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Queen’s Speech - Debate (4th Day)

Part of the debate – in the House of Lords at 6:16 pm on 9th January 2020.

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Photo of Baroness Hollins Baroness Hollins Crossbench 6:16 pm, 9th January 2020

My Lords, I will speak about mental health.

I am thrilled by the Government’s commitment to put mental health on an equal footing with physical health. However, this has to be about more than just mental health services. First, greater mental health awareness needs to underpin the Government’s approach to all public services. In her eloquent speech, the right reverend Prelate the Bishop of Gloucester reminded us of the early years manifesto and of the importance of both early intervention and understanding the impact of adverse childhood experiences on future relationships, later mental illness or an increased risk of offending.

The Government would do well to take a longer-term public mental health approach to prevention. In their new investment in schools, are they investing enough in the mental health of pupils and teachers, giving them the skills and resources they need both to implement fully the new curriculum in social, emotional and mental health, and to respond to mental health crises?

Other public mental health approaches are ripe for development and we have heard about some today; for example, measures to reduce the risk of harm caused by online abuse or the harm caused by the sensational and negative behavioural norms so often portrayed in our media, both in print and on television. Public interest journalism requires a responsible attitude; I submit that this includes some responsibility for the public’s mental health.

Of course, investment is needed in mental health services too. The gap between mental health and physical health services remains huge. The Government’s estimate is that mental illness represents 23% of the total so-called disease burden but receives only 11% of NHS England’s budget. Some proposals that could make a real difference in the medium term are: doubling medical school intake, particularly attracting candidates who might make good psychiatrists; making it mandatory for all GPs have psychiatry and paediatric training, as recommended by the Royal College of General Practitioners commission on generalism, chaired by my noble friend Lady Finlay; and consulting on the effectiveness of a fourth emergency service to attend mental health crises in the community and provide health-based places of safety.

I welcome the Government’s inclusion of learning disability and autism as clinical priorities in the NHS long-term plan, and their commitment to introduce learning disability and autism training for all healthcare professionals. As a precaution, I have tabled a Bill that would make such training mandatory; it may prove a useful vehicle to progress the Government’s aim of improving the safety of this group and reducing the health inequalities it experiences.

I am also concerned for the safety and well-being of staff in the public services. At the Second Reading of the Health Service Safety Investigations Bill in the last Parliament, I asked:

“If the HSSIB undertakes investigations of the systems failures that result in risks to the safety of patients, could we not include the safety of staff too? After all, the same systems underlie risks to both groups.”—[Official Report, 29/10/19; col. 915.]

Will the Government respond positively to the growing requests for staff safety to be included in this Bill?

I welcome the commitment to produce a national disability strategy, which should make it easier to think about the needs of disabled people early in the preparation of relevant policies rather than considering impact and relevance only later. As always, I will be looking at whether the lives of people with mental illness or learning disabilities, and the lives of autistic people, will be centre stage. I always say that if we can get it right for people with learning disabilities, we can get it right for everyone.

This brings me to social care. The social care crisis has considerable mental health consequences—for the people who need care and support as well as for those providing both formal and informal support. Fixing it requires the effective integration of health and social care. More than half of social care spending in England is on working-age disabled adults; that is, people who need various forms of support and not just personal care, which is more often needed by older adults. They may need help to access healthcare, manage finances, access community events, sustain contact with friends and family, and to gain and stay in employment. These are the cornerstones of good mental health. For example, having a job means more than just a pay packet; it encourages a sense of pride, independence and social contact. One positive action would be for the Government to recommit to making more apprenticeships available for people with learning disabilities and to provide them with more support to gain paid employment as part of the effort to reduce the disability employment gap.

A mental health Bill will be welcome if it truly addresses some of the needs I have sketched out. Could the Minister provide the House with any details of the proposed timescale for such a Bill and for the White Paper on the reform of the Mental Health Act? Currently, people at many life stages can be detained under mental health legislation because the right support is not available in the community to meet their education, communication, care, housing and health needs.

Media coverage and a recent report by the Joint Committee on Human Rights have brought the specific issue of how the Mental Health Act is being used to detain people with learning disabilities and autistic people right into the spotlight. I should remind the House that last November, the Department for Health and Social Care asked me to chair an independent oversight panel on this critical issue. I have agreed to do so. We will be looking at the care and future prospects of people with learning disabilities and autism who are currently being detained in segregation and seclusion in in-patient units, and considering how to avoid such admissions as well as the best way to ensure the best therapeutic care for them, their timely discharge and the right skilled support in the community. I look forward to working with Ministers and other noble Lords on these issues.