My Lords, I, too, congratulate my noble friend Lady Neuberger on such a timely debate and, as one might have expected in a debate secured by her, on assembling such a wonderful list of contributors.
I say that the debate is timely for two reasons. We await with eager anticipation whatever is due to emerge as the new Mental Health Bill. My noble friend Lord Carlile said that the draft Bill had been kicked into the long grass but only a few weeks ago, the Minister in another place, Rosie Winterton, assured Members of both Houses that a Bill would be introduced in this Session and that, contentious as it might be, it would not be subject to pre-legislative scrutiny.
There is an element in the timing of tonight's debate that is slightly unfortunate. The Audit Commission will tomorrow publish its report on managing finances in mental health. Unfortunately, the report is embargoed until tomorrow, but I suggest that it will make extremely interesting reading.
I had the privilege of being on the Joint Committee on the draft Mental Health Bill, chaired so ably by my noble friend Lord Carlile. As we sat there week after week, listening to people tell us how much they hated the Government's draft proposals, the evidence of one young man stood out. He came to talk to us about the Child and Adolescent Mental Health Services; he had been a service user. He talked about just what being subject to compulsory treatment does to somebody and how disempowering it is. He then talked about what it was like to have been subject to compulsory treatment—to sit in a ward where nothing much is happening, one does not know when one will get out, it is hot and one cannot go outside, and there is an immense amount of boredom. He said to us, "You know that in that situation, the smallest of things can tip you over into a crisis—not being allowed to decide which TV programme you can watch or being locked up with people you don't like". For the first time, he began to make me understand what this whole system does to individuals and why it does not work.
It is true—and I am sure that the Minister will tell us in his reply—that there have been increased resources for mental health. There has been a 10 per cent real increase in investment in adult acute inpatient facilities since 2001–02. At the same time, there has been an overall increase of 25 per cent in adult mental health services. As my noble friend Lady Neuberger said, problems that we thought would be addressed by crisis resolution teams, assertive outreach teams and so forth have not managed to decrease the number of people being referred for acute services.
What then can one draw from this welter of reports, all of which indicate problems in acute mental health services? Perhaps one of the first things is that care plans are not implemented. If an emphasis were placed on involving users in the design of care plans and in their implementation, many of the acts of violence and so forth to which my noble friend Lady Neuberger referred would not happen, because the source of such aggravating problems would have disappeared from the lives of people who were already feeling pressured and largely ignored.
Secondly, links between the acute and community sectors must be improved. Throughout the rest of the acute services within the NHS, much greater emphasis is now put on the process of rehabilitation and discharge and on the transition from an acute setting to a community setting. I was very interested to listen to what the noble Baroness, Lady Murphy, had to say—I always am—about how community teams and acute teams never see the person they are treating in the other setting. If they were to do so, that process of transition and discharge could be made more accessible. There could be far fewer avoidable re-admissions.
My noble friend Lord Carlile was absolutely right when he talked about this as being an illness, but one that we simply do not treat in the same way as any other illness. For example, we would not in any other setting where people were receiving treatment put together young people and old people or men and women. It is staggering that, despite the investment in resources, adult wards are still receiving children as young as 14. That is inappropriate, in some cases dangerous, and, to them, it is frightening. We would not let it happen in any other healthcare setting.
What can we take from these many reports that might be hopeful? One thing in particular stood out for me—the emphasis on access to talking therapies. When my noble friend Lord Carlile and I were privileged to go to those centres in south London, we met a marvellous assertive community outreach team. But we also met service users who told us that they were going into debt in order to pay for talking therapies which they needed and could not access any other way. Individual people should not be driven to the point of knowing that there is a source of healthcare that they need and then having to pay for it. It does not make sense for the NHS either, because the lack of access to talking therapies in community service almost inevitably leads to a build-up of demand on the acute services when people reach a crisis point.
Much is going on and much notice is being paid in the world of mental health to Professor Layard's recommendations about the use of cognitive behavioural therapy for depression. We should also recognise that NICE has recommended that cognitive behavioural therapy should be available for people with schizophrenia. The lack of access to that is taking a great and unnecessary toll on many of the acute services within the NHS. If one were to talk to many of the professionals, they would say that that would be one thing that the Government could do that would make a real difference to the picture overall.
My noble friend Lady Neuberger and others talked of the ongoing problem of the disproportionate numbers of people, particularly young men, from black and minority ethnic communities, who are in our acute mental health services. I sympathise with those from the Sainsbury Centre for Mental Health who wonder how often they have to raise this before the issue is really taken on board, because they have been quite explicit that what we are talking about is the impact of institutional racism within mental health services, disproportionately adversely affecting one part of our community.
Many times when people talk about mental health, they talk about the much-forgotten need to remember that the physical health of people with mental health problems should be treated hand-in-hand—and so frequently it is not. Much of what the noble Lord, Lord Ramsbotham, said played well into that point. We know that many people sitting on acute wards are smoking and engaging in other activities that are simply not conducive to all-round physical health. That is a contributing factor overall.
Finally, I want to raise one question that is central to all of this. We are at a point with our mental health services when professionals are working with outdated legislation and there is a great deal of uncertainty and anxiety about the appropriateness of what legislation may come down the track shortly. We have a great deal of good advice and guidance in the national service framework, much of which is not being implemented. In many ways, the world has moved on. Is it not now time to ask what acute mental health services are for, where they should be based and how they should be configured to achieve the optimum therapeutic outcome? If we did that, we might abandon some of the PFI building plans, which have been so dominated by the acute sector. We might free up resources to spend on some of those innovative services that noble Lords have mentioned. We might invest in the voluntary sector rather than taking services away from them, as I understand to be the case. Organisations such as Mind are struggling to fulfil their advocacy role, among others. When we answer the question of what our acute services are for, we shall begin to see the beginning of the end of those inappropriate buildings, of staff working in isolation from those involved in provision of community services, and we shall begin to answer the many questions raised by the many reports.