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Mental Health

Volume 459: debated on Tuesday 17 April 2007

Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Michael Foster.]

I appreciate the opportunity to introduce this debate for several reasons, the first being that it is national depression awareness week. I do not know whether Government managers were aware of that when they scheduled the Second Reading of the Mental Health Bill, or whether the Speaker’s Office was aware of it when my name was drawn out of the hat for today’s debate, but I learned of it in the course of preparing for this debate. The event is organised by SANE, the mental health charity, and by the Depression Alliance. Sadly, I suspect that not many hon. Members or anybody else is aware of it. One of the underlying problems with mental health as a political issue is that it does not have a high profile, so I am doing all I can to raise it.

The second reason that I welcome today’s opportunity is more personal. Like other Members of Parliament, I am struck by the number of people who come to me for help with problems arising from mental illness. Large numbers of people come to my surgery for advice on problems with incapacity benefit that are linked to mental illness; many neighbourhood disputes or episodes of antisocial behaviour have at their root someone in a community who is unable to contain the symptoms of their mental illness. I have heard some heart-rending personal stories. I give the following examples because I undertook to the families involved that I would try to raise the profile of their cases.

One lady, Mrs. Knox, whose daughter committed suicide, wrote to the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton), and to the Secretary of State for Health stating:

“I can assure you that I am not looking for either an enquiry or compensation—just ACTION.”

Mrs. Knox wrote to Ministers and to me in the hope that somebody in the Department of Health would take notice. Her case is not untypical. Her daughter was schizophrenic and was well dealt with by clinicians, but she was then released into the community. Mrs. Knox believes that her daughter would still be alive if the sheltered accommodation that is available to elderly people as a matter of course were available to people with mental illness.

I congratulate the hon. Gentleman on obtaining this debate. I have an interest to declare: I am a patron of a befriending scheme for mental health patients in North-West Leicestershire.

Does the hon. Gentleman agree that schizophrenia is one of three conditions—anxiety and depression are the other two—whose sufferers benefit greatly when given psychological therapy within the NHS? A report published some time ago, “We Need to Talk”, urged greater resources and targeting of waiting times for access to such treatment. I do not know whether his constituent was waiting for access to support or psychological therapy, but it would be helpful if the Chancellor and the Minister were to announce a higher priority for such treatments today, to add to what is a good record on mental health over the past 10 years.

As it happens, the case to which I referred was more acute and therapy would probably not have been beneficial, but the hon. Gentleman is absolutely correct. I shall devote a substantial chunk of my comments to what has become known as the Layard plan, which is designed to build psychotherapy up to be a more central part of mental health treatment. The hon. Gentleman is right to emphasise its importance.

The second case I wish to mention to illustrate the importance of the subject involves some long-standing personal friends whose children went to school with mine. As their son grew up, it was discovered that he had serious mental health problems that were later compounded by alcoholism. Not untypically, when he approached mental health services, they would not deal with him because of his alcohol problem; he went to alcoholism services, but they could not deal with him because he had a mental health problem. He finished up in prison and, like many others in our overcrowded prisons, he should not be there. He should be dealt with by mental health services, but they are not structured to help him.

The examples that my hon. Friend has given are of individuals with mental health illness within families. Does he agree that in many cases severe mental health illness impacts on a whole family, not only on the individual with the clinical problem? Is he aware that, since a ruling by the Law Lords a year ago, the courts have been unable to refer families whose members are suffering severe mental health disorders for treatment at specialist centres such as the Cassel hospital in my constituency? As a consequence of the ruling, the Cassel and other hospitals report that a significant number of children are now being placed in local authority care or are being put up for adoption, because their families are not receiving support and treatment.

That is clearly an important point. I was not aware of the specifics of the case that my hon. Friend mentioned, but I am grateful that she has brought it to our attention. I shall refer later to the Cassel hospital, which is one of the institutions that are under financial pressure.

The final personal point relates to my own family. One of the difficulties that people have with mental health is that they are coy about discussing it because it carries a stigma. However, one in three families are touched by mental illness in some way. I still remember a particular day from my own childhood. I was 10 years old when my mother was taken off in an ambulance to what all my friends called the loony bin because she had what is now called post-natal depression. At that time the condition was not described in such sympathetic terms; people were described as “mad” or “loony” and that was it: one was stigmatised. The tradition of not wanting to talk about such conditions has remained, and so their prevalence is not properly understood. A further reason for the debate, therefore, is to bring out such personal experiences.

A third reason is to draw attention to some of the financial pressures in the system. The Minister will be very well aware of them and I shall address them in more detail later. Unfortunately they are also well hidden. Often the cuts that are currently necessitated are occurring through commissioning bodies rather than directly through providers, and those bodies are in turn shunting costs on to local authorities. Much of the pain and the impact is therefore not publicly displayed but exists nevertheless, and I shall describe the effects in my local area.

The final reason why I welcome the opportunity for the debate is because I am my party’s economics spokesman. It might seem odd to link economics and mental health, but the link is a strong one. That was highlighted by a fellow economist, Lord Layard, who drew attention to the enormous economic costs of incapacity benefit, the impact on the prison system, and so on. Throughout the debate I shall inquire as to the Government’s progress in implementing his recommendations.

One way to come to that topic is by stressing the sheer scale of the problem. My understanding of the professional data is that approximately 30 per cent. of all recorded illness now relates to a mental condition of some kind. One in every six adults has experienced clinical depression or chronic anxiety, and among those very large numbers only one in four is ever treated, so the problem is largely concealed. Moreover, the scale of the problem is not static, but growing. The Institute for Public Policy Research recently produced an interesting report which pointed out that in a 30-year period the number of young people and children with mental conditions has increased by some 70 per cent. The problem is extensive and is increasing in its share of the sick population.

There are massive economic implications. A good illustration of that is in a parliamentary answer given to my hon. Friend the Member for Inverness, Nairn, Badenoch and Strathspey (Danny Alexander), who asked a few weeks ago for data from the Department for Work and Pensions on incapacity benefit claimants. Various points emerged from the data, including the fact that now almost 1 million people are on incapacity benefit because of mental illness, and 30 per cent. of all new applicants are people with mental illness. Even more striking was the statistical breakdown of that large number. Some three quarters—755,000—are people who have been out of work for more than a year. Yet more striking was the nature of their conditions. Approximately 377,000—about half of those on long-term incapacity benefit—were people with depression, and about a quarter, or 160,000, suffered from anxiety and neurotic conditions. The mental illnesses with which we are more familiar, and which are perhaps more dramatic, such as schizophrenia, were way down the list. There were about 36,000 schizophrenics.

The vast majority of people who are out of work, on benefit and unable to enter the labour market are suffering from conditions that are normally regarded as treatable—depression and neurotic conditions. Lord Layard, who did an analysis of the economic aspects of the problem, concluded that the direct cost to the Government of the number of people currently out of work and on benefit with treatable conditions was probably of the order of £9 billion, and that the cost to the economy as a whole indirectly was probably £25 billion, because of course many people are working but suffer high rates of sickness and therefore lower productivity. Therefore high economic costs are associated with mental illness.

As an economics spokesman I am naturally attracted to the idea that there may be ways of spending more money through the NHS to get savings rather than simply additional outlays. On the basis of that explanation, I want to develop further the arguments that Lord Layard put forward, and to pursue with the Minister how far the Government have got in taking the recommendations on board and implementing them.

I am not as familiar with the problem as my hon. Friend, but there is a distinction between those who are depressed and therefore unemployed and those who are unemployed and depressed as a result. Did Professor Layard offer an analysis of the difference?

I think that he did, and that he recognised a circular process. However, the key point was that the conditions are potentially treatable. Although Lord Layard is not a clinician—he is an economist, like me—he drew on the professional literature to demonstrate that psychotherapy in particular can be used to good effect with many of the people concerned.

There is obviously a need to take care in using such arguments; there are cases in which psychotherapy does not work and where drugs may be more appropriate. Evidence and clinical advice should provide guidance on that; it is not a subject for amateurs. However, the key point, which research by the National Institute for Health and Clinical Excellence has reinforced, is that there are many cases of depressive conditions that are best dealt with by psychotherapy, which takes us back to the intervention by the hon. Member for North-West Leicestershire (David Taylor). There are two reasons for emphasising psychotherapy. One reason is economic: Layard’s figures suggested that the cost of a 16-session course, which was regarded as about right for many people, would be about £750. The cost of remaining on invalidity benefit is about £750 a month, so the cost-benefit position is clear. The second reason is that patients greatly prefer psychotherapy to drugs. There is little doubt about that, thanks to the many surveys about choice and about patients’ attitude to mental health treatment. Indeed, one of the reasons why so few people are treated is fear of drug treatment. If patients are offered psychotherapy they are much more likely to come forward.

The problem arises when that basic and apparently sensible argument is contrasted with the reality, which is that there are very long waiting lists for psychotherapy; on average they are six to nine months, but they can be as long as two years. Surveys of GPs show that nine out of 10 doctors prescribe drug treatments, even though they are aware that psychotherapy would be more effective. Only one in 10 mentally ill patients sees a psychiatrist within a year, and one in 20 sees a psychologist within a year. There is an enormous gap between our understanding of best practice and what actually happens. To remedy that, Layard produced a programme, which he recommended to the Government through the Cabinet Office, involving the training of 8,000 extra therapists and establishing evidence-based psychotherapy units in each primary care trust to develop the programme at local level.

The Government responded positively. At the beginning of last year, the Secretary of State indicated that the Government had taken the recommendations on board, wanted to see them carried through and had commissioned two pilot studies. What has happened and where are we going? I asked that of my local mental health trust and its members simply rolled their eyes and said that they did not know what was going on. It would be helpful if the Minister explained where the pilot studies have got to, whether they will be rolled out, where the training programme has got to, what is a realistic objective for the 8,000 therapists—if that is the number that the Government are working towards—and when people in the field can expect the new approach to bear fruit.

There is a link between that specific issue and the more general question of how financial cuts in the NHS impact on mental health. Clearly, if mental illness is increasing proportionately, relative to other illnesses, one would have thought that it should take a larger share of the NHS budget, which would reflect the Government’s general philosophy of shifting to preventive treatments. However, since 1997—I am sure that the Minister will confirm this—the proportion of NHS spending given to mental health has shrunk from 14 per cent. to 11 per cent. today.

There is a lot of evidence of financial stress in mental health services. The Minister has acknowledged that 11 our of 84 mental health trusts are under financial pressure, and I hope that in view of all the evidence presented to her she acknowledges that the problem is, in fact, much more widespread. SANE pointed out that in May 2006 it was calculated that deficits had resulted in £30 million of cuts across mental health services, which have now doubled to £60 million. In July 2006, a report revealed that 68 per cent. of finance directors of mental health trusts believed that cash was being diverted to bail out primary care trusts that had overspent. At the end of July 2006, David Nicholson, who was then head of the London strategic health authority, outlined savage cuts to mental health services throughout the capital.

The hon. Gentleman is recognised throughout the House as being fair and objective. He referred to 14 per cent. of the 1997 spend going to mental health services. Does he acknowledge that that spend has now doubled in real terms and that 11 per cent. of it is still an increase of more than half in real terms? I accept the hon. Gentleman’s general thesis that the proportion should be higher, but to attribute stress and pressure to budgetary problems when the budget has increased by almost 60 per cent. in real terms is a bit harsh.

I do not entirely share the hon. Gentleman’s optimistic interpretation. We know that the cost of clinicians in particular has risen substantially and has absorbed much of the real-terms increase, and it is not clear that the increase has fed through into service provision. In fact, the opposite is probably the case.

The Government’s response has often not been satisfactory. At Prime Minister’s questions some months ago I asked about the impact on my local area and drew attention to the fact that mental health provision and provision for people with learning disabilities were being cut back. The Prime Minister’s response was that there are many more doctors and many more hospitals. However, there has been contraction in the specific area of mental health. The trust in my area—Richmond—was not included among the 11 trusts that the Minister acknowledged. The mechanism by which it is happening is real.

I am grateful to the hon. Gentleman and agree with the points that he is making, particularly on financing. It can only add to the stigma attached to mental illness if the funding for mental illness is advanced disproportionately relative to the funding for physical illness. Does he acknowledge that the number of completed episodes of mental illness treatment and patients has been falling too? A lot of money has gone into the extra costs of employing agency staff because of the disproportionately higher number of vacancies among qualified mental health professionals. Therefore, disproportionately less money is being spread more thinly on fewer patients.

I was not aware of the precise details, but the hon. Gentleman has made the point well. In addition, demand is increasing rapidly at a time when the number of treatment episodes has been declining, so the gap is widening.

I imagine that the process in my area is common throughout the country. The primary care trust, which is well managed and runs surpluses, has found that the surpluses are being top-sliced and transferred to other parts of the NHS. That has been covered by a substantial chunk of the deficit having been offloaded on to the mental health trust, which has had £800,000 taken out of its £21 million budget. The mental health trust has dealt with this in two ways. First, it has shunted the costs on to the local council, which is not in a position to absorb them. The main consequence of that is a decline in the services for the elderly chronically mentally ill, such as people with advanced dementia who were given continuing care. The second way in which the cuts manifest themselves is that the requirements under the national health service framework to create outreach and support for people in their home, which is a positive initiative, are operating at a skeletal level. Local mental health trusts do not have the resources to improve that.

In practice, cuts are taking place, but they are neither visible nor dramatic, so they will not lead to banners in the streets. They are not like hospital closures. The elderly mentally ill will not be marching down the high street. Indeed, perhaps those are the reasons for what is happening. They are largely invisible, but they are very painful and real cuts in service provision.

I wish to round off my remarks with some specific questions about the Layard proposals and general financing. In their analysis to follow up depression awareness week, SANE and the Depression Alliance deal with how general practitioners operate. Most diagnosis is carried out at GP level and there are many deficiencies. SANE is asking whether the Government are looking again at the GP contract to ensure that doctors have a maximum incentive to produce prompt and efficient diagnoses of mental illness to get around at least some of the delays within the system. Is the Minister looking at the GP contract in the light of the professional criticisms that have been made?

I do not think that anyone argues now for institutional care on a substantial scale, but we acknowledge that care in the community has often not worked because of the lack of back-up. My constituent, Mrs. Knox, has asked whether there has been a concerted attempt to provide more sheltered accommodation for people with mental illness who have left institutional care and who need much more support than is provided traditionally by the mental health teams that visit someone’s house once or twice a month. Do the Government monitor such matters? Are they encouraging action in any way?

A third issue relates to co-ordination. The Minister has a role not only in the NHS itself, but in co-ordination with other Departments. How does the right hon. Lady approach the linkages with the Department for Work and Pensions? We know that pathways to work is working well for many long-term unemployed, but it does not seem to work for the mentally ill. Has that approach to employment been revisited? Does the Minister have any proposals for revising it?

As a result of the problems with financing the mental health sector, we are discovering the difficulties arising out of the localisation of decision making. We are now operating in a more decentralised mode, which is very welcome. There is greater emphasis on primary care trusts making their own decisions locally. However, the problem is that some local providers such as councils, which are democratically and locally accountable, and mental health trusts and primary care trusts acting as commissioning bodies, which are not, are shunting costs and responsibilities between themselves to avoid accepting the responsibility for the difficult choices that have to be made. How far is the Minister helping to produce greater coherence at a local level to ensure that mental health budgets are properly managed between local authorities and primary care trusts, and that there is an overarching local accountability through local authorities? What we are seeing at a local level is simply a shifting of responsibility from one body to another, with the elected bodies being landed with the worst of the difficult choices that have to be made.

Mental health is a vital part of NHS provision, and it does not always get the public or parliamentary attention that it warrants. I congratulate the hon. Member for Twickenham (Dr. Cable) on securing the debate and, together with Government business managers, making this week something of an exception.

I want to take the opportunity to thank the staff working in the mental health services in my constituency, in the Oxfordshire and Buckinghamshire Mental Health Partnership NHS Trust, and to draw particular attention to areas of work locally that are topical and relevant as the House moves to consider the Mental Health Bill, which received its unopposed Second Reading last night.

As the hon. Gentleman said, there are huge humanitarian and economic consequences of mental ill health. I would also urge that in the difficult choices facing the NHS in managing its budgets, even expanding budgets, full weight is given to the needs of mental health patients who, because of continuing stigma—that must be challenged at every opportunity—and their own situation, are not in a position to mobilise the sort of public pressure that is often brought to bear in other areas of NHS services and funding. In the past, I have spoken out against damaging pressures and unfair cuts in our local mental health budget. My right hon. Friend the Minister will recall responding to one such debate on the Floor of the House last year.

Let me also say, and I am sure that the hon. Member for Twickenham will accept this point, that there is an important distinction to be drawn between mental health trusts having to cut back to meet deficits elsewhere in the NHS that are not of their making and service reorganisation within the mental health care sector which, although often controversial, can be justified because it enables service improvements to be made ensuring that more care is available to more people more quickly and more appropriately for their needs. Examples of this in our own mental health care trusts are the much-needed extension of crisis services, and the development of early intervention services which allow more people to be treated outside hospital. Both improvements were funded by cost savings last year.

The Oxfordshire and Buckinghamshire trust is also able to look forward to the opening of a women-only forensic unit at Littlemore later this year, which will provide a dedicated and much-needed service for women across the Thames valley who are currently being looked after in mixed-sex wards or in distant secure units. Other local innovations that are improving provision include the bridge-builders service operating from the acute day hospital at the Warneford. It helps people to make that crucial move back towards independent living and employment which benefits their health, their family and the wider community. There is no doubt that if we are to help more people either get off incapacity benefit—that has been referred to—or avoid getting on to it in the first place, mental health support, advice and counselling have to be right up there with other rehabilitation services and work much more closely with Jobcentre Plus and other employment providers than they have in the past.

I want to focus particular attention on an especially important innovation that has been piloted in Oxfordshire and a number of other trust areas. I commend it to the Minister as appropriate for extension across the country. I refer to the complex needs service, started four years ago, which meets the needs of people with a range of personality disorders and with tendencies towards self-harm, attempted suicide, chronic relationship problems and drug and alcohol abuse. The service operates in close partnership with the voluntary sector—in our case, with Mind—and works to treat personality disorders through a therapeutic community of members.

The results of the service, which operates from a dedicated centre in my constituency, are encouraging. I have met patients who have greatly benefited from the service’s approach. Indeed, their personal testimony, as they literally put their lives and personalities back together and rebuild their self-esteem, gives an inspiring picture of what modern mental health services and their dedicated staff at all levels can achieve. The evidence is that people using the service spend less time having in-patient treatment, can be discharged faster from their community health team and make 65 per cent. fewer visits to their GP than prior to their treatment. That is also an important consideration when we bear in mind that as many as 40 per cent. of visits to GPs are directly or indirectly related to mental health.

The service shows an important way forward. My understanding is that although it has been funded as a pilot, there is still uncertainty over its longer term funding. I hope that the Minister will be able to tell me in her closing remarks that she recognises the benefits of that approach and that she can reassure the complex needs teams, in our area and elsewhere, that the success and benefits that they are bringing to patients will be matched with longer term funding.

I dare say that as part of her answer the Minister will say that the money is there in PCT baselines, but I am told locally that that money is hard to identify and find—and, of course, it can all too easily be subject to other pressures. I urge the Minister to highlight the funding available, supplement it when necessary and do anything else that she can to push forward that important and valuable approach. As I am sure she recognises, such services will be very important in making a success of the provisions in the Mental Health Bill, demonstrating that real and effective help can be provided to people who in the past have risked being seen as untreatable, or who have not had the treatment most effective for their needs.

On a related issue, I congratulate our mental health care trust and Oxford university on having been awarded a £500,000 research grant to enable them to examine how community treatment works out in practice. That was announced last month by Professor Louis Appleby, the national director for mental health. The study will consider who gets community treatment orders and what the benefits are. That research is very important, because supervised community treatment—part of the Mental Health Bill that will be subject to much more discussion as the Bill proceeds—needs to work properly. It must ensure not only that the community has proper protection from the minority of patients who present a risk, but that people with mental health problems are given the chance to rebuild their lives, for which family, social contact and employment are vital.

I am following closely what the right hon. Gentleman is saying; the project in his area sounds very interesting. However, does he not agree that the Government have now commissioned research into the effectiveness of community treatment orders on the back of international research that has not been able to give any empirical evidence for their efficacy? Would the Government not do better to wait until that research has come up with positive results before going ahead with legislation that would enforce the orders, which may have a detrimental effect on some patients with personality disorders who at the moment are benefiting because they are treatable?

The Government would be vulnerable to criticism from another direction were they to embark on legislative innovation in this area without properly monitoring and learning from the experience of such work as it progresses. The hon. Gentleman is right to say that lessons must be drawn from research elsewhere in this area and from international experience. This dedicated research project is invaluable because, like mental health services themselves, research into mental health issues has often been a poor relation when comparisons are made with other areas of medicine. The new funding is all the more welcome for that.

My final point relates to a national concern. This is not a particular issue in my area, because it has a specialist adolescent unit. I understand that as many as 1,000 children and adolescents with severe mental health care problems are placed on adult psychiatric wards each year. We all agree that that is unsatisfactory. Those young people need to be able to be referred to specialist provision. Again, that will be debated further elsewhere as the Mental Health Bill proceeds, but will the Minister tell us what progress is being made in tackling that pressing matter? Mental health services need to cater properly for the needs of the whole community and we all agree that children and adolescents are a high priority in terms of our fulfilling that responsibility.

The Government have made good progress in mental health policy generally. I note what the hon. Member for Twickenham said about the share of the budget, and I shall always be to the fore in arguing that mental health services need to be given proper priority, as, I am sure, will the Minister. Equally, as my hon. Friend the Member for North-West Leicestershire (David Taylor) pointed out, we should recognise just how big a funding increase has taken place under this Government—£1 billion in real terms since 2001. In many areas, mental health provision is being transformed beyond all recognition for the better, notwithstanding the pressing concerns and pressures that have arisen from tackling deficits.

I commend the innovations that are taking place locally, and congratulate the staff who are working in mental health. All too often they fail to get the public recognition that they deserve, partly because of the stigma in this area. In a minority of cases, staff face the risk of abuse, and their contribution should be properly recognised.

My right hon. Friend is right to pay tribute to staff in the mental health sector of the NHS, but will he also pay tribute to the role of volunteers? He talked about social contacts. Good numbers of befriending groups and others play a huge part in the recovery of patients who are emerging from periods of mental ill health. Will he acknowledge that such an approach is often an effective way forward and that it does not cost a great deal to train volunteers to have that type of role?

I strongly agree with my hon. Friend. I should include the work of the voluntary sector in the praise that I have been giving to staff. I referred to the importance of Mind’s contribution to the complex needs service that I was advocating. My constituency has an excellent initiative called Restore, which helps people to move forward through training programmes and work experience. It has dedicated employment advisers who help people, often those with acute conditions, to rebuild their lives, their social contacts and their family involvement and, in many cases, to move forward to employment. Progress is being made, although there is lots more to do.

I thank my hon. Friend the Member for Twickenham (Dr. Cable) for securing the debate. He has a long and distinguished interest and expertise in this area, which was fully on display in his articulate exposition. I should like to raise two matters. The first has not been mentioned but is of enormous national interest—the provision, or lack of it, of mental health services in prisons. Secondly, I should like to dwell on the experience of the changes and cuts being introduced into mental health service provision in Sheffield, as an example of some of the knock-on pressures that have been mentioned.

It is difficult to see much of a silver lining in the increased public attention on the state of our prisons in view of the burgeoning overcrowding crisis in the prison system, but if there is a silver lining, it is that more public and press attention has been focused on conditions in prisons. One fact that has finally been given a little more exposure—it deserves still more, in my view—is that there is a huge number of people in prison with acute mental health conditions who are simply not receiving the treatment they require. It is reliably estimated that one in 10 of the prison population are identified as functionally psychotic. Prisoners are seven times more likely to commit suicide than the general public. As the Corston report on women’s prisons highlighted last month, 80 per cent. of women in prison are diagnosed with mental health problems. The scale of the problem is enormous. On that, we can all agree.

I want to press the Minister to expand on what I thought was an extremely encouraging break with Government rhetoric and policy in a paper on the criminal justice system as a whole. Forgive me: I do not have the precise title of the document to hand. It was published, I think, two or three weeks ago by No. 10, and the Lord Chancellor was active in the press, expounding its virtues. In that paper, which was a fairly wide-ranging and somewhat motley gathering of different observations on the criminal justice system, there was an extremely significant allusion to the need to develop what the document called hybrid prisons.

If I understand it correctly, the purpose of hybrid prisons would be to relocate offenders with acute mental health problems from the closed prison estate to specialised hybrid prisons, where of course incarceration could continue but treatment could be effectively provided. That seems to me to be a very important and promising, although extremely vague, new direction of travel in the Government’s utterances on this major issue. I urge the Minister to explain whether she is aware of quite what the Government have in mind when talking about hybrid prisons, what plans are in place to develop hybrid prisons and what resources would be found to do so.

At the moment, £1.7 billion has been earmarked to expand the prison population by about 8,000 places—places, incidentally, that will not come on-stream until about 2011-12, by which time, judging by current rates, the prison population will have well surpassed that increase of 8,000 places anyway. In common with the conclusions of the Corston report, it would make a great deal of sense to reflect on whether it would be more sensible to spend that money on specialised hybrid prisons and secure and semi-secure mental health treatment facilities, so that the very significant number of offenders in prison with acute mental health conditions could be moved from the closed prison estate into facilities more suited to their needs.

My hon. Friend has introduced a very important and much overlooked theme. I think that we all accept that prison is not conducive to mental health and well-being in any sense whatever and particularly in the case of women. Has he any statistics that reflect the difference between the people who arrive in prison with a mental health problem and those who develop a mental health problem in prison?

No, in short, I do not—the statistics on this issue are quite patchy. Similarly, little empirical work is being done, for instance, on the link between the failure to treat mental health conditions in prison and rates of reoffending, which have increased dramatically in recent years, as we know. Quite a lot of empirical work therefore needs to be done to complete the picture.

Time is short, so let me move on to my second point. The right hon. Member for Oxford, East (Mr. Smith) rightly alluded to the fact that all sorts of controversies and debates may arise if changes are required to the provision of mental health services. Such changes can take place within the parameters of competing judgments about the best way in which to provide mental health services. Things become altogether more fraught, however, when changes appear to be forced through because of the knock-on effect of financial pressures, particularly on primary care trusts.

The primary care trust in Sheffield has mooted several extremely controversial changes, although it has at least been open enough to say that they are almost entirely driven by the financial pressures on its own account. None the less, that may have a dramatic and disruptive knock-on effect on the mental health service in Sheffield, which has been a Cinderella service for some time. It is widely recognised among practitioners and patients in Sheffield that mental health in the city has not been given the priority that it deserves. It is all the more incomprehensible to them, therefore, that extremely controversial changes are being rushed through as a result of financial pressures that have nothing to do with the mental health care trust.

The manner in which the changes have been floated and introduced is a model of how not to persuade the public, political stakeholders and workers in the mental health sector that changes are required. In substance, the consultation document, which I have in my hand, amounts to no more than two and a half pages of sweeping recommendations, which is clearly insufficient to explain the wide range of proposed changes. The consultation period has also been somewhat rushed, while the consultation document is vague to the point of being vacuous. It makes several claims about a renewed reliance on GPs, community-based services and social day care and on reducing acute in-patient beds. In other words, it pursues the general drift away from hospital-based treatment and towards various forms of what might euphemistically be called community-based treatment. It also fails to explain how the money will be saved, in what time scale and to what end.

Unsurprisingly, the reaction in Sheffield has been universally hostile, and the Minister may be aware that Labour Members from other Sheffield constituencies have, like me, been active in asking the primary care trust to withdraw the consultation document altogether. Last Friday, all Sheffield Members were informed by letter that the consultation document would not be withdrawn. Ironically, we received another letter at the same time telling us that the PCT’s financial position would be wonderfully restored to good health in the next few months, which raises the question why it needs to impose this set of disruptive proposals on the mental health sector in Sheffield.

I appreciate that—

Order. May I ask the hon. Gentleman to bring his remarks to a close? Some very good questions have been posed to the Minister, and I want to ensure that she has time adequately to respond to them.

I will indeed bring my remarks to a close, Mr. Olner. I realise that the Minister cannot comment on the specific local circumstances that gave rise to the situation in Sheffield, but I hope that she will agree that it is difficult for the public or, indeed, political stakeholders in places such as Sheffield to feel that their voice is being heard if, as in Sheffield, the primary care trust is impervious to the most elementary forms of public and political accountability. In Sheffield, that is reflected in its extremely poor, thin and rushed consultation document, which will have very disruptive effects on mental health service provision in the city.

I congratulate my hon. Friend the Member for Twickenham (Dr. Cable) on opening up a huge and important debate. As he said, mental health issues affect nearly everyone, and I was reminded of that acutely the other day. I was on the phone in my surgery discussing amendments to the Mental Health Bill with my hon. Friend the Member for Romsey (Sandra Gidley) when a regular client who has mild paranoia appeared at the counter. He believes that a member of the House of Lords is out to get him by perpetually sending thugs to his area and he renders himself homeless on a fairly systematic basis. He writes three letters a week to me and has seen every Member in the north-west, including the Leader of the House. He also thinks that his phone calls are being intercepted and that the legal profession is corrupt. Not all of his views are necessarily delusions, but they certainly make a prima facie case for further inspection. His doctor referred him to the psychiatric service, which reported that he was an interesting man with no particular problems, which somewhat disappointed me because he is an elderly man and at some point his behaviour is likely to have adverse effects on his physical health as well as leading to a further deterioration in his mental health.

Mental illness is not exactly the same as, or simply a sub-group of, physical illness. Although it is often politically correct to say otherwise, that is not actually true. However, like physical illness, it covers a huge spectrum of conditions that can be chronic or acute, or chronic and acute, as is obviously the case with schizophrenia. Mental illness is socially disabling to a varying extent and affects personal autonomy, capacity, insight and behaviour to different degrees depending on the ailment. Sometimes the causes are known and sometimes they remain hidden and await further research. Equally, cures in the mental health field are sometimes quite well established, sometimes utterly absent and sometimes quite uncertain. Therapies are mixed and varied, and include the chemical, behavioural, personal and family based. There are few quick fixes and few long-term guarantees.

What is universally true is that there is a stigma associated with mental health and a questioning of the competency, reliability, and predictability of the behaviour of those suffering from mental health problems. As many hon. Members have said, that results in the clamour for better services and complaints about poor services being somewhat muted. Obviously, those who are, in many respects, the most troubled will complain the least, which means that mental health is a relatively soft target for underfunding, for cuts—although of a fairly covert nature—or for virement to other services where people clamour with greater force.

It has quite accurately been pointed out in this debate that the share of NHS funding for mental health has fallen, although it must be admitted, as the Minister will no doubt say, that total funding has appreciably risen. It is still the case that raids from the regional authorities are relatively common, and the fact that it is easy for trusts to maintain a balance shows how easy it is to adjust their costs and to cut services where financial need arises. That often results in a slow response and long wait for psychiatric services, which is one of the most prevalent and pervasive complaints that I receive about mental health services. When there is an issue and people need help it is difficult to get past first base and there is a long wait to receive regular attention from a consultant psychiatrist.

I have received complaints in my constituency about service reductions, but I will not expand on those now. As the Minster has acknowledged, there have also been justified complaints about treatment taking place in inappropriate settings; for example, when adolescents and children have been seen in adult environments. There is, of course, the unspoken difficulty that people are sometimes over-medicated in circumstances where medication is not the sole or even the best answer to their problems. Although that may be the quickest way of dealing with such problems, it may not always be the best.

As my hon. Friend the Member for Twickenham pointed out with his economic hat on, the social effects are even worse. Billions of pounds are paid out in disability benefits and the Sainsbury Centre for Mental Health has said that 91 million working days are lost because of mental health problems. One third of all new claims for disability allowance are on the grounds of depression and anxiety. In the past, when the care model was the mental hospital, there were heavy, fixed and immovable costs that could not easily or covertly be adjusted. Now, in the community, it is far easier to adjust costs and, if necessary, reduce them.

It is good that there is more money—we must all admit that—but that money must be spent within a framework, monitored and assessed under performance management. That is the goal to which I think everybody aspires. We have not got there yet, and it is hard to see how payment by results will benefit. Obviously, we call for the performance of PCTs and mental health trusts to be better monitored, but their delivery on mental health services is somewhat hard to measure because some conditions are not curable, only manageable. The social background of different areas makes an appreciable difference. Clearly, if there is a lot of unemployment in the area, we expect a high rate of depression and anxiety to go with it.

Mental health is an area in which the voluntary sector can perform in different ways and places. The sector has a key and beneficial role to play in mental health, a field where imagination and innovation pay off. We are all familiar with some exciting and worthwhile projects involving mental health users and art. I also mention the increasing use of IT and software therapies. Years ago, a chap called Weizenbaum designed a programme called Eliza, which was supposed to act as a substitute for psychotherapy. One can download it and try it oneself. An odd feature of Eliza was that some people preferred the software to their own consultant psychiatrist. The computer never looked away and always gave a response, and it was always a remarkably tolerant and interested response. There are better examples, as much development has taken place in the field, but it indicates that innovation in mental health can make a substantial difference. However, it is often difficult to monitor and assess.

Professor Layard calls for concentration on the less acute sector, bearing it in mind that only one in two depressed people receive treatment and that only 8 per cent. see a psychiatrist, yet where pathways to work pilots have concentrated on the issue, substantial effects have been recorded. Therefore, he calls for an extra 5,000 psychological therapists and double the number of consultant psychiatrists. I think that we would all go for that, but the therapies must be tested—NICE has a key role there—and the services must be validated.

We are all aware of a number of counselling services of various kinds and qualities springing up in our constituencies. They are mushrooming. Some are very good, some are not so good and some are a waste of time. It is important when services are offered that they are properly validated and assessed. The Department for Work and Pensions also needs to offer a more holistic service, particularly to the unemployed, because one thing people need before they can get back into employment is a boost in morale and maybe to address underlying psychological problems. There is some evidence that it is doing so. I went to my DWP office recently and found that that is precisely what is going on to get people off disability benefit and back into work.

Another Layard theme is that mental health should be seen as a social goal for the Government—what might be called the happiness agenda, whereby the Government are charged with the positive promotion and encouragement of a good and mentally whole life in the workplace, family and community. It is a tough task for the Government, I must say, though I record in passing that Plato regarded it as a fundamental chore of the state. As my hon. Friend the Member for Twickenham might know, Plato regarded the economy as something that the state would do better to butt out of and leave to the merchants, and the promotion of the good life as its fundamental aim.

Unlike my hon. Friend, however, Plato was a totalitarian. We must acknowledge that any liberal state allows for diverse concepts of the good life, and that many of those concepts will be contestable. However, it seems self-evident that where social conditions identifiably lead to unhappiness, removing those obstacles is a fairly important and uncontentious task for the state. That is the modest aim of a liberal state.

Apart from the wider goal of generating social happiness, which I have no doubt every Government have tried to achieve in some way, there is the more pressing need to improve existing mental health services. As my hon. Friend indicated in his introduction to the debate, there is an awful lot of work still to be done.

We have had a very interesting debate. I add my congratulations to the hon. Member for Twickenham (Dr. Cable). The timing of the debate is fortuitous. We shall be mental healthed-out by the end of the week: debate on the Mental Health Bill started yesterday, and as he mentioned, this is national depression awareness week, which is an initiative of SANE and the Depression Alliance.

The hon. Gentleman raised some good points and introduced a wide-ranging debate on the subject, unlike the limited one that we had yesterday on the Mental Health Bill. I am pleased that this debate is part of a profile-raising exercise for mental health, which is not a fashionable subject. As he rightly said, many people who suffer from mental illness will not be the first to admit their own problems, let alone demonstrate in the street, so it is incumbent on us as legislators and the representatives of those most vulnerable people to speak up for them. This debate is another good opportunity to do that.

All hon. Members in this Chamber and, I am sure, across the House know from their surgeries and constituency post of distressing cases of people who suffer from mental illness but are unable to access services. I refer to two cases in my constituency. One constituent recently had a psychotic incident that involved the police. He was arrested and kept in the cells for five days before he was assessed by a mental health professional and then able to be sectioned to the Maudsley hospital. That is no way to deal with somebody with a disturbing illness.

Secondly, I had a very distressing case a couple of years ago of a father who had killed his own daughter. She had asked him to kill her because of her mental illnesses. She had just been thrown out of a local mental hospital. The help that she needed was not there, and the system failed her. That was a deeply tragic case, and the trouble is that there are too many such cases all over the country.

Whatever the Minister and the Government may say, mental health services remain the Cinderella service of the NHS. I was pleased that the hon. Member for Twickenham gave the figures. We know that extra money has gone into the NHS across the board in large portions, quite rightly, and that extra money has gone into mental health services, but the percentage of NHS funding going to mental health services has fallen during the past 10 years—it has not increased. That can only help to compound the stigma that is attached to mental illness.

I believe that every Member mentioned problems with deficits. Mental health was last in the queue to benefit from the Chancellor’s largesse, and now it is first in the queue when services are being asked to hand money back to pay for deficits in other parts of the health service. Mental health is suffering a double whammy: mental health trusts had to tighten their belts because of the present funding crisis, and they have to tighten them a second time to bail out other parts of the NHS. That really is not fair. Louis Appleby, the mental health tsar, said that acute trusts should be ashamed for taking money from underfunded mental health services. The Government have admitted that that is happening, but they must do something to ensure that it does not happen even more in the future.

As I said earlier, vacancy rates among mental health professionals are much higher than for the rest of the NHS, and there is a postcode lottery for services, particularly in talking therapies. Several Members mentioned the lack of availability of talking therapies such as cognitive behavioural therapy. The hon. Member for Twickenham was absolutely right to mention the depression report and the excellent work of Lord Layard. From an economic perspective, funding such services makes sense—the numbers add up. More than 1 million people are on incapacity benefit for a mental illness-related problem. A relatively short course of treatment, which would involve a relatively small amount of money, would have a success rate of around 50 per cent., as calculated by Lord Layard. We could get those people back into the economy and into employment, at great personal benefit to themselves and to the state and the NHS budget, so it has to make enormous economic sense.

We heard some interesting contributions in addition to those made by the hon. Member for Twickenham, who opened the debate. The hon. Member for Richmond Park (Susan Kramer), who is no longer in the Chamber, spoke in an intervention about the Cassel hospital. It is unfortunate that she did not elaborate on that. I visited the Cassel hospital a little while ago. It is worrying that that excellent institution is facing a funding squeeze at the moment, particularly for the work that it does with mothers facing mental health problems—often being able to keep them with their babies. One in six women will suffer from depression around the time of a pregnancy. That is a largely unseen mental health problem, but it has enormous consequences. Four out of five women with babies are admitted to psychiatric hospitals without them. That can only engender greater distress in those women. The Cassel hospital has made great strides in being able to keep families together.

I reiterate the praise that the right hon. Member for Oxford, East (Mr. Smith) gave to staff and volunteers. There are enormous challenges and pressures for the staff working in mental health trusts around the country. We have some excellent mental health voluntary organisations, such as Rethink, SANE and MIND, which do fantastic work for the sufferers of mental illness.

Hon. Members were right to say that there is a continuing stigma attached to mental illness. I was interested in a local project in Oxford that the right hon. Member for Oxford, East mentioned, particularly as it deals with treating personality disorders, with therapeutic benefit, on, I would guess, a voluntary admission basis in many cases. However, the proposals in the Mental Health Bill for people with personality disorders would regard those people as largely untreatable. It is for that class of patients that the Government are now introducing community treatment orders, with no empirical evidence to underline their efficacy. There is no research internationally to suggest that such things work. The right hon. Gentleman’s constituents who are benefiting at the moment from the great advances and innovation in mental health treatment, particularly for personality disorder, could be subject to those community treatment orders. Nothing would deter them more from presenting in the first place for therapeutic treatment than the fear that they may be subject to some degree of compulsion. After last night’s debate, we face the bizarre prospect of Ministers saying, “We must have more compulsory treatment to guarantee treatment for those patients”. However, the compulsion is on the patient to receive the treatment, not on the mental health trust or the providing authority to provide it. The Government have got their priorities wrong.

I am worried about the sort of projects that the right hon. Member for Oxford, East mentioned, which are doing great work on a pilot basis, although funding is not guaranteed. For those projects, the prospect of people turning up in future could be greatly imperilled by coercive measures, which this Government seem hellbent on pushing through the House, that are having great ramifications outside.

The hon. Member for Sheffield, Hallam (Mr. Clegg) mentioned problems in his constituency with the deficit crisis. I know Sheffield well and I know the problems with the health service there. Too much is being done in the name of reconfiguration. In Sheffield there is a rather vague reconfiguration to save money, which is really what it is all about. The hon. Gentleman mentioned prisons and he was right to do so, because the state of mental health in our prisons is an absolute scandal and is highly counter-productive. There are large numbers of prisoners suffering from mental health problems and there is a lack of integration to get them sorted out mentally before they can be properly rehabilitated and not reoffend. It is worse in young offenders institutions. I visited the young offenders institution in Feltham just a couple of months ago, where a lot of impressive work is going on. Again, though, it is a deeply depressing place. A lot of work is being done to try to address the mental health needs of young offenders there. The recidivism rate for young offenders who are sentenced to jail terms of less than 12 months is 92 per cent. A lot of that is due to not dealing with the underlying problems that may have led them to get into crime in the first place.

The hon. Member for Twickenham mentioned the problems of dual diagnosis. It is ridiculous that we do not have better inter-agency working, so that while we may be able to deal with a person’s mental illness we cannot deal contemporaneously with their alcohol or drug misuse problem. The two things are closely linked and we need far better progress on dual diagnosis. Whether the hybrid prisons will do anything about that I do not know; it sounds to me like another soundbite from No. 10, which the Prime Minister may hope will form part of his legacy, but which will not amount to much.

Mr. Olner, you are right to say that hon. Members have raised many questions about mental illness, which the Minister needs to answer. I ask her in particular to give detailed indications of what will happen to the CBT pilot projects in Newham, which I visited recently, and in Doncaster. There are fears that those will not carry on, despite the fact that they do great work. I should like her also to comment on the lack of progress in dealing with the black and minority ethnic community given that Matilda MacAttram, director of Black Mental Health UK, said recently:

“Absolutely nothing has changed for black people over the last 12 months”.

She also commented:

“The 2006 Bill as it is currently drafted will make this situation a lot worse. This calls into question the Government’s commitment to address race issues within mental health services.”

Many people in the black and minority ethnic community suffer disproportionately from mental illness. They suffer particularly from being disproportionately subject to sectioning and other coercive treatment, and the Government need to take that far more seriously.

There are many other things that we could say in a mental illness debate. I am glad of the opportunity to air problems within the mental health community and I shall not recount again the problems affecting young people and children, one in 10 of whom will now suffer some form of mental illness, with one a day in the past few years being admitted to highly inappropriate and intimidating adult mental health wards. As the Children’s Commissioner for England said recently:

“It wouldn’t surprise me if children leave adult wards worse than when they went in. Putting children in an age-appropriate and developmentally appropriate environment can only be better for them.”

Mental health needs to be a far greater priority than it currently is in the NHS and the Department of Health. It is a false economy not to make it a greater priority. It is one of the most challenging ticking health timebombs that we face in westernised countries. It is a particularly false economy not to take the subject of young people with mental illness more seriously. I hope that at last the Minister will treat that as a priority. She might start by guaranteeing that the Government will restore mental health funding in the NHS to the level that she inherited in 1997, which was much higher, in percentage terms, than it is now.

I congratulate the hon. Member for Twickenham (Dr. Cable) on securing the debate. As he said, it is particularly relevant this week, and it provides a good opportunity to raise awareness of mental health issues in the House. Debates in the past couple of days have suggested how many Members of Parliament have relevant constituency cases: carers, families and patients are all very much affected when, as we know, about one in six adults at any one time report having a mental disorder, and one in every four GP consultations are directly related to mental health.

I shall deal, as other right hon. and hon. Members did, with some of the specific issues that the hon. Gentleman raised about Lord Layard’s report, but I want to deal with some wider issues first. It is important to start with the question of finance. There has been a consensus that extra money has gone into our mental health services. An extra £1.5 billion is now being spent on mental health services. According to the European Commission, and despite what the hon. Member for East Worthing and Shoreham (Tim Loughton) says, the proportion of the overall health budget devoted to mental health in the UK is among the highest in any EU member state. That extra investment has led to some great improvements, and I join my right hon. Friend the Member for Oxford, East (Mr. Smith) in paying tribute to the many staff in the mental health service who have made them possible.

The way in which some of the 700 new community teams work is completely different from the traditional delivery of mental health services. Teams work with people in their own homes and communities, reducing some of the stigma that many right hon. and hon. Members have mentioned. If we can treat people in their home environment, they will not have to be removed for the whole time to an in-patient setting, where it can be more difficult for them to make a recovery and where things can be more difficult for carers and families. There are also 14,000 extra staff working in mental health services, which, again, has made a difference.

It is also true, however, that mental health services in some areas have been asked to make a contribution to ensure that the overall NHS budget is put on an even keel. However, I should say two things about that. First, I have been absolutely clear that mental health services should not be asked to make a higher contribution than any other services in an area. For example, if other trusts or primary care trusts have been asked to make a top slice of 3 or 5 per cent., mental health services should not be asked to do anything disproportionate, unless they, for example, contributed to the deficit in the first place. I am more than happy to take up any cases in which people think that mental health services have made a disproportionate contribution, and we have pursued every case that hon. Members have brought to my attention.

Let me add, however, that we have raised the profile of mental health services in recent years. They are no longer a Cinderella service, although they can be prey to raids on budgets if the NHS is not in overall financial balance. Many people who work in mental health services tell me that it is important for the NHS in their local health economy to be in financial balance because mental health services might suffer otherwise. Overall, therefore, mental health services staff want us to ensure that budgets are properly balanced so that they can plan services properly in the longer term.

Let me move on to some of the specific questions raised by the hon. Member for Twickenham. On GP contracts, we are developing quality and outcomes framework standards so that GPs can recognise and refer cases of depression and anxiety to the new services as they become available. Therefore, we are looking at issues relating to GPs, who play an important role. The new graduate workers who have been working out of GP surgeries have also been extremely important in delivering some of the psychological therapies that everybody has mentioned.

The hon. Gentleman also talked about the importance of multi-agency working and of looking at issues such as sheltered housing and social services support. The Government have tried to ensure that provisions such as local area agreements assist in that process and enable mental health care services and local authorities to pool budgets and staff in certain instances. In that way, they can provide the necessary support, which, as he rightly says, is extremely important for securing co-ordination at local level.

I pay particular tribute to my right hon. Friend the Member for Oxford, East, because it was his personal commitment that made some of the pathways to work projects so successful. There was a great breakthrough in considering the link between employment and mental health. There are too many instances in which, even if people did not start their unemployment because of a mental health problem, a mental health problem develops because of the stigma, discrimination and low self-esteem that accompany unemployment. Pathways to work projects have been important in that regard, as has consideration of how to get better links with jobcentres.

People in the DWP have told me that, when they are successful in getting people off disability benefit and back into work, the savings for the Department revert to the Treasury and are not reprocessed into doing more of the same—not even a proportion of them. Is it worth investigating ways to incentivise those parts of the DWP that get people back into work after mental health problems, so that they do more?

One of the triumphs of our current work is the adoption of a cross-Government approach—an approach that was taken in the case of the work of the social exclusion unit, which reported last year, and which applies to the close relationship between the DWP and the Department of Health. One can certainly extol the benefits of that approach.

My right hon. Friend the Member for Oxford, East made a point about the complex needs service in his constituency. I hope that benefits are being seen at the local level as a result of in-patient stays being reduced through development of services. The new services whereby people can be prevented from entering patient care are both cost-effective and effective in their own right, and I hope that they will receive appropriate local consideration.

The hon. Member for East Worthing and Shoreham seemed to confuse the issues of treatability and supervised community treatment. We want to get rid of the treatability test in mental health legislation because people with personality disorders have for too long been told that they are untreatable. That has meant that services have not been set up, and people have been turned away.

Supervised community treatment is an entirely different issue. The hon. Gentleman seemed to suggest that certain people in my right hon. Friend’s constituency might somehow be placed on supervised community treatment because of a personality disorder. People enter supervised community treatment if they have had an in-patient stay and if their clinician feels that it is appropriate. We do not want people to be in-patients for any longer than necessary. If it is more effective to return them to their home environment under supervision, that course is known to lead to better recovery and prevent relapse. That is the point of the proposals in the Mental Health Bill.

My right hon. Friend referred also to supervised community treatment in the context of the funding that has been put into research. The research by the Institute of Psychiatry said that existing research was not definitive. The Government have stated their intention to adopt the path of supervised community treatment, which is already used in many other countries and has been implemented in Scotland. The existing legislation in this country does not permit implementation of a programme that would benefit patients. We shall ensure that we monitor the work that is done so that it is effective as possible.

I want to address the issue of mental health in prisons, which was raised by the hon. Member for Sheffield, Hallam (Mr. Clegg). He was right to refer to the Corston report. Jean Corston said that she supported the Mental Health Bill provisions on treatability, because there were too many women in prison who had ended up there because they had a personality disorder and, because of the way the Mental Health Act 1983 is phrased, did not receive help.

The hon. Gentleman made the important point that we need to ensure that good court diversion schemes are in place, so that people can get a hospital disposal early if that will be effective, and that there are proper transfers of people from prison to the acute setting if that is appropriate for them. We also need to ensure, as we are doing through the prison in-reach teams, that there is good help for people in a prison setting. Not everybody wants to be transferred to a hospital, because of some of the implications of that, which is why we need to ensure that there is good support in prisons for people who need it. On the hon. Gentleman’s point about the consultation document, I agree that it is important to get consultation right.

The hon. Member for Southport (Dr. Pugh) rightly pointed out how important the relationship with the voluntary sector can be. We need to do more work with the voluntary sector, which is making very good progress in providing services that people sometimes access more readily than they do some of the statutory agencies. It is right to have that relationship.

With regard to Lord Layard’s ideas, we made a commitment in our manifesto that we would increase access to psychological therapies. That is because it is very important that people with mental health problems have the choices that people have in other areas of health care. It is right to say that such therapies are not necessarily the answer to everything. Sometimes people need drug treatment as well, but what we are doing at the pilot sites, which have seen about 4,000 people, is examining the effectiveness of the demonstration sites. We are expanding those this year—there will be about another 10 sites during 2007—so that we can demonstrate the benefits and show that that system can be delivered across the country. We can consider the new commissioning strengths of primary care trusts to ensure that they develop those services locally.

As well as rolling out not only 10 sites this year but more than that the year after, we are considering how there can be proper accreditation not only of the types of therapy that are available, but of the practitioners who work in those fields. This is important. Not everybody needs to be a full-blown psychologist. Other people can provide important counselling services, but we need to ensure that there is proper accreditation, and we are doing that.

I turn now to group therapy sessions and computerised CBT. Last month we issued implementation guidance for computerised CBT, which means that PCTs should now be in a position to offer that technology to patients with mild to moderate depression. That represents real progress in ensuring that the NHS understands that alternative therapies, particularly talking therapies, are available and we need to make them much more widely available.

We can take away from the debate the fact that there is consensus that extra funding has gone into mental health services and that services have improved quite significantly. We also all agree that mental health care still has some way to go. New therapies are available and there are new changes that we need to make and improvements that I think we all agree are necessary. I assure right hon. and hon. Members that better mental health services remain a priority and we will continue to support people who need care and help at what are some of the most difficult times of their lives.