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My Lords, in Her Majesty’s gracious Speech yesterday, we heard that the Government will,
“promote a fairer society that rewards people who work hard … where aspiration and responsibility are rewarded”,
and where people,
“who have spent years caring for children”— and, I hope, other dependent relatives—are given more help with their pensions.
As a psychiatrist, I have been reflecting on how these commitments will affect people with mental illness or intellectual and developmental disabilities, and their families—groups that I have particular knowledge of. In my experience, these people are not short of aspirations but their work opportunities are severely restricted. I am sure that it is not the Government’s intention to make people who cannot contribute economically feel like an unwelcome burden, but there is a risk that younger disabled people and older people nearing the end of their lives will feel unwanted. As Giles Fraser wrote in the Guardian last week, speaking about the end of life:
“I do want to be a burden on my loved ones just as I want them to be a burden on me—it’s called looking after each other … This is what it means to love you”.
We need a societal response that is also accepting of burden at all stages of life.
During the previous parliamentary Session, the Government made some laudable steps towards addressing the inequality and discrimination that people who have experienced mental illnesses have historically faced. The explicit inclusion, under Section 1 of the Health and Social Care Act, of mental health and mental illness alongside physical health and illness in new Section 1(1)(a) and (b) of the National Health Service Act 2006 is just one example, but the existing lack of parity between physical and mental health care is highly significant.
A recent, comprehensive report by the Royal College of Psychiatrists, Whole-person Care: From Rhetoric to Reality, estimated that mental illness represents nearly 23% of the disease burden in the United Kingdom, yet mental health care receives only 11% of the NHS budget. Despite mental illness representing the largest disease burden in the UK, it remains relatively underfunded, underresearched and underprioritised by politicians and policymakers. This situation needs urgent attention if parity of esteem and equality for those who experience mental illness is ever to be achieved.
Mental health is not just a matter for health and social care services. A recent study of people with depression found that more than three-quarters described discrimination in at least one area of their lives, and a quarter had not applied for employment because of their illness. The current financial crisis is at risk of disproportionately affecting those with intellectual and developmental disabilities. This group often relies on state assistance to maintain equal access to basic human rights and to achieve the most fundamental of life goals, such as having a safe and comfortable place to live, and accessing education, healthcare and appropriate advocacy when needed. It is vital that in understanding the vulnerability of these people, their needs are prioritised and protected in all legislative changes.
This is perhaps never more important than in times of economic austerity, when competing demands on limited funds may result in disadvantage being compounded and those least able to advocate for themselves losing out to more vocal or visible interests. In striving for equality for people with learning disabilities, we need proactive legislation that addresses entrenched discriminatory practices and processes, and to scrutinise all legislative changes from their perspective.
Further legislation announced in the gracious Speech proposes to reform the way in which offenders are rehabilitated. This should provide the Government with an opportunity to access particularly vulnerable groups of people, who are often difficult to engage, with high rates of reoffending. The Prison Reform Trust, as part of its “No One Knows” project, estimated that,
“20-30% of offenders have learning difficulties or learning disabilities that interfere with their ability to cope within the criminal justice system”,
and I understand that 60% of prisoners have a reading age of less than five.
It is well documented that mental illness and addictions are significantly overrepresented in the offending population; for example, it is estimated that at any one time there are about 5,000 people with a serious mental illness in prison. Planned reforms to probation and rehabilitation services must hold these statistics to heart. Back to work programmes must include provisions for those with learning disabilities and literacy problems. Probation, substance misuse and mental health care services need to collaborate to improve the co-ordination of care and rehabilitation. Careful legislation and reforms backed by appropriate funding could bring great benefit not only to the individuals concerned but for society in its broadest sense.
On the question of victims being hurt and communities damaged, which was raised by the Minister, I must voice my disappointment about the lack of any legislation to introduce minimum pricing for alcohol. The BMA and the Royal College of Psychiatrists both believe that a minimum unit price would lead to a decrease in the thousands of alcohol-related deaths. This is not just a health issue but one that contributes to public disorder, domestic violence and homicide, as well as to suicide.
I will comment briefly on the Government’s plans to reduce crime. Fortunately, in this country we do not have the problem of firearms being widely available in people’s homes, as in the United States. Gun crime is relatively infrequent and, in wanting to reduce crime, the Government will be cognisant of this. However, noble Lords may not be aware that two-thirds of gun deaths in America are suicides and only one-third homicides—perhaps not what the Second Amendment, which permits American citizens to own guns, had in mind.
Our Government have the National Suicide Prevention Strategy, and the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness reviews all such deaths for people in contact with mental health services. After a decade of falling rates of suicide, there has been an upward trend since 2010. The highest rates of suicide in men since 2002 were recorded in 2011. Recent studies have shown what impact specific mental health service improvements have on suicide rates, but there is also evidence that restricting access to the methods used by suicidal people, including medication and guns, reduces the number of completed suicides. Maintaining a strong government position on suicide prevention at all ages and for all reasons is critical and, I suggest, needs a cross-government focus.
My reason for speaking about mental health and disability in today’s Motion for an humble Address is to raise awareness outside the health and social welfare agenda and to make the point that aspirations for a good life are also about relationships and respect, not just economic productivity.
Finally, while on the subject of respect, I must speak briefly about the Leveson inquiry. In supporting the royal charter and its attendant clauses of legislation, this Parliament took a historic step to protect citizens from abuse while safeguarding our free press from political interference. We should be proud of that and should now be able to look forward to the introduction of effective, independent press self-regulation. I trust that there really will be no looking back, despite attempts by editors and their organisations to derail the decisions made by Parliament by arguing for nothing more than the pre-Leveson status quo. Our press carries much responsibility for the tone of public discourse. I hope that our debates in this House will try to set a tone that others will follow.