental health issues. I am really concerned about the lost opportunity for those children, because everyone only gets one chance at education, and there are cases where children have been out of school for nearly a year, waiting for diagnosis. I am aware, as I think we all are, of the pressures that there are on child and adolescent mental health services and social services, but we must try to streamline the pathway to early diagnosis.

Huw Merriman spoke about schools. The most appalling thing I have seen is that a school excluded a child with autism, even though he had a diagnosis, because “he was too difficult”—and clearly affecting the league tables. We should monitor that, because it is a disgrace. Thankfully, the local authority stepped in and put that right, but the pressure on that parent and the child is unacceptable.

We are talking about mental health and a Health Minister will reply to the debate, but this issue is wider than just health. We have made great strides in terms of parity of esteem, and the point that Mrs Trevelyan made is right. We are winning that battle. Now we need to win the next battle, and that is how we hardwire mental wellbeing into public policy. That is not just health; it is education, housing, social care, local authorities—

Photo of Kevan Jones Kevan Jones Labour, North Durham

And employment, as my hon. Friend says from a sedentary position.

There is another big problem that a lot of individuals with autism encounter. They go through the school system. Education finishes and they transition into work. I know of quite a few examples of this from my constituency. A lot of these young people, who are perfectly capable of engaging in some type of employment, seem to get lost in the system. The pathway that the hon. Member for East Kilbride, Strathaven and Lesmahagow mentioned must therefore continue from diagnosis all the way through an individual’s life and involve a cross-section of services, not just health. To get that idea hard-wired into the system, the Government must make sure that, from Cabinet Committee level downwards, consideration of mental health and mental wellbeing forms part of the process of policy making in each Department. The last Labour Government did something similar with veterans.

Photo of Kevin Brennan Kevin Brennan Shadow Minister (Digital, Culture, Media and Sport) (Arts and Heritage)

I am grateful to my hon. Friend for giving way, because I know that time is short. Does he agree that those Cabinet Committee-style discussions should involve ensuring that the Ministry of Justice and the Home Office understand the ways in which people with autism come into contact with the criminal justice system and understand the behaviours—such as stimming, which is often misinterpreted and ends up with people being arrested—that those individuals exhibit?

Photo of Kevan Jones Kevan Jones Labour, North Durham

I totally agree, because autism is not just a health issue. The hon. Member for Berwick-upon-Tweed made a very good point. How many times have we seen people reacting to a child in a supermarket kicking off, as it were, with no recognition of the fact that the child is on the autism spectrum or of the challenges that that poses for the parents? We need to hard-wire that idea in.

The Government also need to look at health funding. I accept that they have committed to more funding for mental health, but the system that was set up in the Health and Social Care Act 2012—I hate to come back to it—makes it more difficult for the money that goes in at the top to get to where it is needed on the ground. If I were a Health Minister, I would be completely frustrated by the fact that I was pushing a lever that was not connected to anything. Clinical commissioning groups and others are taking money that should be going to mental health and diverting it towards other priorities, which I accept they see as important.

I finish by again congratulating the hon. Member for East Kilbride, Strathaven and Lesmahagow and everyone who has spoken. The debate has allowed us to shine a spotlight on mental health again—that is a good thing—on autism, which is not widely understood in the broader community, and on the particular challenges faced by those on the autism spectrum who suffer from mental illness.

Photo of Patricia Gibson Patricia Gibson Shadow SNP Spokesperson (Consumer affairs) 4:27 pm, 30th November 2017

I add my thanks to my hon. Friend Dr Cameron. I think I am the first person to pronounce the name of her constituency correctly. I am pleased once again to participate in a debate about autism, a condition that, as we all know, for too many years has not been sufficiently recognised or its challenges fully appreciated. That is starting to change, which is good news for all who are living with autism and who have been either not recognised or misunderstood for too long.

Autism is not a mental health condition, but autistic people are more likely to develop mental health problems such as anxiety disorders, OCD and depression. That is for a host of reasons, such as not being supported and experiencing social isolation. Research shows that a diagnosis of autism can lead to an increased risk of mental health conditions.

Support for those living with autism is very important, as has been widely recognised in the Chamber this afternoon. Anxiety disorders are very common among those on the autism spectrum. Roughly 40% have symptoms of at least one anxiety disorder at any one time, compared with around 15% of people in the general population, and such disorders in themselves can lead to depression.

It is very worrying that young people living with autism are 28 times more likely to consider suicide than other young people are, and it also affects adults who have not been diagnosed. There is no doubt that people with the condition have an increased risk of suicide, as my hon. Friend has pointed out. That could well be because 66% of autistic people and 67% of their families have reported feeling socially isolated.

Photo of Madeleine Moon Madeleine Moon Chair, Defence Sub-Committee

Does the hon. Lady recognise that another major problem for families of autistic children is that should one of their children take their own life, the postvention support—the after-suicide support—is not there either, so the social isolation that they experienced in life continues after death and complicates families’ grief? That area must also be tackled.

Photo of Patricia Gibson Patricia Gibson Shadow SNP Spokesperson (Consumer affairs)

I absolutely agree with the hon. Lady’s excellent point. Should such a tragedy occur and a suicide take place, it is important that the family is supported through that as much as possible.

Some 70% of autistic people are reported to have mental health disorders, such as anxiety or depression. As we have heard, suicide is one of the leading causes of death in the autism community, and that alone tells us that this issue demands our attention. As Liz Twist pointed out, diagnosis is important because it should be the foundation on which effective support for autistic individuals and their families is built. Similarly, a delay in diagnosis can hinder effective support and prevent intervention strategies from being put in place.

The National Autistic Society Scotland reported in 2013 that 61% of those it had surveyed said they felt relieved when they received a diagnosis, because such a diagnosis can end years of feeling misunderstood and isolated. We have talked a lot about this as a UK issue, but as a Scottish MP, I want to mention the Scottish Government’s strategy for autism. The strategy, which is based on research, is working to improve waiting times for diagnosis and assessment to create consistent service standards across Scotland, and is providing training opportunities. The entire autism spectrum needs to be addressed, as well as the whole lifespan of people living with autism in Scotland. This is the logic behind this autism strategy, so it is a very positive step.

We have heard about initiatives such as autism hours in supermarkets and special autism-friendly cinematic screenings, and these are all very important and positive steps. There is a greater awareness and understanding of autism in this country but, as we have recognised today, we still have a long way to go. I will end by saying that we often think of those with autism as finding it difficult to see the world as we see it, but the truth is that we need to see the world as they see it, because if we do so we may then be able to start to make real progress.

Photo of David Linden David Linden SNP Whip 4:32 pm, 30th November 2017

Thank you, Madam Deputy Speaker. On St Andrew’s day, may I say what a pleasure it is to serve under the chairmanship of a daughter of Elderslie?

I commend my hon. Friend Dr Cameron for securing this debate, and it is a real pleasure to follow my hon. Friend Patricia Gibson, although I am beginning to be a bit disappointed that I do not have three communities in my constituency name. I welcome the opportunity to take part in this debate, and to sum up on behalf of the Scottish National party.

Today’s debate is on a very serious and important issue. It is important to address it for a multitude of reasons, but primarily because of the prevalence of poor mental health in those living with autism. About one in four people across the UK have a mental health problem, but the figure for autistic people is almost four out of every five. As Liz Twist mentioned, the autism research charity Autistica reports that up to two thirds of autistic adults have thought about committing suicide and, quite shockingly—this figure is utterly concerning—35% have attempted suicide. Although only about 1% of people in the UK are autistic, up to 15% of the people hospitalised after attempting suicide have a diagnosis of autism. These are very sobering statistics, which is why it is crucial that this issue is out in the open, and I am very glad that we have managed to bring this debate to the Floor of the House today.

Despite all this information, there is not much research to indicate why such a disparity exists, and I will come back to that point in a moment. That is why the research projects commissioned by Autistica—the ongoing work with the University of Nottingham on understanding suicide and autism—are to be commended. While we await the findings of this research, we must continue to do all we can.

Given that people with autism are more likely to be diagnosed with a mental health condition, early diagnosis and support are vital. Delays in diagnosis can hinder the implementation of effective support and intervention strategies. Members from other nations in the UK will no doubt know—indeed, they have highlighted this—where such delays are, but I would like to say a few words from a Scottish perspective. I will not, however, repeat what my hon. Friends the Members for East Kilbride, Strathaven and Lesmahagow and for North Ayrshire and Arran have said, for reasons of time.

The Scottish Government acknowledge that there is more we can do to improve waiting times, which is part of the strategy that was outlined by my hon. Friend for North Ayrshire and Arran. Surveys have shown that a positive diagnostic experience is associated with lower levels of stress and more effective coping strategies. Shorter waiting times for diagnosis can not only cut down on the time during which autistic people may feel misunderstood and isolated, but allow proper support to be given, which is very important. In addition to working towards faster diagnosis, the Scottish Government are investing record sums in mental health. Luciana Berger is no longer in her place, but I know that she has an interest in this. I commend what she has done in mental health. This financial year, investment in mental health for NHS Scotland will exceed £1 billion for the first time. This represents a huge increase on the £650 million spent in 2006-07, and it underlines the greater seriousness with which mental health in general is now being treated. I welcome that.

I am the son-in-law of someone who has recently retired from a medical practice in Stornoway. My mother-in-law would often say that about half the people who came through the door had mental health issues, but that was not necessarily how the funding had been distributed in recent years.

Photo of Jamie Stone Jamie Stone Liberal Democrat, Caithness, Sutherland and Easter Ross

I praise the SNP Government for their autism strategy. I can see the benefit of it in my constituency. The only slight point I would make is the tiniest wee niggle. Does the hon. Gentleman agree that the good work that the Scottish Government have done could perhaps be more widely advertised? There is still a slight gap between the Scottish general public’s understanding of it and the work that has been done. Perhaps via advertising or some sort of media campaign, it would be good to flag that.

Photo of David Linden David Linden SNP Whip

I am more than happy to agree with the hon. Gentleman on that. He brings considerable experience to the House; he is a former Member of the Scottish Parliament.

The additional funding for 800 additional mental health workers in key settings such as accident and emergency departments, GP surgeries, custody suites and prisons will reach £35 million by 2022. This local provision is crucial in ensuring that those with mental health problems get the help that they need when they need it. There is still much more to do, but we are moving in the right direction and clearly taking these matters seriously.

All these figures and actions might seem like hot air, but there is an understanding in this place that they can make the difference between life and death for some people. It is crucial that we get this right and learn from past mistakes if we are to prevent what are in essence preventable deaths.

It is clear from the shocking statistic that I gave earlier —that 35% of autistic people have attempted suicide—that much more can be done. There is a big challenge here and if we cannot collectively take responsibility and see that percentage fall, we will fail all those who live with autism.

I am conscious of the time and I want to make sure that my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow has a significant amount of time to wind up, but before I conclude I pay tribute to a few of the organisations that do fantastic work in Scotland such as the Autism Network Scotland and the National Autistic Society for Scotland. At this juncture I commend Bob MacBean of the National Autistic Society, a former Labour councillor in my constituency. Scottish Autism continues to do fantastic work, not least in conferences and children’s mental health. At a much more local level, in my constituency of Glasgow East, local families engaged with PACT for Autism came to visit me at one of my recent surgeries at Parkhead library. PACT is a friendly, parent carer-led support group that provides support, information and advice to all with a focus on autism spectrum disorders. I am sure that all hon. Members will have these kinds of groups in their constituencies. They provide wonderful support at a very local level, and the impact cannot be underestimated. There is a point to be made about the funding for such groups, which is probably a subject for another day.

Something as simple as one of PACT’s regular coffee mornings can be a lifeline for individuals and families in the east end of Glasgow. I commend that and I hope that the House will join me in recognising their work. We realise that such groups do an awful lot to help autistic people and their families to lead happy, healthy lives every single day.

I commend my hon. Friend, but we need to resolve in this place to do everything to ensure that people on the autistic spectrum can lead healthy, happy lives. I wish everyone a happy St Andrew’s day.

Photo of Sharon Hodgson Sharon Hodgson Shadow Minister (Public Health) 4:39 pm, 30th November 2017

I congratulate Dr Cameron and others on securing this important debate and on her excellent opening speech. I thank Autistica, the National Autistic Society and Ambitious about Autism for the important work that they do and the support that they provide for people living with autism.

This is our second debate on autism since our return from the summer recess and it is good that it has been so constructive. I also thank all other hon. Members here for their excellent and passionate speeches. The hon. Members for Berwick-upon-Tweed (Mrs Trevelyan), for Bexhill and Battle (Huw Merriman) and for North Ayrshire and Arran (Patricia Gibson), and my hon. Friends the Members for Bristol West (Thangam Debbonaire), for Blaydon (Liz Twist) and for North Durham (Mr Jones), all spoke movingly, often from personal family experience or about constituents. This debate may have been short, but it has none the less been very powerful.

It is important to say that autism is not a mental health condition: it is possible to have both autism and good mental health, but that is not always the case, as we have heard. Between 70% and 80% of autistic people develop mental health problems such as anxiety and depression, and four out of 10 children with autism have at least two mental health problems.

Adults with autism who do not have a learning disability are nine times more likely to die by suicide than the general population; those with a learning disability are still twice as likely to take their own lives. Clearly, more needs to be done to support the mental health needs of people living with autism. Reducing the health inequalities experienced by people living with autism is a priority for the NHS mandate for 2017-18, and that is welcome. Mental ill health is a major contributory factor to health inequality for people with autism. Ensuring access to appropriate mental health care is important in the fight to tackle these disparities.

However, there are too often significant barriers to accessing the right treatment. In a debate in September, we talked about waiting times for autism diagnosis—it is a scandal that those can be as long as 125 weeks. Accessing a diagnosis is the first step towards securing the support that people living with autism need, and that is also true for mental health support. We are pleased that data on autism diagnosis waiting times is going to be collected and published from April 2018; hopefully, it will help to drive an improvement in this area.

Today, I want to focus on how mental health services can be improved for people living with autism. Last week, my hon. Friend Dr Williams told the Health Committee about T, a young boy with autism. As we heard from the hon. Member for East Kilbride, Strathaven and Lesmahagow, T was rejected four times for treatment by child and adolescent mental health services, despite reporting suicidal thoughts and having a family history of suicide. He was rejected because he had not yet attempted to take his own life.

The Children’s Commissioner for England confirmed concerns about the issue when she stated to the Health Committee that this type of situation was now “the norm” within children’s mental health services. That is worrying generally for children’s wellbeing, but for those living with autism it is particularly so, for a number of reasons. Experiences of suicide are different in the autism community from those in the wider population; relying on certain behaviours and expectations of what someone in need of support will look like can be dangerous.

As the Children’s Commissioner put it, children with mental health problems will become adults with mental health problems very soon. We cannot continue to miss opportunities to intervene early. That means, sadly, that T’s experience is just one of many. The five year forward view for mental health recommended that NHS England develop autism-specific mental health care pathways, but there is currently no information on the timetable, the scope of the pathway or who will be leading the issue. The pathway should cover children, young people and adults on the autism spectrum. It should take into account the fact that mental health conditions can present themselves in different ways for people with autism and it should recognise that mental health treatment may need to be tailored for people with autism. I hope the Minister will reflect on that in her response. Will she tell the House when and how the pathways will be developed?

Early intervention and prevention should form the basis of our mental health services. However, too often specific issues make it difficult for people with autism to access that early support that is so vital. The first point of call for many people experiencing mental health problems is their GP; for many people with autism that can be difficult, as GP surgeries are often not autism-friendly. This is how one autistic adult described their experience:

“When anxiety is really bad I start to feel a panic attack at the prospect of just having to step out of my front door. So having to go to the GP is like having to climb Everest.”

It is important that GPs understand that every autistic person is different, and that each person may need some adjustments to be made before he or she can feel comfortable about attending the local GP’s surgery. For example, some autistic people may be hypersensitive to sound and light and may therefore need an appointment at a quieter time of day, while others may be hyposensitive and benefit from a more stimulating environment. GPs may also need to tailor the way in which they communicate with patients—for instance, using clear language, or finding ways of communicating with somebody who does not speak. To do that, GPs must be able to access detailed and accurate records about their patients’ needs. Currently GPs often do not record much information about their autistic patients, and may not even record that a person is autistic at all.

In August, the National Institute for Health and Care Excellence recommended that GPs keep a set of local autism registers similar to those kept for people with learning disabilities, asthma and diabetes. Will the Minister tell us when she expects the NICE recommendations on autism GP registers to be adopted, and whether NHS England will work to ensure that the data gathered is used to inform better commissioning of autism and mental health services?

We have heard powerful accounts today from Members on both sides of the House about what happens when we get mental health treatment wrong. It is all too easy for people with autism to receive inappropriate mental health treatment, or to be blocked altogether from access to treatment. As the Government review the Mental Health Act 1983, it is important that they consider everything that has been raised in today’s debate and ensure that autistic people are supported. The shocking suicide statistics and testimonies from Members today show starkly how crucial it is that more is done on the issue, and the power is in the Minister’s hands. I hope that she has listened and will act.

Photo of Jackie Doyle-Price Jackie Doyle-Price The Parliamentary Under-Secretary of State for Health 4:47 pm, 30th November 2017

I have greatly enjoyed listening to the debate, because I have heard so much good common sense and so much passion and care expressed about this important issue. It has been a pleasure. I am glad that we reached it in the end, although it was slightly truncated.

I congratulate Dr Cameron on securing the debate, and I congratulate all the other Members who have participated in it. Everyone was absolutely right to say that we need to understand more about mental health, autism and suicide, and to understand more about what constitutes appropriate mental health treatment and treatment for people with autism. The existence of the suicide statistics, unpleasant as they are, demonstrates that we really must do better in this regard.

As I have said, I enjoyed all the speeches today, but I pay particular tribute to the hon. Member for East Kilbride, Strathaven and Lesmahagow for the expertise and the personal passion that characterised her arguments. She has given me a lot to think about, but let me reaffirm to her that my door is always open so that I can hear more. I particularly want to hear what the strategy in Scotland has delivered, because she is absolutely right: when we see good practice, we should all share it and ensure that it becomes the norm for everyone.

We can never debate autism without considering the issue of waiting times, and, as Members have pointed out, in some areas they are very poor indeed. As we have confirmed, we will be publishing more data from April which will provide us with the tools with which to “give challenge”. However, it is clear that waiting times are not good enough, especially in the north-east, and we are failing people when we do not give them an early diagnosis.

Kevin Brennan mentioned the criminal justice system, which is where people with autism and mental health issues often end up. As he said, we need to improve the sensitivity with which the criminal justice agencies deal with such conditions. I can tell him that the Ministry of Justice is working with the Home Office and the Crown Prosecution Service to develop new guidelines to help officers to support people. I think I need to do more with the MOJ to ensure that we do not put people in a setting that will damage them further, but I am pleased that there are now liaison and diversion services covering 80% of the country to achieve exactly that.

The hon. Member for East Kilbride, Strathaven and Lesmahagow also described very well, as did Mrs Hodgson, how for some people with autism accessing support from GPs can cause distress in itself. This is where debates such as this can be so useful, because sometimes the most simple, practical things can make the biggest impact. It surely cannot be beyond the wit of any of us to make sure that GPs receive appropriate advice about things like lighting, and even having a quiet area. We often now have multi-service GP and health centres, and there must be space in them to have a quiet area.

Photo of Madeleine Moon Madeleine Moon Chair, Defence Sub-Committee

One of the risks is that, rather than going to their GP, people will look on the internet, where, sadly, they will find far too much information about how to take their own life and what methods to use. Also, if they go into chatrooms to share, they find encouragement to take their own life. This is an area that we must tackle.

Photo of Jackie Doyle-Price Jackie Doyle-Price The Parliamentary Under-Secretary of State for Health

I thank the hon. Lady for that intervention and the work she does in this area; I know she cares about it a great deal. She is absolutely right that there is a serious vulnerability among people who feel uncomfortable about accessing medical care. We must consider the proximity of the internet where it is possible to buy drugs and where nobody really understands what they are buying. We can do a lot more to enable people to protect themselves. The internet is a great source of information, but it can be less than benign when people want to use it for these purposes.

I have limited time and know I will not be able to do justice to all the contributions to the debate, but I will do my best. If I do not cover them all, it is not because I have ignored any of the points raised; rather, it is because there were too many good speeches to address in a short space of time.

Thangam Debbonaire made some extremely good points. She rightly highlighted the issue of unemployment, and I, too, am particularly concerned about that. We have just published the work and health strategy, and this is an area where we need to do better. The reality is that there is a great skillset here for particular disciplines, and enlightened employers recognise that. We can do a lot more to spread good practice here, as with GP surgeries, such as about what would be sympathetic interview styles for people with autism, so that we can enable them to become integrated. The hon. Lady is right that work is probably the best tool with which to protect our mental health, and we will look at that.

I was also intrigued by the hon. Lady’s autism surgeries, and wonder whether she might consider making that a toolkit that all of us with an interest in the issue could roll out in our own surgeries. Again, a lot of this is about raising awareness of the challenges people with autism face. We are in the public eye and have the ability to do that, so I ask the hon. Lady to tell me how she organised those surgeries.

My hon. Friend Huw Merriman rightly mentioned schools. There is a problem with provision, and whether we always get it right—whether it should be mainstream or alternative provision, and whether we have enough places for alternative provision if that is the appropriate setting. That is particularly challenging in my local area, but it is not fair to fail individuals by excluding them because maintaining them in mainstream schools is either challenging or not appropriate for them. The state needs to ensure they get appropriate schooling.

My hon. Friend Mrs Trevelyan spoke at length about her own experience and set me a number of challenges. I will be happy to report to her on them. I can also give her every guarantee that the data she asked for will be made public next year.

I shall now turn to some of the things we are doing to develop the autism pathway and autism strategy. We have set an expectation in the NHS mandate that the NHS will reduce the health gap between people with mental health problems, learning disabilities and autism and the population as a whole, and support them to live full, healthy and independent lives. We acknowledge, however, that the complexity of autism and the multifaceted nature of the needs of those on the spectrum poses particular challenges to professionals and commissioners. I am keen that mental health should be considered by the new task and finish groups that are being established to implement the autism strategy, and I will ensure that progress is made in implementing the strategy in line with the Autism Act 2009.

It is important that the NHS accommodates the requirements of vulnerable groups such as autistic people through staff training, awareness raising and reasonable adjustments to services, as we have heard. Autistic people should be able to access mental health services like everyone else if they are supported to engage with services and helped to explain their problems so that they can receive treatment. They should not fall between two stools—between autism or learning disabilities services on the one hand and mental health services on the other. We need to ensure that we are giving bespoke treatment and care to people with both issues.

A lot of the treatments that we are developing in mental health will not be suitable for people with autism. We are therefore looking at what we can do to alter the psychological therapies that are available to make them more user-friendly and sympathetic to people with autism. I was horrified to hear what was said about group therapy. I am a lay person, but it is pretty obvious to me that group therapy is not appropriate for people with autism. Clearly, the fact that that is happening is an indication of how much more we have to do to ensure that society is more sensitive to the needs of those people.

I am running out of time, and I really want to hear from the hon. Member for East Kilbride, Strathaven and Lesmahagow, but I just want to emphasise that research will play an important role. We are looking at many projects at the moment. There is a research theme on neurodevelopmental disorders, and a project at Avon and Wiltshire Mental Health Partnership NHS Trust looking into guided self-help for depression in adults with autism, as well as work at Leeds and York Partnership NHS Foundation Trust. In the East of England, a project is being led by Professor Simon Baron Cohen focusing on suicide, autism and autistic traits, which will obviously be of interest to everyone who has participated in the debate today. I am grateful, too, for the research undertaken by Autistica, which has really highlighted this issue and brought us to where we are today. I am pleased to say that Autistica has met the national suicide prevention strategy advisory group, which advises the Government on the national suicide prevention strategy, to talk about its research. We will be reflecting on the advice that it has given us.

I thank everyone once again for participating in the debate. As I have said, I am always interested to hear about good practice and what more we can do. Rest assured, we still need to do much more to support people with autism, and particularly to ensure that they can access appropriate mental health services.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health) 4:57 pm, 30th November 2017

This has been a wonderful debate. It has been truly cross-party and collegiate, and we must work together to improve the lives of people across the autistic spectrum and the services that we provide for them. This is about lifespan, so it involves a number of services for all aspects of the lifespan. It is also about streamlining the transfer from child to adult services. This is a multi-departmental matter, and I urge the Minister to speak to other Departments to ensure that the autism strategy is embedded in all their policies. As has been said, we need more early diagnosis, awareness and support in schools, and treatments that can be adapted. There is also vital research to be done, and we could be world leaders in that regard. That is a key aspiration that we should endeavour to meet. People with autism need support from school to the workplace, and carers and families also need support. We also desperately need to provide crisis services. Parliament must be inclusive, and I am keen to hear more about what we can do as individual MPs, both in our surgeries and through Parliament, to take these issues forward. We need to make our surgeries autism-friendly places, to ensure that we are role models in service development.

The Minister has many issues to take forward, and I am thankful for her response. I am glad that her door is open, because I might be coming through it on numerous occasions. I am also keen to visit the projects that she has described, which are going to pave the way for progress. It is vital that we take this forward and save lives. Let us work together and do this right across the United Kingdom. Finally, I would like to wish everyone a happy St Andrew’s day.

Photo of Eleanor Laing Eleanor Laing First Deputy Chairman of Ways and Means

Happy St Andrew’s day.

Question put and agreed to.

Resolved,

That this House
has considered the support available for autistic people experiencing mental health problems;
calls on the Government to ensure that the NICE-recommended indicator for autism in GP registers is included in the Quality and Outcomes Framework;
and further calls on the Government to ensure NHS England works closely with the autism community to develop effective and research-based mental health pathways.

Photo of Ian Blackford Ian Blackford SNP Westminster Leader 4:59 pm, 30th November 2017

On a point of order, Madam Deputy Speaker. I want to raise with you a conversation that I have had in the past few minutes, in which I have been informed that Royal Bank of Scotland is going to close three branches in my constituency, at Kyle of Lochalsh, Beauly and Mallaig. I am asking for your assistance, Madam Deputy Speaker. What do I need to do in order to ask one of the Treasury Ministers to come to the House to discuss this important matter? We understand that Royal Bank of Scotland is operationally independent, but none the less, we as the state are the majority owners of the bank. The bank in Kyle is one hour’s travelling distance to the nearest Royal Bank of Scotland branch in Portree. The one in Mallaig is an hour’s distance to Fort William. Those banks have thousands of customers. The branch in Beauly is the last remaining bank in that village. We need to have an urgent debate in the House about the responsibility that banks such as Royal Bank of Scotland have to their communities.

Photo of Eleanor Laing Eleanor Laing First Deputy Chairman of Ways and Means

I thank the right hon. Gentleman for his point, but he knows that it is not a point of order for the Chair and I cannot give an answer on the substantive issue that he has raised. He seeks my advice, however, on how to bring a Minister to the Dispatch Box, and I can advise him that there are various methods that he can use to do that. He might like to consult the Table Office on the best way forward. I am sure that he will also consider other ways, such as approaching the Backbench Business Committee in order to arrange a debate, if he is so inclined. If he is certain that this is a matter that ought to be discussed on the Floor of the House, I am sure that his ingenuity will ensure that that happens.