My Lords, how does one follow such a passionate, energetic and fabulous speech at this late hour? I am afraid that mine is going to sound a bit like “Macbeth”, but I am pleased to have the opportunity to raise a somewhat neglected issue in the Queen’s Speech. I am talking about mental health, which does not feature prominently in the Government’s planned legislation and on which there are some critical issues that I want to raise.
The noble Earl will be pleased to hear that I shall start off on a positive note. I have to say that the coalition Government, when they first came to power, actually made a good start in trying to address inequalities in the area of mental health. In particular, the Government should be commended on their mental health strategy, No Health Without Mental Health, and the ambition it represented to see mental health provision achieve “parity of esteem” with physical health. I was also very pleased when on
However, in spite of these positive developments, the problems are not getting any better. My noble friend Lord Layard, in his report last year with the London School of Economics, set out some of the starkest evidence I have seen that the problems are actually getting worse. For example, those with severe mental illness are more likely to be the victims of violent crime, have poor physical health, and a life expectancy up to 25 years shorter than that of the general population; in fact, mental illness now accounts for nearly half of all ill health suffered by people under the age of 65, and it is more disabling than most chronic physical disease. Yet only a quarter of those involved are in any form of treatment. The hidden costs of this to the economy in terms of lost employment and productivity are immense, at an estimated £105 billion, which is more than the entire NHS budget.
Despite this, only 13% of NHS funds are devoted to the treatment of mental health issues—and I have to question the efficacy and the appropriateness of some of the ways in which that money is being spent. For example, we know from the Health and Social Care Information Centre that prescriptions for anti-depressants are rising. In fact, the NHS in England spent more than £270 million on anti-depressants in 2011—a massive 23% increase on 2010. The NHS spent almost £1 million a week more on these drugs than the year before, resulting in a startling 46.7 million prescriptions a year. Can the Minister explain how this is happening against a background of a national programme to increase access to psychological therapies, which the evidence supports as being far more effective? While we are on the subject, how is increasing access to psychological therapies making a difference for people from black and minority ethnic backgrounds? I fear that even after decades of lobbying Governments of all persuasions to address the disproportionately poor outcomes of people from black and minority ethnic communities in mental health services in Britain, there continues to be little progress with adults and young people. There are some notable successes, such as Open Mind in Leicester, but on the whole the situation is extremely poor.
We know from the Count Me In census, which for the first time collected statistics on ethnic minorities in mental health services, that there are stark differences in access, experience and outcomes for minority ethnic groups in terms of mental health. In fact, some groups of young black men are up to 18 times more likely to be admitted to a mental health ward than their white counterparts. There are also significantly disproportionate numbers for black and minority ethnic women.
These are extremely worrying figures but they are not the only ones. The coalition Government’s own No Health Without Mental Health strategy shows that 20% of children and young people are believed to have a mental health problem. That is a fifth of all children, but we do not know how many of those young people are from a black and minority ethnic background. Given what we know about the breakdown of disorders for black and minority ethnic adults, surely it is unacceptable that these data are not available for minority ethnic children and young people. Can the Minister urgently look into this area and rectify what is obviously a glaring omission? In fact, I would welcome a commitment to gathering these data so that we can get a full picture and be better equipped to start doing something about these gross inequalities. This is vital because I fear that, without proper attention to these issues, the services for black and minority ethnic adults and young people will only get worse, especially against the background of the current upheaval caused by the NHS reforms.
The impact of this disruption within the NHS can also be seen by the fact that Section 117 services, which are for the most vulnerable mental health service users, are under threat again in the Care Bill. I was very dismayed to see that the Government have chosen to return to this issue, given that we have already dealt with it under the Health and Social Care Act. As noble Lords will recall from previous debates, Section 117 of the Mental Health Act concerns the provision of aftercare services for people leaving treatment after a period of detention in hospital. The Government finally accepted our amendments to the Health and Social Care Bill that these vital services should be preserved, and yet here we are again facing significant changes to the definition of aftercare that will in effect remove these services from many people. Clause 68(5) of the Care Bill introduces for the first time a statutory definition of “after-care services”, which I and others believe is too restrictive and could generate complex legal disputes over whether a service should be provided under Section 117. I fail to see the Government’s rationale for this and will be seeking answers from the Minister about the impact of these changes during the passage of the Bill.
Care of the vulnerable should surely be at the forefront of our efforts. I would have thought that after everything that happened at Winterbourne View we should be much more focused on preventing harms. What have we done since the scandal of Winterbourne View? For example, at the time, the case refocused the spotlight on the appropriateness of restraint and physical intervention as an approach to managing challenging behaviour. The review into the failings recommended that the Government should consider banning the use of certain forms of restraint on patients with learning disabilities. Can the Minister update us on the Government’s progress in meeting this recommendation?
However, this issue does not concern only those with learning disabilities. It would be fair to say that the approach to restraint has been confusing and shambolic within the mental health sector as a whole. Many providers do not carry out risk assessment of techniques. If we are to develop appropriate regulations and consistent training for staff, work urgently needs to be done, by appropriate medical experts, on the likelihood and probability of physical and psychological harm with regard to each restraint technique in each position. Restraint is a physical intervention and should be seen as such; therefore, like all other physical interventions, it should be based on evidence of efficacy, safety and acceptability. Is it not time that this issue is reviewed by NICE and clear recommendations made, based on evidence? Finally, the Care Quality Commission should review its actions and ensure that a robust inspection process is in place that covers not only the process of restraint in care homes but the training that staff receive.
In conclusion, I am calling on the Government to take this opportunity to do more to address the inequalities in mental health for black and minority ethnic communities, adults and young people alike; to hold to their commitment to protect aftercare services, as defined by Section 117 of the Mental Health Act; and to bring forward actions to ensure appropriate use of restraint and physical intervention across mental health and learning disability services. I would like to see a clear commitment by the Government to take action within this parliamentary Session to tackle these issues. Without such action, we could be heading towards a crisis point and once again placing some of the most vulnerable people in our communities at real risk.