I beg to move,
That this House is concerned that despite mental illness affecting one in six adults in the UK the proportion of NHS spending allocated to mental health has decreased in the last 10 years, despite the growing burden on the disability benefit system and criminal justice system of dealing with mental illness; recognises that historic under-funding of mental health services has been exacerbated by the Government’s top-slicing of budgets in order to bring the NHS out of deficit; notes the damaging impact that this has had on providing access to mental health services, with particular regard to the unacceptably poor state of many acute mental health wards in providing appropriate settings for the treatment of children and young people, addressing the race inequalities in the mental health system and improving patient safety through, for example, the eradication of mixed sex wards; further notes the warning in last year’s Health Select Committee Report on NHS deficits that cuts in mental health services are simply unacceptable; calls on the Government to deliver on its promise to ensure that trusts whose budgets were top-sliced in the last financial year will get their money back this year and to take active steps to ensure that within each health economy mental health trusts receive their fair allocation of funding; and further urges the Government to accelerate its implementation of Lord Layard’s report, which says that expanding therapy services could be paid for by the savings this would create for expenditure on benefits.
Another Opposition day and another debate on health—we have been getting rather used to them in recent months. I was particularly keen to use this opportunity to raise concerns about mental health services. It is something of a paradox that, although mental health problems touch one in three families, mental health still does not get nearly enough attention in this place or in the broader public debate. One in six of us will be diagnosed as having depression or a chronic anxiety disorder at some time in our lives, and yet in many respects mental health remains a Cinderella service. Mental health problems bring misery and deprivation. In many families, someone who suffers from mental health problems can end up being excluded from the job market, meaning that the whole family suffers in poverty, particularly if that person is the breadwinner. I hope that the debate will be constructive and that the Government will respond positively to the concerns that I and no doubt many others will raise. The subject is far too important for cheap political point scoring.
The timing of the debate is interesting. The Mental Health Bill is going through Committee and it is fair to say that there are fundamental disagreements. I do not in any sense seek to undermine the Government’s genuine position on the Bill, but none the less there are genuine disagreements between the Government and both Opposition parties and the Mental Health Alliance—a pretty remarkable alliance, which represents many people who work in the mental health field. I do not want to spend time today talking about the issues that are central to the Mental Health Bill. Suffice it to say that in our view the best approach to safeguarding the interests of people with mental health problems and to protecting the public is to ensure that those who need help can access the services that they need.
It is worth noting that one in three people who are sectioned report that they were previously turned away when they sought help from mental health services. Recently, I heard from an eminent psychiatrist that the people at the extreme end—those who are most likely to demonstrate violence—are those who are not accessing services at all. It is thus important that we use the debate to focus on access to services. I remain disappointed that the Government seem to focus on compulsion when there is a real risk that that approach will divert resources into acute services and away from the services that provide the critical early intervention that can do so much good. That would be damaging for patients and would put the public at greater risk.
My hon. Friend might be aware that the 24-hour emergency clinic at the Maudsley hospital, which is the main psychiatric hospital in the country, will be closed next week. Since the last general election, no Health Minister has visited the clinic. People have specifically said that there is a risk that that closure will make the difference to them between being in control of their own life and losing their life through taking their own life. Does my hon. Friend agree that people’s access to the services that they need is the practical aspect of today’s debate? While the Government might often say warm words, they do not take the right decisions.
I will be saying more about the fact that deficits throughout the country are leading to the loss of key services. Sadly, the example that my hon. Friend cites is one of too many from around the country.
I acknowledge that the Government have invested extra resources in mental health services. Since 1999, investment in specialist mental health services has increased by £1.5 billion.
If the hon. Gentleman is acknowledging that there has been a growth in resources, at least until 2006, why does the motion suggest that
“historic under-funding…has been exacerbated by…top-slicing”
in the most recent year? Is that not rather harsh?
There is no inconsistency at all. I am sure that the hon. Gentleman agrees that there has been historical underfunding of mental health services over decades. This has been a Cinderella service for a long time. However, I am trying to be open and straightforward by saying that I acknowledge the extra investment that was put in place until deficits and top-slicing in many parts of the health economy caused real problems over the past year or two. There is no inconsistency in my argument.
The Lib Dems supported the extra investment—[Interruption.] We voted in favour of the increase and argued the case for it—[Interruption.] I am being heckled.
I am grateful to you, Mr. Deputy Speaker, for rescuing me from my rather disorderly colleagues.
The Lib Dems argued the case for extra investment. When the Government proposed an increase in national insurance to fund investment in the health service, we supported them. No argument of inconsistency or opportunism can be made against us. We have argued our case consistently.
The motion implies that the Liberal Democrats would make additional resources available for mental health services, rather than support the existing resource base that the Government have created. Where would those resources come from?
Let me attempt to find some cross-party common ground in this debate, which started promisingly. Does the hon. Gentleman agree that Parliament should be examining carefully the way in which this country treats people with dementia? Alzheimer’s sufferers often find themselves without resources and in acute hospitals in which there are no personnel who are trained to cope with Alzheimer’s patients. We are putting too great a burden on hard-pressed families and not giving patients with dementia the opportunity to live the dignified life that they deserve.
I absolutely agree with the hon. Gentleman. Many of my elderly constituents have to look after loved ones suffering from dementia, even though they are often frail. They are often isolated, and we do not have the support infrastructure in place to help them to cope with the real pressures that they face.
There are several reasons why we should not be complacent about the situation. First, while we supported the real-terms increase in investment, the proportion of total NHS spending going to mental health services has decreased at a time when need is clearly increasing. Secondly, despite the extra investment, services throughout the country remain inconsistent and are often inadequate. Thirdly, the deficits of the past two years have had a damaging impact on core mental health services.
My hon. Friend makes an excellent point. Reform and change have been planned and put into effect, but the deficits have had a negative impact on the change process. In the hospital in Bodmin, which is in my constituency, in-patient wards were amalgamated on the basis that more support would be available for people in the community. There is now a worry that the change in the financial set-up will mean that the resources in the community will not materialise, so a ward will be lost without the alternative benefit being put in place.
My hon. Friend’s concern will be shared by many people throughout the country, especially, I suspect, those in rural areas. We in Norfolk have the same worry.
Let me deal with the areas to which I referred. Although real-terms spending has increased, the proportion of NHS spending given to mental health services has fallen from 14 per cent. of the total spend in 1997 to 11 per cent. today. I appreciate that the situation presents real challenges, but I am trying, in a mature way, to point out that at a time when concern about the need for mental health services is rising and there is an increased prevalence of mental health problems in our society, we should collectively be worried that the proportion of total health spending going to mental health is going down. For example, the mental health of children and teenagers in this country has declined over the past 30 years, although, interestingly, the prevalence has remained relatively stable in other areas. The Nuffield Foundation has found that the prevalence of behavioural problems has doubled over 25 years while that of emotional problems such as depression and anxiety has soared by some 70 per cent. It is especially striking that the prevalence of mental health problems has increased at a time when economic conditions and physical health have improved. It appears that this is the emerging health problem of our age.
I am interested in the hon. Gentleman’s comments about the figures on the prevalence of mental health problems among teenagers. Is he suggesting that such problems have increased by the amount that he mentions, or has the recording of problems among people of that age group increased? Also, what would his party do to increase funding for mental health? Which area of health funding would he take the money from to increase funding for mental health?
The hon. Lady makes a fair point; in part, the increase may be down to an increased recording of problems, but certainly the Nuffield Foundation concluded that there was increasing prevalence. I am not here to suggest any simplistic solutions. If there is an increase in the prevalence of such problems among teenagers, I should have thought that we could agree, across the parties, that we all ought to try to address it.
I have tried to be generous in giving way, but I would prefer to make a little progress. I will perhaps give way later. I shall come back to the issue of teenagers later, but surely it is tragic that youngsters often do not get access to the support that they need. We know all too well the price that we pay, and more particularly that they pay, if they do not get effective early intervention. We need only look at the problems in our prisons and consider the fact that 80 per cent. of women in prison suffer from mental health problems. That is quite apart from the reduced life chances, in terms of education, for youngsters who suffer from mental health problems in their teenage years.
The second and related point is that despite the increased investment, which we acknowledge, we have a long way to go if we are to ensure consistent access to high-quality services across the country in both rural and urban Britain, and for all sections of society, including ethnic minorities.
I am grateful to the hon. Gentleman for giving way; he has been very generous. He talks about access. I was part of a primary care psychiatric team in a previous job, and I was allowed to admit and see patients. Why does his party support giving that role back to doctors? If the role is given to the whole mental health team, that would deal with the issue of access.
My experience contrasts completely with that of the hon. Member for Livingston (Mr. Devine); outreach teams have real difficulty reaching people. A friend of mine had a daughter who was suicidal. That daughter was at home and in serious danger of injuring herself—she subsequently committed suicide—and her husband, who also has mental health difficulties, was told to try to restrain her for a minimum of two hours, because that was how long it would take to send someone out, as a shift change was taking place. That is the kind of difficulty that is being faced on a day-to-day basis. There is a real difficulty in terms of capacity.
I am grateful for that telling intervention. My hon. Friend tells an incredibly depressing story about her friend’s circumstances. My experience is of North Norfolk, a very rural area. For people with mental health problems who live in a village, the support that is on offer is often threadbare or non-existent, and the sense of isolation is very real. That experience is common to many parts of rural Britain, where people who suffer mental ill-health have problems accessing support services.
There is clear evidence of unequal access to services for ethnic minorities. The Sainsbury Centre for Mental Health concluded that investment in community-based services would free up millions of pounds that is currently spent on African and Caribbean people in psychiatric hospitals and secure units. Such people are six times more likely to be in medium-secure units than white people in our capital city. There are all sorts of reasons for that discrimination within health services—[Interruption.] Well, it does amount to discrimination, because those people are far more likely to suffer compulsion than white people are. We need to find the reasons for that and to address the issue. We have to ensure that the early intervention services, which ethnic minority communities often cannot access, are there for them.
The Government have rightly made a commitment to securing race equality in mental health services, but progress has been too slow. There is evidence that mental health facilities continue to be the poor relation to acute services, not just in relation to ethnic minorities, but generally. A Mind survey found dissatisfaction with the state of repair on wards, and the Healthcare Commission found that mental health facilities had markedly poorer standards of cleanliness than acute hospitals. There can be no justification for mental health patients being treated less favourably than patients in any other acute unit.
To reinforce my hon. Friend’s point, does he share my concern that people with mental health problems often have worse problems with their physical health than people who do not have mental health problems? Their mental health problems often mean that they do not access physical health services, and that reinforces the disadvantage that they already have.
There is a clear correlation between mental health problems and physical health problems, and I am grateful to my hon. Friend for reinforcing that point.
One of the most serious continuing failings of mental health services is that services for children and teenagers are too often inadequate. Last summer, it was revealed that the Government’s key targets for children and young people accessing psychiatric care would be missed. In a quarter of the country there is no emergency help for teenagers suffering a psychotic crisis or severe depression. Far too many 16 and 17-year-olds continue to end up in adult psychiatric wards when they are compulsorily sectioned, and I realise that Ministers agree with me on that point. I am sure that we can all agree that that is completely unacceptable in this day and age, but it is still happening.
The hon. Gentleman did not have the advantage of attending the Mental Health Bill Committee this afternoon. We heard the Minister of State, Department of Health, my right hon. Friend the Member for Doncaster, Central (Ms Winterton), give serious assurances that the Government would come back to the House with amendments on how to tackle precisely the issue that he mentions. It is a shame that this debate curtailed debate on the Mental Health Bill this evening.
I am grateful for the intervention of the hon. Member for Hackney, South and Shoreditch (Meg Hillier). There seems to be some dispute about exactly what the Minister did commit to, but perhaps we will hear from the Minister herself later. I will address the issue of the massive under-provision of psychological therapies in detail later.
My third concern relates to what the Select Committee on Health described last December as the “simply unacceptable” cuts that have resulted from the financial crisis that has afflicted many parts of the NHS. In many parts of the country, valuable support services have been lost, and that has affected some of the most vulnerable members of our society. Rethink has estimated that some £60 million of cuts have been made to mental health services, not as a result of financial crises within mental health trusts, but as a result of primary care trusts cutting block grant funding for mental health.
On cuts, does the hon. Gentleman agree that local authorities are key providers of mental health services, yet authorities such as Newcastle city council, which is controlled by the Liberal Democrats, have deliberately taken the party political decision not to increase council tax above inflation, and have therefore cut social services budgets, including the budget for mental health funding?
I said earlier that I hoped we would all take the view that the issue was too important for cheap political point-scoring. My concern is about the funding of mental health services within the NHS; that is what the debate is all about. I want to raise a specific and important point about the impact of payment by results. In a survey by the Sainsbury Centre for Mental Health last year, two thirds of mental health trusts said that the introduction of payment by results for acute services was causing a diversion of funds from mental health. Acute trusts are now incentivised to do more work because of payment by results—payment following patients—but that does not apply in mental health services, and primary care trusts therefore seek to make savings elsewhere. Mental health is exactly the sort of soft target, which the Select Committee on Health identified in its report last December, that has suffered cuts as a result of the crises experienced by many PCTs. The Committee was right to criticise the impact on soft targets such as mental health. Surely, it is unacceptable that people suffering from mental health problems should pay the price for financial crises in the health service.
As for my own experience of the impact of cuts in Norfolk, the mental health trust has suffered a cut in funding from Norfolk PCT. Recently, I met some GPs who told me that they had referred a number of youngsters so that they could receive mental health support such as anger management, cognitive behavioural therapy and so on. In each case, they were told that there was no service available for those people. They said that the situation was the worst that they had ever experienced in their time working as GPs, which is surely a cause of concern. The Heron coach was a wonderful initiative that provided a movable drop-in service for people in rural North Norfolk. It moved around rural areas during the week, providing a local access point for people suffering from depression, anxiety and so on.
I was looking at the internet today, and I discovered that in 2003, the mental health trust lauded the initiative as something that provided services to people in remote rural areas. In 2006, the service was lost because of the cut in funding, again making people in remote rural areas more isolated. I remember a woman who came to see me in my village advice surgery last September. She had struggled just to drive up to the village in her car, and she was at a loss to know what she would do without the support of that service, which had provided such valuable support until then.
May I move on to the fourth issue that I wish to raise—the economic impact of mental health problems for both the individual and society, and the need for Government Departments to work together much more effectively to ensure that resources are used to optimum effect? May I respond to interventions from Government Members, by saying that to a large extent that is about using resources more effectively, rather than simply increasing them? Lord Layard focused on that in “The Depression Report” last June. He highlighted the waste of talent and the loss to the economy of the extraordinary numbers of people who are left stranded on incapacity benefits—people who could be successfully treated but who do not gain access to psychological therapies. One million people are on incapacity benefits as a result of mental health problems, and 30 per cent. of new applicants for incapacity benefits have a mental illness. Half the people on long-term incapacity benefit suffer from depression. Those are extraordinary figures: the human cost is massive, not just for the person suffering but for their families, too, and there is distress and deprivation. For children and teenagers, depression and anxiety often stop them learning, and condemn many of them to limited life chances as a result.
May I just press the hon. Gentleman again on that point, because he will know that Lord Layard’s report calls for 10,000 more psychologists? Why, therefore, did he vote against the Government proposals to give more powers and responsibilities to people such as psychologists? He voted against that, so I cannot understand how he ties it in with supporting Lord Layard’s report.
That is a complete confusion of the issues, and the Minister knows that. It has nothing at all to do with the case for increasing investment to provide the therapies that people simply do not receive at the moment. The Minister does herself an injustice by making that somewhat disingenuous point.
May I uncharacteristically help the hon. Gentleman, because the situation is slightly unfair? The Minister mentioned things that have come up in our debates on the Mental Health Bill. The hon. Gentleman may well wish to ask her why she is not prepared to give psychologists the additional powers necessary to enact sectioning in the first place, only to renew sectioning after the statutory period. She is the one who should answer those questions, not someone who has not been privy to proceedings on the Bill in Committee.
I wholly agree with the hon. Gentleman’s point about incapacity benefit, and the way in which it weighs down in particular constituencies. In my own area, 21 per cent. of people of working age are on incapacity benefit, more than 50 per cent. of them for mental health reasons. I am concerned about how we are going to raise the capacity of mental health services fast enough to be able to meet demand so that we stop people just popping pills to deal with mental health problems, and provide more talking therapies, as we find it very difficult to fill vacancies.
I appreciate the hon. Gentleman’s intervention, and he makes a valid point. Our case is simply that a great deal of priority needs to be given to expanding capacity, because—I shall come to this later—the National Institute for Health and Clinical Excellence itself concluded that we can make a real difference if we can increase capacity.
I want to focus on not just the cost to individuals but the cost to the economy. Layard estimates that the total loss of output as a result of depression and chronic anxiety is £12 billion a year or 1 per cent. of national income. Despite that, however, people are not receiving the help that they need. What is missing? As I said in response to the hon. Member for Rhondda (Chris Bryant), NICE has issued guidelines stating that psychological therapies should be available to all people with depression and anxiety disorders or schizophrenia, unless the problem is very mild or recent. However, there are not enough therapists, as the hon. Gentleman highlighted. As a result of the inadequate number of therapists, waiting times are often very long—nine months is common—and often there is no therapy available at all, so GPs in those circumstances have no option but to prescribe drugs or to offer no help at all. GPs themselves acknowledge that they over-prescribe drugs in circumstances in which they would prefer to refer their patient for therapy which, however, is not available. Only one in four people suffering from depression or chronic anxiety receive any kind of treatment. That is a scandal in this day and age, and it needs to be addressed.
The Government make much of their commitment to choice in health care, yet for those people there is no choice at all, unless they can afford to opt out. If they can afford to do so, they can gain access to the therapies that we are discussing. We are spending a fortune on benefits, and the economy is suffering a loss of billions of pounds in lost output. Therapies are available that have a proven track record and which are recommended by NICE, yet most people who could benefit and who could be helped back to work cannot get the help that they need. Lord Layard estimates that an effective course of therapy costs about £750, which is about what it costs in benefits and lost taxes every month that someone remains out of work.
I acknowledge that the Government are pursuing pilots—the Minister referred to that in a recent Westminster Hall debate—and that the number of those pilots is expanding, but progress is too slow. Imagine the outcry that there would be if there were NICE guidelines on, for example, cancer treatment that were being ignored across much of the country. There would be an enormous outcry—rightly so—and it would achieve a response. We owe it to people with mental health problems to demand exactly the same response that people who suffer from cancer and other physical conditions can get from their politicians. This demonstrates yet again the extent to which this is a Cinderella service. Implementing the guidelines requires a significant increase in the number of therapists—Layard estimates a figure of about 10,000. It will take time—he reckoned seven years—but he argues that the cost would be totally offset by savings in benefits and increases in tax revenues.
Another area that the Government need to deal with relates to stigma associated with mental health. In New Zealand, a Government programme to tackle stigma appears to have been very successful. They have invested in the job of reducing the stigma of mental illness. Persuading employers to take on people who have had mental health problems is sometimes a significant challenge, but it has had some effect in New Zealand. I urge the Government to look closely at what they have done and to pursue a similar route in this country.
Instead of looking as far away as New Zealand, would the hon. Gentleman care to look at what is happening in Hull? Mind in Hull runs a project working with employers to get alongside them and persuade them to take on people with mental health difficulties. It works with employers for a considerable amount of time to support them and the person concerned. That is an excellent example of the voluntary sector working alongside the NHS in the wider sense of mental health services.
I am grateful for the hon. Lady’s intervention. She makes a valuable point about the enormously beneficial and positive role that the voluntary sector can perform in working together with employers and statutory agencies, for example to reduce stigma in mental illness. It sounds like an extremely impressive project, and I am grateful to her for alerting me to it.
The hon. Gentleman refers to stigma. Does he accept that there is still a great deal that the national media can do in terms of how they describe and portray the problems associated with mental ill health? It is not that long since The Sun described a crisis that Frank Bruno was going through with the headline, “Barmy Bruno lashes out”, or something similar. The outcry from the population and their readership was such that they had to pull that headline, and later editions of the paper were rather more balanced in tone. Does he think that the media can do a lot more to address the stigma that still exists in society?
That is an extremely important point. There is often enormous hypocrisy in the media when they, on the one hand, argue the case for better resources for mental health but, on the other hand, behave in that pretty disreputable way. The challenge is there for all of us to work to reduce stigma, and the media are very much part of that.
We need a renewed focus on mental health. The Government need to remedy the damage that has been done in the past two years as a result of deficits.
I agree with most of what the hon. Gentleman has said, which is extremely reasonable. However, as he reaches the end of his remarks, the question that he still has not dealt with is where the additional resources are coming from, which taxes will be put up, and which parts of the NHS will be reduced to take account of the additional resources needed.
The Minister is suffering from the problem of having left the Chamber for a short while; perhaps he can consult with his colleagues. The argument that Layard put forward is one example of how resources can be better used to achieve beneficial results.
The Government need to remedy the damage done by deficits over the past two years and to acknowledge that and to commit to ensuring that that damage is remedied. They also need to be honest enough to recognise that there is a long way to go before we achieve consistent access to services and choice for people in the treatment that they receive. That must be a priority. The Government have to be much smarter at joined-up government. We can achieve the great prize of helping so many people to get better, helping them back to work, and benefiting the economy by ensuring that they have access to the therapy that NICE recommends. Surely we have a duty to those people who suffer in silence and in isolation.
I beg to move, To leave out from “House” to the end of the Question, and to add instead thereof:
“welcomes the extra £1.65 billion spent on mental health services since 2001; supports the record number of staff working in mental health since 1997 including almost 9,400 more psychiatric nurses and over 1,300 more consultant psychiatrists; further welcomes the lowest suicide rates since records began; recognises the work of the 700 new mental health teams in the community; notes the national patient survey, which shows that 77 per cent. of community patients rate their care as good, very good or excellent; recognises that between 2001 and 2005 £1.6 billion capital was spent by mental health trusts on improvements to mental health wards; further welcomes the Government’s commitment to expanding access to psychological therapies; and further welcomes the Government’s Mental Health Bill, which will update the legislation to reflect advances in knowledge and new ways of treating people, particularly in the community.”
I notice that, unfortunately, lots of Liberal Democrat Members, including their leader, have flooded out of the Chamber. I was rather hoping that I might be able to say something that would cheer him up a little.
Despite this being an Opposition day debate, I think that there is a certain amount of consensus about the fact that, first, there has been considerable investment in the NHS over the past decade; secondly, mental health services have been modernised and reformed; and thirdly, a large part of the credit for making services better for patients is due to a willingness for staff working in mental health services to maximise the use of that extra investment by adopting new ways of working and using their skills to the full, whether that be by working in new community teams or by taking on more responsibilities.
My hon. Friend is right. I shall come on to discuss the Mental Health Bill later. It is important that the Liberal Democrat spokesman should be aware of everything that his party is doing with regard to that Bill. Given his remarks, I would be surprised if he was in favour of some of the positions that are being taken.
Mental health services have changed considerably over the past decade. Of course, we are not saying that they are perfect, but we are making real progress, particularly in specialist mental health services, which are relied upon by more than 1 million people every year. That progress did not happen by accident, or just by putting the extra money in; it happened because this Government put mental health at the top of their list of priorities. In 1998 we set out our view of modern mental health services in a White Paper, and by the following year we published the national service framework for mental health, which defined for the first time a set of standards that mental health services are expected to attain.
In 2000 the NHS plan spelled out an ambitious modernisation agenda, with new community teams, secure beds and additional funding. We now have strong multidisciplinary networks for supporting people in the community. In total, more than 700 crisis resolution, assertive outreach and early intervention teams are in place in England. Those teams work to keep people out of hospital, supporting them in the community and providing care in the least restrictive environment consistent with their individual needs.
First, the number of in-patient stays has decreased. We are trying to ensure that we get treatment to people when they need it. The number of people sectioned under the Act every year has remained fairly stable; I do not know where the hon. Gentleman got the idea of its having doubled. However, we continue to want to make changes, and community teams are part of that process, to ensure that we can provide help early, as the hon. Member for North Norfolk (Norman Lamb) said, to prevent the deterioration that too often leads to sectioning.
Traditionally, a view developed that removing people with mental health problems from their families and their home environment was the best road to recovery. However, that is often not what people want. They have repeatedly told us to give them help and support in the community, often in their homes, and that is what we have done. In the past four years, I—I am sure that I speak for other hon. Members too—have visited many community-based teams and seen first-hand evidence of the difference that they make in transforming people’s lives. That applies not only to service users but to carers. The teams help maintain social networks, help people take control of their treatment and, crucially, provide timely support at times of crisis. In addition to the 700 new teams, we have 1,500 new community gateway staff to improve patients’ access to specialised services.
The Minister has outlined various things that the Government have done to increase the resources for mental health services. However, the proportion of health spending on mental health has fallen in the past 10 years. There are two ways of tackling that if one believes that the proportion is too low. First, other spending in the NHS could be cut. Secondly, the spending on mental health services could be increased faster than other health spending. Does the Minister hope that the proportion that we spend on mental health services will increase in the years ahead?
I challenge some of my hon. Friend’s points. The proportion of spending has not fallen. Some figures show that the proportion for in-patient care has fallen, but the overall spend has increased. However, I shall deal with that later.
We also recognised the need to modernise in-patient services, so that when people must go into hospital, they have access to more therapeutic opportunities and make a speedy recovery. That is why, on top of the capital allocations made available to trusts, we have provided an additional £190 million in the past five years.
The national service framework was accompanied by record investment. There has been an increase every year since we published the framework. According to the European Commission, the UK devotes one of the highest proportions of its overall health budget to mental health of any EU member state. We now spend £1 billion more in real terms on mental health services than we did six years ago; that is £1.65 billion in cash terms.
The motion states that the proportion of NHS spending on mental health has decreased over the past 10 years. In 1996-97, expenditure on specialist mental health services was 8.03 per cent. of the total net NHS spend. By 2005-06, that had risen to 8.41 per cent. It is important to see the overall picture. In 1996-97, we were spending 8.03 per cent. of a net budget of almost £33 billion on mental health services, whereas in 2005-06, the figure had risen to 8.41 per cent. of a net budget of well over £76 billion. The figures must therefore be viewed in the context of increased overall expenditure from £33 billion to £76 billion. The real-terms increase in investment is clear. That has not been disputed by any party for some time. The increase has happened, and made some genuine differences.
Such unprecedented investment has allowed us to make significant staff changes. Compared with 1997, we have almost 9,400 more psychiatric nurses, more than 1,300 more consultant psychiatrists and 2,700 clinical psychologists. The suicide rate—again, something against which to measure the success of our policies—has fallen to its lowest recorded level. According to the European Commission, it is one of the lowest in Europe, thanks to our national suicide prevention strategy.
I do not want to go into detail about statistics; the Minister and I have discussed those in other contexts. However, does she accept that short-term reductions in funds have occurred in some areas? My part of south London is one of those, because of the top-slicing of primary care trusts that are less able to give money to our South London and Maudsley NHS Foundation Trust—with adverse effects. However, if the Minister accepts that need is increasing, have she and her colleagues put in a bid to the Chancellor? In the comprehensive spending review announcement that we expect in the next couple of months, will there be an additional real-terms significant allocation of money for mental health services for the next three years?
It would not be appropriate to give all the details of our bid in the comprehensive spending review. However, let me consider deficits and their effect on mental health services. We have made it clear that we would not tolerate any mental health trust being asked to contribute more in financial savings or cost improvement plans than any other service in the local health economy, unless that trust contributed to the deficit. My Department has investigated a small number of allegations in the past year, and found that in each case the savings required of mental health trusts were not disproportionate compared with the rest of the local health economy. I assure the hon. Gentleman that if any similar cases are brought to our attention, we will investigate them.
I am grateful for the Minister’s reassurances. In my intervention on my hon. Friend the Member for North Norfolk (Norman Lamb), I was trying to emphasise the great change that is taking place. The Minister has already alluded to the refocusing from in-patient services to services in the community. At such times, services may be even more vulnerable to an overall re-examination of funding. If all trusts are being asked to examine where they spend their money, it may be especially important to examine closely those that offer mental health services to ensure that the impacts on them are not adverse.
As I said, we have made it very clear that we do not expect mental health trusts to have to make any disproportionate contribution. I recall an hon. Member coming to see me about the proposed withdrawal of an early intervention team. Because that related to one of the very clear targets that we had set, we pointed out that it would not be the right approach, and the health authority did things slightly differently. We were able to ensure that the early intervention team remained in place.
When I meet mental health staff, I always find that they want us to ensure that financial deficits are sorted; it is important to recognise that. Although mental health trusts have historically often kept their finances in good order, they have always felt slightly vulnerable in the event of financial problems. One thing that mental health staff often say to me is, “We just want the overall situation sorted out. You are quite right to go down the road of doing that, because in mental health, we worry that if things are not right, people will come back to us and ask for more cuts in services.” We are on the right track there, but with the proviso that we ensure that mental health services are not asked for disproportionate amounts of money.
The Opposition motion also calls for appropriate settings to be provided for young people who need to go into hospital for a mental health problem. My hon. Friend the Under-Secretary of State has made a commitment to eliminate within two years the use of adult psychiatric wards for children younger than 16. We are writing to strategic health authorities, informing them that if a child younger than 16 is placed on an adult psychiatric ward, it should be reported as a serious untoward incident. That is against a background of massively improved spending on child and adolescent mental health services—CAMHS—from £284 million in 2002 to something like £513 million in 2005, which is a rise of more than 80 per cent.
I was asked to look again at the Mental Health Bill with particular regard to age-appropriate accommodation. I said in Committee this morning that I would look at whether it was possible to amend the Mental Health Bill along the lines put forward by YoungMinds about age-appropriate settings. Bearing in mind what was said about political point scoring, I have to say that I was disappointed to find that the Conservative Opposition put out a press release saying that all Labour Members had voted against this, when I specifically said that I would take the amendments away. We discussed why they were not appropriate at the time and I undertook to keep the Opposition informed about any decisions in order to involve them in the issues. I am therefore very disappointed that they have decided to act in this way.
The decision announced by the Under-Secretary is certainly a step forward, but does not the national service framework for children and young people refer—in standard 9, I believe—to the need for the broader group, not just under-16s, to receive care and attention appropriate to their age? What progress can we look forward to for the wider group? That is fine for under-16s, but there are still far too many adolescents older than 16 in adult wards. That cannot be tolerated much longer.
That is absolutely right—but it is all about ensuring that the correct assessment is made. We have to recognise that sometimes circumstances will be difficult, as in the case of emergencies, and we need to be clear that we can deliver treatment where it is necessary rather than turn a child away. However, we have made particular commitments about how best to handle that situation. I want to ensure that we get the services right, and that any legislation that we introduce does not create a perverse incentive for children not to get treatment because a clinician feels that what he wants to do is unlawful. It is a delicate balance and, as I said, we are looking further into the position. We were all agreed in Committee along the lines that I have outlined—that we want to see the change happen, but we want to ensure that we get it right.
Far from apologising, I want to challenge the Minister’s sanctimonious claptrap. She knows full well that all 12 of her colleagues in Committee voted against a provision in the Mental Health Bill, added in the other place, that would have given guarantees for age-appropriate treatment to some of our most vulnerable children. She knows that that is what they did. Furthermore she—along with her mental health tsar and colleagues in the Lords—has been talking for months and months and months about looking into the problem and doing something about it, but at no point has she promised to come back with a new amendment that will specifically address those concerns. She has said only that she will have a look at the problem, which is far removed from promising to do something about it.
The hon. Gentleman knows very well that the debate in Committee this morning was quite reasonable and sensible. We agreed that there were some real issues that needed to be looked at. Particular points were raised under one of the amendments to the amendment, which again put the doctor in charge by referring to registered medical practitioners. That was different from what we wanted, which is to give more powers to people such as psychologists and nurse consultants. The hon. Gentleman knows that that is why we said that we would take the amendment away. His comments are purely for political point scoring: he well knows that, and he is being slightly disingenuous if he fails to admit it.
I am glad that the Opposition motion mentions our work on improving access to talking therapies. As the hon. Member for North Norfolk said, the Government will expand its programme to gather more evidence to support the hypothesis put forward by Lord Layard and his colleagues at the London School of Economics. We are also working very closely with colleagues in the Department for Work and Pensions and the Health and Safety Executive, particularly looking at the connections between the pathways to work condition management programme and our work on improving access to psychological therapies. It is important for the various strands to work closely together to ensure that we can provide holistic support for those who really need it. I think that the Treasury recognises the importance of the work that we are doing, particularly in the two pilot sites. That has been a major part of the Government’s cross-cutting review of mental health and employment.
It is right to talk about the importance of getting employers to take responsibility and help employees who are having mental health problems. Some of that is also about the Government and others providing the right kind of information and support, of which our “action on stigma” programme forms an important part. Organisations such as Royal Mail and BT have put forward some good policies and we should ensure that others are made aware of them. We should gradually get people to sign up to that kind of approach. My hon. Friend the Member for Kingston upon Hull, North (Ms Johnson) said that there were good examples around the country, and my hon. Friend the Member for North-West Leicestershire (David Taylor), who is no longer in his place, pointed out that the media also have an important part to play.
My hon. Friend mentioned holistic working. Bolton, Salford and Trafford have a single mental health trust, and I recently attended a meeting with GPs in Salford and Trafford at which they raised the significant differences in access to psychological services in the different areas. Their conclusion was that services were better in Salford precisely because of the things that my hon. Friend has described, such as improved counselling—the service is keen to shift resources around the city to improve access—and the fact that people are prepared to work outside silos and to prepare maps of counselling services to try to provide access. They highlighted projects such as Salford women’s centre, which has very good counselling services that can be made available. Apart, possibly, from certain bigger factors, the difference seemed to be made entirely by those things. People in Salford are getting right those holistic approaches and different ways of working. Waiting times and access to psychological services are considerably better in Salford than in Trafford.
My hon. Friend is right. I invite her to come to Doncaster to look at the pilot there, which has been incredibly successful. To date, about 4,000 people have benefited from access to psychological therapies. The Minister of State, Department of Health, my hon. Friend the Member for Don Valley (Caroline Flint), and I would be more than happy to entertain her in Doncaster and to show her all the good things there.
It is a great step forward that we have the NICE guidelines. Computerised cognitive behavioural therapy is also coming on stream. We still need to make progress, however; there is no doubt about that. The important thing about our approach is that we are demonstrating through the pilot sites that these methods can quickly have a real effect. In such circumstances, we often need to convince commissioners that this is a good approach and that it will help to get care to a large number of people. That is why we are pushing in that direction. There is certainly a commitment; indeed, that was in our manifesto.
It is also right to say that there are some very real issues that we need to tackle, and we are doing so. Those include the experiences of people from black and ethnic minority communities when using and accessing mental health services. However, our national director for mental health, Professor Appleby, recently gave his summary of the progress made in the past 10 years, and he concluded that removing the inequalities of patient experience between ethnic groups through more responsive services, community engagement and staff training was a central part of the agenda and a key priority for the coming years. We are making progress with implementing the “delivering race equality” programme. We now have 160 community development workers in post and we are working with local services to employ the full complement of 500 workers as planned.
I also recommend the very good work in the focused implementation sites, which are looking particularly at why people do not come forward to access services, the experiences of people from BME communities when they get into the services, and what problems are involved in ensuring that people receiving those services are treated with respect for their cultural background. That work is about looking at how we can deliver our race equality programme in practice.
The Government have spent 10 years improving the mental health service and rescuing it from being the Cinderella service that it was during the Conservative years. As the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), pointed out, there has been a great deal of talk from the Liberal Democrats about all the changes that are necessary, but very little illumination of where all the money would come from. On the Mental Health Bill, they have turned fence-sitting into a fine art.
As part of our changes to the delivery of high-quality mental health services, we must ensure that we update our mental health legislation so that it not only reflects current service delivery but deals with problems involving human rights and court judgments. That is why we decided to update the legislation. Our work has not been helped by scaremongering from certain organisations and, indeed, from the hon. Member for East Worthing and Shoreham (Tim Loughton). One of his more bizarre comments was that the Bill would make lobotomies more widespread. He also said that anyone addicted to cigarettes could be detained under the Bill. Such depictions of legislation are the one thing that puts people off using services. The aim of the Bill is to ensure that people are treated; to paint it as some have painted it is quite wrong and unfair to some very vulnerable people.
The Opposition parties now claim to be the champions of mental health, but time and again they vote against measures that would ensure provision of treatment for those who desperately need it in order to prevent harm to themselves or to others. As I have said, I am not sure that the hon. Member for North Norfolk is aware of everything that his party is voting for, but I can give an example.
The Opposition parties want to introduce an impaired decision-making test. That would mean that the use of detention was no longer determined by a patient’s needs and by risk to self or others. The first question would be whether the patient’s capacity to make decisions about treatment was impaired. If their capacity could not be shown to be impaired, detention would be forbidden, however much the patient needed treatment and however much the patient or others would be at risk without it. The hon. Members for East Worthing and Shoreham and for North Norfolk argue that we are wrongly detaining people who have the ability to make a decision about their treatment. The hon. Member for East Worthing and Shoreham said that many people under section retained the capacity to determine their treatment. The implications of the impaired decision-making test are clear, however. Not all suicidal patients have impaired judgment.
The Opposition parties have taken a very libertarian view. If someone has been through all the options and, although seriously ill, understands the treatment and does not pass the impaired decision-making test, who—they ask—are we to ensure that that person is treated? Given that people can refuse physical treatment, why should those with a mental disorder be given treatment? I have been given examples of young women suffering from borderline personality disorder—women who are suicidal and have had a terrible time in life as a result of physical, emotional or sexual abuse, but who, when all the options are explained to them, will still say, “I want to commit suicide.” The impaired decision-making test would mean our saying “That is okay. You go and do that.” I do not think we are helping anyone by not enabling clinicians to give treatment to such people.
Will my right hon. Friend enlighten the House as to the precise definition of impaired decision making? If somebody has gone through traumatic experiences and wants to commit suicide, that implies to me that they have impaired decision making.
One of the problems in this respect is that there is no definition of impaired decision making. My hon. Friend should ask Opposition Members what they mean by that. If they are saying what they said in Committee and elsewhere, which is that many people under section retain the capacity to determine their treatment, then presumably those people will not get treatment if an impaired decision-making test is introduced.
Let me return to the case of young women with a personality disorder. Do Opposition Members feel that it is fine to say, “Well, you know all the options and you’ve still decided that this is what you want to do, but we cannot treat you now as you have understood all the options”? If Opposition Members are content to take that view, I am surprised, but that is their position at present. That is the position that the Liberal Democrats take.
What does my right hon. Friend mean by understanding all the options? Is it not the case that someone might understand their options—although I am unsure whether there is a great array of options in such circumstances—but that they can still have impaired decision making if they want to commit suicide?
They can have impaired decision making if they want to commit suicide, but it does not always follow that such people necessarily do have impaired decision making. I refer my hon. Friend to the comments of the British Psychological Society. It has said, “Yes, there will be people who do not pass the impaired decision-making test.” I wonder what is my hon. Friend’s position in respect of those people who, once the options and the effects of treatment have been explained, do not pass the test. It is important to remember that mental health measures currently have a simple test: is the person concerned a danger to themself or to others? Introducing another test trumps that, so that even if the individual is a danger to themself it still follows, if there is an impaired decision-making test, that that person may have to be let go without having treatment—indeed, that they must not be given treatment. That is the big problem with the impaired decision-making test. We should consider what the experts have said. The hon. Member for East Worthing and Shoreham said that many people will not pass the test. That means that they will not get treatment.
The Government also believe that people who need mental health care should be able to access it. That is why we will change legislation to cover the significant number of people who under the current legislation cannot be treated because of the treatability test. The hon. Member for North Norfolk mentioned women who had not received the mental health care that they needed ending up in prison. If he looks at Jean Corston’s report on women in prison he will see that many of them have personality disorders and have been turned away from having treatment. Jean Corston is very clear that an amendment should be made to mental health legislation to remove the treatability test, because there is no doubt that that has pervaded mental health services and has meant that people with personality disorders have been turned away time and again. The Opposition know that that is the case, but they keep rejecting it.
The hon. Member for East Worthing and Shoreham said that it would be a better idea to have special legislation that comes under the Home Office for people with personality disorders. Those many people who have not committed a single crime and who are not necessarily a danger to others but might be a danger to themselves would suddenly be dealt with under criminal justice legislation. That is not the way to reduce stigma and discrimination. The hon. Gentleman should be aware that his party’s proposal to restore the treatability test would perpetuate the situation whereby people with personality disorders are refused treatment. I am surprised that he does not know that from his constituency experience, because I know it from mine.
The Opposition also want to introduce all sorts of exclusions into the legislation. They propose that people should not be detained for their political beliefs, for example, or for their religious or cultural beliefs. Of course, we agree with that. The exclusions under the Act, however, relate to people who have a mental disorder. Political and cultural beliefs, however, are not a mental disorder. The Opposition are creating a lawyer’s paradise. As for their argument that some terrible future Government—not the present Government or perhaps the next—might lock people up for their political, cultural or religious beliefs, one would be unlikely to wave the Mental Health Act at such a Government.
The Opposition also want to amend the Bill to restrict supervised community treatment to patients who have been detained as compulsory admissions at least twice. That will benefit fewer patients, restrict clinicians, exclude patients whose first compulsory admission has been preceded by several voluntary admissions, and make patients wait until a further crisis and a further compulsory hospitalisation have occurred. As a supporter of the Zito Trust wrote in March,
“What possible benefit can the mentally ill person gain by obtaining a CTO only after being hospitalised twice? Once is enough”.
It is beyond belief that the Opposition are supporting that—[Interruption.] Stranger still is the Opposition amendment to restrict supervised community treatment to those who are a risk to others—
Order. We cannot have sedentary interventions. If the hon. Member for East Worthing and Shoreham (Tim Loughton) wants to intervene, he ought to do so in the usual way.
I talked a lot about the motion, and made points relating specifically to it. Perhaps the hon. Gentleman was not in the Chamber at the time.
I have addressed the points made about deficits, employment and the need to ensure a multidisciplinary approach. That brings me to the point made about teamwork in mental health care being essential, with which the Government obviously agree. But when we introduce legislation that will improve the working of mental health teams and help to ensure continuity of care for patients, the Opposition consistently vote against it. In relation to professional roles, the Opposition fundamentally undermine the role of the responsible clinician by expecting a doctor to be involved at key points, and requiring the responsible clinician to get permission from the doctor. That would keep mental health services rooted in the past. Their approach is about paternalism and protection.
I am astonished that the hon. Member for North Norfolk can talk so freely about psychological therapies and the importance of getting more psychologists to work in mental health, given that the reality of the amendments to the Mental Health Bill that he supports, which are against the role of the responsible clinician, mean that psychologists will be unable to have such powers and responsibilities. I suggest that he talk to organisations such as the British Psychological Society, the Royal College of Nursing and Unison, which represent 85 per cent. of staff working in mental health services and which vigorously oppose those amendments.
I have made it clear that I will talk to all those organisations, but this is a completely different point. The amendments to the Mental Health Bill have nothing to do, as the Minister knows, with the case for increasing the number of therapists available for psychological therapies.
The hon. Gentleman does not understand that we have spent 10 years devising new ways of working and a multidisciplinary approach, the point of which is to allow people other than psychiatrists to take responsibility for patients. We are trying to reflect that in legislation, so that this House sends a clear message about ensuring that we can recruit more psychologists, for example. The hon. Gentleman has obviously set his face against that, and I suggest that he think about the real implications of his position, which does not help and would set back all the work that has been done in achieving a multidisciplinary approach to delivering health care and in encouraging more people into the profession of psychology.
We are updating the Mental Health Act 1983 because the world has moved on in the last 24 years. The Mental Health Bill is relevant to the Liberal Democrats’ motion, in that it is important in ensuring that the people who need treatment get it. The Liberal Democrats, however, are supporting amendments that would prevent that from happening.
Let me finish by reminding Members of a recent statement by Dr. Matt Muijen, the World Health Organisation’s head of mental health in Europe. Dr Muijen, who spent many years in the UK mental health sector, pointed out that England has the best mental health services in Europe and that this is acknowledged in other countries. Interestingly, despite having spent quite a long time in the campaigning part of mental health services, he also said that we had a “culture of criticism” that prevented that fact from being acknowledged here. I know that there is still more to do, but I invite Members to free themselves from that culture and to join me in paying tribute to the many thousands of people who work in mental health services. Without them, we would have been unable to make the improvements that mean that high-quality services can be, and will continue to be, provided under this Government to some of the most vulnerable people in our society.
Forty-eight minutes later, it is safe to come out from behind the sofa. What a bizarre speech by the Minister! She has been re-running debates that we have had, or might still have to come, in Committee, and has tried to make up for the paucity and confusion of her logic there by resorting to complete caricature and rather bizarre claims, in response to a motion that does not actually mention the Mental Health Bill anyway and is supposed to be about mental health services. I shall not discuss what she said in detail, other than to say that I shall be fascinated to see the record of where I have said that the Mental Health Bill will lead to an increase in lobotomies, because that is news to me. I seem to recall raising with her the subject of whether lobotomies are still permissible under certain circumstances, regardless of the Mental Health Bill.
I also challenge the Minister on the hoary old chestnut that she has trooped out for some months now about the prevention of suicide by community treatment orders and other provisions of the Mental Health Bill. She has not provided a shred of evidence to back that up, but she is already going on about how suicide rates have fallen. Even so, she still requires, apparently, some of the most coercive mental health legislation of any country in the world.
I was delighted to receive so many mentions by the Minister—rather more than by the Liberal Democrats whose debate this is, and five of whom remain in their places. I am glad that they did not all head for the door when I started to speak, unlike the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint).
The arguments I make are not just my arguments or those of my colleagues in the House of Lords. They are the arguments of 80 members of the Mental Health Alliance, occasionally including members of the British Psychological Society and a couple of others that the Minister mentioned several times. I welcome this debate. I am glad that the Liberals are following the Conservative example of trying to raise the profile of mental health issues at Westminster. I have to say, however, that this is the only debate that the Liberal Democrats have had on health matters in this Parliament and only the second since the last election. However, converts late to the party are welcome.
The timing of the debate is curious. As the Minister said, it curtailed the debate that we were having.—more rationally than she suggested in Committee on the Bill. Bill. It is good to raise the profile of mental health. The Mental Health Bill has attracted much publicity, much of it negative because of its controversial contents. I make no apology for my role in raising those objections, but it is important that we also raise the profile of the positive developments in the mental health world and the dedication of all the staff working in difficult circumstances, something that the Minister just managed to squeeze in in the 48th minute of her contribution. We should also mention the contribution of the excellent voluntary organisations and support groups such as Mind, Rethink, the Sainsbury Centre for Mental Health, YoungMinds and so on, as well as the carers of all those living with mental illness, on whom much of the responsibility for care falls, however good or not the legislation is. Not least among the carers are young carers, and the estimate is that some 20 per cent. of the 175,000 young carers are living with someone, usually a relative, who has a mental illness.
While the Liberal Democrat motion is right to flag up the problems and we can support those sentiments, the tenor of the Government amendment is far too complacent. That was borne out by the rather self-congratulatory tone of the Minister’s introductory remarks. The amendment paints a far too rosy picture of what most people still agree is the Cinderella service of the NHS, and CAMHS is the Cinderella service of that Cinderella service—[Interruption.] Well, I fear that my definition of a rosy picture is rather different from the Minister’s and perhaps we should put that into the lexicon of how this Government look at things differently from reality and from the experiences of our constituents.
I also query why, in a motion about mental health services, one of the co-signatories to the Government’s amendment—alongside the Secretary of State for Health and the Minister, the right hon. Member for Doncaster, Central (Ms Winterton), whom one would expect—is the Home Secretary. That says a lot about the way in which the Government view mental health and the pitch of the Mental Health Bill. It is about locking people up rather than providing therapeutic benefit for a health problem.
I would point out that the Prime Minister and the Chancellor of the Exchequer are also on the list of signatories. That is just joined-up government and perhaps the hon. Gentleman will withdraw that comment.
The hon. Gentleman raised an important point about mental health services often being seen as the Cinderella services, but he is being limited in his congratulations to the Government. I will raise later the many issues that still need to be tackled in mental health services, but he must acknowledge the huge improvements in investment and increases in psychiatric nurse and consultant numbers that are making a big difference on the ground, even though we could always do more.
I thank the hon. Gentleman, but does he stand by the proposition that separate, Home Office legislation should be used to deal with people with personality disorders? If so, that would be slightly inconsistent with what he said about the Home Secretary simply signing an order in this House.
No, because the proposition does not refer to people with a personality disorder—it refers only to people with a dangerous and severe personality disorder, which was the position adopted by the pre-legislative scrutiny committee. It is the position to which I signed up, and the one to which every Labour Member from the Lords and this place who formed the majority in that committee signed up. It remains relevant today, so it is up to the Minister to explain why Labour members of the Public Bill Committee—including those who were members of the pre-legislative scrutiny committee—now appear to have changed their minds.
The Minister of State was happy to trot out figures released by her mental health tsar last week in a report entitled “Mental Health Ten Years On: Progress on Mental Health Care Reform”. The tone was self-congratulatory, but in that litany of statistics there was a heavy dependence on head-count figures. I shall therefore give the right hon. Lady some more statistics.
The Government have admitted that, under the previous Conservative Government, the proportion of NHS spending devoted to mental health was in double figures. We could argue about the exact figure, but it was between 11 and 14 per cent. According to the document released by the Government’s mental health tsar, the proportion has been reduced over the past 10 years to just 8 to 9 per cent. That figure does not refer to in-patient spend, as the Minister claimed: that is total mental health spend, as the figures on page 4 of Lewis Appleby’s document show.
We need to be consistent about those figures. The proportion of funding that has gone to mental health in this country over the past 10 years is lower than it was in the previous 10 years under the last Conservative Government. By the Minister’s logic, therefore, the spending on mental health by the previous Conservative Government must have exceeded that of other European countries by an amount even greater than that achieved by this Government.
The figures can be a little confusing. When we talk about the proportion falling from 14 to 11 per cent., we are talking about the spend in secondary mental health services as a proportion of all secondary NHS spend. Therefore, that figure does not take account of the new services based in primary care trusts.
I do not think that anyone is convinced. The Government can spin and fudge the figures as much as they like, and we may all agree that the spend has gone up by £1.5 billion since the national service framework was established, but there is no doubt that spending has fallen in percentage terms. That is because mental health has been a lower priority under this Government than it used to be previously. There is no getting away from the fact that the absence of a level playing field can result only in promoting the stigma felt by people involved in mental health in this country.
Other figures counter some of the claims made by Lewis Appleby. Last year’s report from the Sainsbury Centre for Mental Health found that nearly two thirds of mental health trusts had been asked to cut their budgets to cover overspending in other areas of the NHS. Since 1997, the number of NHS beds in the mental illness sector has declined by 6,799—almost one fifth of capacity—yet, as I said earlier, twice as many people have been sectioned in the same period. More people are requiring mental health services. The King’s Fund report showed that vacancy rates for psychiatrists were over 10 per cent., compared with 4 per cent. across other disciplines. It also showed that vacancy rate for mental health nurses was double that for all nurses.
The Rethink reports “A Cut Too Far” and “A Cut Too Far: Six Months On” gave a catalogue of cuts, both planned and potential, worth £67 million. They included proposed cuts of £5 million to older people’s mental health day hospitals and other services in Suffolk. In Westmorland, proposed cuts involve the closure of two mental health wards at Westmorland general hospital. In the South West London and St. George’s mental health trust, which the hon. Member for North Southwark and Bermondsey (Simon Hughes) mentioned, Yew ward has been closed and Bluebell ward, previously women only, is now mixed. The drug addiction ward has been closed and in-patient provision for eating disorders has been closed.
The list goes on and on. Most recently, in Milton Keynes the PCT is to cut £1.4 million from mental health services, including drug and alcohol treatment and a memory screening clinic. Those are rather different figures from the rosy picture that the Minister’s mental health tsar has trotted out. I am sure that she will agree that the National Institute of Mental Health is not partisan. Its report, published in 2005, found that the bed occupancy rate was 100 per cent. on average and in London the average was 107 per cent.; that staff in a quarter of wards had to work unpaid overtime; and that half of wards lack a lead consultant, 13 per cent. have no ward manager, 12 per cent. have no administrative support and three quarters have no housekeeper.
The Mind ward watch survey of 2004 found that 53 per cent. of in-patients said that the ward environment did not help their recovery; 27 per cent. of patients felt unsafe in hospital and 51 per cent. had been verbally or physically abused. The “Count me in” survey, which did not see the light of day for some while, was produced earlier this year. Far from repeating the Government’s assertion—repeated even by the Minister in Committee this morning, remarkably—that 99 per cent. of hospitals were complying with the requirement for no mixed-sex wards, the survey showed that this year 55 per cent. of patients were not in single-sex accommodation.
The situation is getting worse and it is worst of all in mental health hospitals. That is particularly frightening for young people, inappropriately placed in adult wards, in mixed-sex wards. It is a frightening prospect for a 15 or 16-year-old girl who has undergone a psychotic incident; many have given evidence to people interested in the Mental Health Bill.
The Commission for Healthcare Audit and Inspection and the Department of Health use the same criteria to classify exactly what a mixed-sex ward is, so the Department really must explain how it has come up with such extraordinary figures that are completely out of touch with reality. I could go into detail about the situation for children and young people, which we debated at length in Committee this morning, and the alarming report by the Mental Health Act Commission, relayed by its chairman, Lord Patel, in the House of Lords. The report revealed that between April 2003 and October 2006, no fewer than 1,308 under-18s were detained in adult psychiatric units with no special safeguards—that is one a day. When the commissioners asked ward staff whether there were any plans to transfer the young person or child to more appropriate surroundings within the next seven days, they were told that there were no such plans for nearly three quarters of the children. Those are not short-term emergency measures; such things are happening day in, day out and the situation is getting worse. It is getting worse under the Labour Government, on the Minister’s watch.
My hon. Friend is entirely right. Such provision is a stipulation of the UN convention on the rights of the child, to which the Minister—I thought—adhered.
When the Minister was giving her figures, she did not mention that the Government have failed to meet their target for a public service agreement for CAMH services in every authority area by December 2006—nor was it mentioned in the mental health tsar’s report. The scandal of age-inappropriate treatment for our vulnerable children and young people should be a source of shame to the Government, not a source of self-congratulation as they trot out headline figures that bear no reality to the alarming and deeply harrowing experiences that many of our young people continue to suffer. Today, the Government, the Minister and her 11 colleagues voted out of the Mental Health Bill assurances that would give some succour, security and hope to those vulnerable young people.
If the hon. Lady will forgive me, I will not, because I want to allow her and others time to speak later in the debate.
The hon. Member for North Norfolk (Norman Lamb) repeated the figures for the number of people on benefits by reason of a mental health disorder. The number has risen from 732,100 in 1997 to 1,092,910 last year. There has been a 194 per cent. increase in severe stress and an 82 per cent. increase in depressive episodes. Of course Lord Layard’s proposals make sense. They make economic sense, but they also make sense in relation to the health of people who suffer from depression, who would be able to get back to being viable members of a community and of society, contributing through jobs and taxes.
The Pulse report last year revealed that 93 per cent. of GPs had been forced to prescribe anti-depressants because of long waiting times, against their better medical judgment and against best clinical practice. Three quarters of those GPs were dissatisfied or strongly dissatisfied with their local services for depression. Patients were waiting on average 94 days for assessment and treatment in primary care and 249 days in secondary care, with the worst waiting times, again, for children. At least 50,000 children—some as young as six—are on anti-depressants. What a start in life for those vulnerable individuals. They are being fed powerful chemicals that, in many cases, are not the most appropriate way of treating them. There has been an enormous explosion in drug prescriptions for attention deficit hyperactivity disorder.
When it comes to taking Lord Layard’s experiments and proposals seriously, there is not only a clear economic payback, but there is a clear social and personal health payback. We have had two pilots, in Newham and in the Minister’s city of Doncaster. Perhaps her colleague, the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), can enlighten us as to what will happen to the findings of those pilots and whether there is going to be a full roll-out. My visit to Newham to speak to the staff who are running that excellent project certainly suggested that it had been a great success.
There is also the issue of the disproportionate effect of the lack of mental health care on the black and minority ethnic community. That is another area that we have discussed at length in the Mental Health Bill Committee. It is no surprise that the BME community is perhaps most alarmed of all at the disproportionate effect the Bill’s provisions will have on its members. There is a fear that, given the disproportionate number of people with a mental illness in the BME community, the proposals in the Mental Health Bill and particularly community treatment orders—which I will not prejudge because we have not debated them yet—will drive people away from presenting for services in the first place, and that their condition will therefore fester under the clinical radar, which is the worst of all worlds.
I will not go into great detail about the importance of dealing with mental health problems in the workplace. We have a lot more to do in that respect. Certain examples of good practice among certain companies were mentioned, but the Government have to do a lot more to get the work-life balance right and to achieve an approach to the work force that considers their general well-being, so that people work in partnership with their companies, companies benefit from a healthy work force and the work force benefit from good mental health.
At the last election, my party produced a mental health manifesto. We talked about making mental health a national priority in our health policy and about public health being a key feature of our future Government’s health policy. Mental health is one of the most worrying ticking time bombs when it comes to the health of our nation, and, not least, the health of our children. We want greater choice for service users in mental health. That choice does not exist in mental health services at the moment. We want urgently to tackle the recruitment crisis, which the Government seem to be in denial over. The figures do not back them up. We want to see an increase in CAMHS beds and we want to place duties on health providers to admit children and young people to age-appropriate facilities. We voted for that in the Mental Health Bill Committee today. We want to see better help for black and ethnic minorities, who face particular difficulties, and we want to have more appropriate services targeted at getting them to present to mental health services in the first place. We want help for carers dealing with mental health issues and we need to address the mental health crisis in our prisons. The Conservative party signed up to all those things at the last election and we will continue to put them at the forefront of our health policy because not doing so would be a false economy.
Conservatives will continue to move mental health up the political agenda. It is important that the Mental Health Bill is not used as a substitute for inadequate mental health services, as the Minister seems to wish to do all too often. There are no grounds for the sort of complacency about which we heard from her in ranting form. I fear that professionals throughout the country, the 80 members of the Mental Health Alliance, service users and voluntary organisations do not agree with the rosy picture that the Minister and the Government paint.
The most vulnerable in our society deserve better. They deserve a better response to this important debate than that given by the Minister. We need a level playing field for mental health, at least to prevent the mental health time bomb from getting worse. We need to do something at last to shift the stigma attached to people with a mental illness. Addressing that fate is still one of the biggest challenges that we face, but I fear that the Government’s complacency has only served to make it bigger.
First, I must tackle some of the comments made by the hon. Member for East Worthing and Shoreham (Tim Loughton). It is frankly an insult for him to suggest that Labour Members are complacent. I, like others, represent a constituency in which there are severe mental health needs. I remind him that under the watch of the previous Conservative Government, it was the first time that more young black men were in prison than in university. Such inequality and the inequalities that we still see in the mental health service started under that Conservative Government. It is disingenuous for the hon. Gentleman to suggest that there are problems that are down to this Government alone. Such an approach does not help to solve the problems that affect many of my constituents and others. Even if there is nit-picking and the issuing of petty press releases as part of the shilly-shallying on the important matter of the Mental Health Bill, I had hoped for an acknowledgment that we have a joint responsibility to tackle some of the problems. We do the people who use mental health services no favours by caricaturing things in such a way.
After hearing the hon. Gentleman’s speech, I have much nicer things to say about the hon. Member for North Norfolk (Norman Lamb). However, he was disingenuous about the percentage fall in health funding. As my right hon. Friend the Minister said, overall NHS funding increased from £44 billion to £76 billion over the period in which there was the drop in funding that the hon. Gentleman highlighted. However, that drop in funding relates to hospital services. If I have time, I will mention some of the issues surrounding hospital and community services.
The hon. Gentleman also talked about the important issue of the incidence of teenage mental health problems, which we have discussed during our consideration of the Mental Health Bill. However, surely the situation is arising because there is a greater recognition of the problems among young people, for which we should all be grateful. I hope that we can reach a consensus on tackling the situation.
During today’s Committee proceedings on the Mental Health Bill, we had an interesting and informed debate about children on adult mental health wards. Among the Labour Committee members who spoke—forgive me, Mr. Deputy Speaker, if my memory is not entirely accurate at this late hour—were my hon. Friends the Members for Rhondda (Chris Bryant), for Bolton, South-East (Dr. Iddon) and for Stafford (Mr. Kidney). They put it on the record—many of us who did not speak agreed with them—that they were firmly in favour of children not being put on adult mental health wards, but indicated that they trusted my right hon. Friend the Minister following her promise to consider the matter again. They listened sensibly to her comments about why simply accepting the Opposition proposals would cause difficulties. It is easy to make cheap points, but being in government is about delivering real results for children on adult mental health wards, the mental health service users in my constituency and any of us who might need to use mental health services in the future.
The hon. Member for East Worthing and Shoreham talked about the use of mixed wards. I have met mental health service users in my constituency a couple of times. When the question of mixed wards came up during my most recent discussion with them, I was surprised that everyone in the room—men and women from a range of backgrounds—indicated that they were in favour of mixed wards. They said that it meant that their lifestyle while detained was more normal, as they mixed with people of the opposite gender; being segregated and separated added an extra difference to their already different lifestyle while on the hospital ward. That may not be a universal view, but we should listen to the service users. As I have said before in debates in the House, we too often do not hear the voice of the user. We may be here to legislate, but in this debate we should listen to the voice of the user.
Sadly, I am not a member of the Committee that is examining the Mental Health Bill in detail, but I have written many articles and a chapter of a book on the subject of mental health. Is the hon. Lady seriously suggesting that mental health patients would prefer to be in mixed wards with other patients with specific mental health conditions? Is she really suggesting that that should happen? That is certainly not a reflection of anything that I have learned on the subject.
I am not suggesting anything; I am telling the House what mental health service users said to me. They did not mean sleeping in beds next to each other. They meant being on mixed wards, but a mixed ward very rarely means people of different sexes sleeping next to each other in a bay, or sharing a bathroom. They specifically said that they wanted to socialise and mix with people of the opposite gender during their detention period. They have said that to me as their MP, and I think that it is right to pass those comments on to the House.
I will not get drawn into a debate about mixed and single-sex wards; I am simply reporting the views put to me by mental health service users in my constituency, and I think that it is important that those views are put to the House. The hon. Gentleman may want to make mischief with that, but I am simply reporting the views of one group of mental health service users to whom I spoke.
It is important to put on the record once again the many challenges that face residents and mental health service users in my constituency. People in Hackney are three times more likely to be admitted to hospital with schizophrenia than people across England as a whole. Some 40 to 45 per cent. of people detained in the City and Hackney mental health services area, mainly male, are from African and Caribbean groups, yet those groups represent only 22 per cent. of the population. Black people in England and Wales are three times more likely than the rest of the population to be admitted to hospital. Overall, African and Caribbean people, and particularly black people born in London, are 10 times more likely to be given a diagnosis of schizophrenia. We know that there are many factors involved in that. Like the hon. Member for East Worthing and Shoreham, I do not believe that the Mental Health Bill will tackle the problem; that is not what the Bill is about. There are many issues that we need to address if we are to tackle the problem. In Hackney, the problem is partly unemployment, but it is also the issue of there being many migrant communities, lots of single people, a high population density and a high turnover of population. People are without the social and support networks that there are in other parts of the country.
The 2006 “Count me in” census survey found that black and mixed race in-patients were 85 per cent. more likely to be detained, and Asian, Chinese and other in-patients were 50 per cent. more likely to be detained than white people. White people made up 43 per cent. of the total in-patient population but only 30 per cent. of the detained population. Black people were 35 per cent. of the total in-patient population, but 46 per cent. of the detained population. To put it another way, rather starkly, there were 50 per cent. more black detained in-patients than white detained in-patients, despite there being more than 24 per cent. more white people. We should all ask ourselves why that is, and we need to recognise in this debate that there are challenging issues. The issue is not about what was done by one Government or another, but about service provision, social and health care provision, and tackling the barriers.
I am a race equality champion for the Commission for Racial Equality, and the commission says that there are a number of barriers. It highlights user ignorance, which can be due to language and literacy difficulties—which I often come across in my constituency—cultural differences related to religion, gender and work patterns, or different needs. In some areas, the location of service delivery is a factor. That is probably not so much the case in Hackney, where everything is on the doorstep, but I hear what hon. Members have said about rural areas; I can imagine the many difficulties that are faced there. Again, I stress the fact that many of those problems will not be solved by the Mental Health Bill, and it is not on to suggest that they will be or to conflate the issues. I started to look at the Bill precisely because of my serious concern about the huge impact on many of my constituents of those inequalities, and I concluded that it will not solve them. Nevertheless, it is an important Bill, which is why I became involved in the Committee considering it.
I join my right hon. Friend the Minister in congratulating the crisis and early intervention teams, whose work in Hackney and elsewhere is critical in tackling the long-term, challenging issues that people with mental health problems face. We should reach people before they are admitted to hospital. As I said today in a speech in Committee, more advocacy support is needed for mental health users and patients so that they can access services. I commend my local mental health trust, which is working to make sure that users are better empowered to be their own advocates. The Mind mental health user group meets fortnightly to raise issues directly with everyone from service providers to people such as me, their MP, about what needs to be done. It is right that we should recognise that people are people: they have their own views, and are not just users of mental health services.
Does my hon. Friend agree that there has been tremendous progress in the past four years in the way in which mental health service users regard their MP as someone who works for them and is an advocate for them? Many people with mental health problems would never have dreamed of approaching their MP before, but the advocacy groups in our communities have given them strength and the belief that, yes, they can move forward and campaign for themselves.
I hope that that is the case but, overall, an MP’s role in the life of someone with a mental health problem is probably less useful than the other services to which I have alluded. Clearly, however, we all have a role to play.
Advocacy services in my constituency include Derman, which works with Turkish and Kurdish groups, and plays a particularly useful role in dealing with both language and cultural issues. It helps psychiatrists meet mental health service users in situ with their families so that they can better understand the cultural and familial set-up. The Revolving Doors agency is not in my constituency, but it is renowned for dealing with difficult issues and chaotic lives to make sure that people reach services that they might not otherwise reach. The Psychiatric Rehabilitation Association is based in my constituency and was set up in 1959—it is no coincidence that that was when the first Mental Health Act was introduced. The Chinese Mental Health Association, too, is important.
Time is short, so I shall not go into the investment that the Government have put into mental health services. I shall merely put it on the record, as my right hon. Friend the Minister dealt with it. However, I wanted to pick up the issue of incapacity benefit, which was raised by the hon. Member for North Norfolk. He was right to highlight it, because it is an important issue. Hackney, South and Shoreditch is the constituency with the second highest number of incapacity benefit claimants in London, and it has the 31st highest number nationally. In my constituency alone, 7,400 people are on incapacity benefit, 63 per cent. of whom are under 50, which clearly indicates that a significant number of people have problems that are not connected with being old and tired from work, or worn out and disabled in that way. Their mental health problems often stem from other problems such as substance abuse. We need to consider the way in which jobcentres deal with people with mental health issues. The time scales involved in requiring people to return to work and the understanding of episodic mental health problems are often severely lacking. I spoke to a user who told me that if they went along on a good day, the person at the jobcentre would say, “You’re fine. Why can’t you work?” Understanding is not always forthcoming, and we all need to work to highlight the issue and encourage employers in our constituencies to recognise that they can employ someone with a mental health problem, as long as they make sure that they have the right support.
A report by the Office of the Deputy Prime Minister on mental health and social exclusion highlighted the need for services to support people with mental health problems back into employment, and it discussed the need to provide a supportive environment with flexible schedules. In the United States, which is not always a model for good practice in mental health services, a project of individual placement and support programmes succeeded in placing more than 50 per cent. of people with severe mental health problems in employment. It was not rolled out more widely, but it compares favourably with the UK, where only 21 per cent. of people with mental health problems are in employment. That is a shocking figure, and we should all think about it—how can we raise the profile of the problem and tackle it? In my constituency we have Routes 2 Employment, which is a project—the first of its kind in the UK—to help people with mental health problems back into work. It works with employers to ensure that they know how to support such people.
While we are looking, rightly, at putting more into community services, we must not take our eye off the ball of the important and sometimes necessary provision in a psychiatric ward. For some patients, that is the best option. I look forward to community treatment orders, which, interestingly, have received widespread support among professionals and users in my constituency, but we must be careful not to view them as an alternative to proper hospital provision. Psychiatrists should not have to release people before they are ready, because that only exacerbates the problems that they can face in the future.
I cannot finish without highlighting the fact that although my local primary trust, City and Hackney Teaching PCT, and my local trust, Homerton University Hospital NHS Trust, have each balanced their budgets in every year since their inception, save for a small deficit of less than 1 per cent. for Homerton hospital in the last financial year—Hackney had its budget top-sliced because a small percentage overall of other NHS trusts did not balance their budgets. Last time I raised this on the Floor of the House, the Minister of State, my hon. Friend the Member for Leigh (Andy Burnham), promised that the money would be returned to Hackney sooner than expected. I wrote to him but I still have no precise date. It may be a tough call to ask him to give me a date here and now, but I am still pursuing getting that money back for Hackney so that we can spend it on, among other things, the decent mental health services that people in my area deserve.
Like the hon. Member for North Norfolk (Norman Lamb), I speak from a rural perspective. Not for the first time, I am standing in this House, having just listened to a Labour Member talking about the services available in her constituency, and feeling that I inhabit a different world. The Minister has been very helpful in the past when I have had cause to raise issues relating to different health problems in my constituency. I know from that contact with her and with Ministers generally that they are invariably decent and well-intentioned people. I make no bones about conceding that I am sure that the Government intend to try to raise standards in this field, to promote its profile and to invest in it.
However, I have to say to the Minister, with great respect, that as I listened to her speech I was struck by the enormous gulf between the tone and tenor of her remarks and the urgency of the problems that I experience in the surgeries that I conduct every week in my constituency. These are all real cases. There is the frightened child with anorexia who finds herself in a ward with adults. There is the schizophrenic 19-year-old who will not take the drugs to control his condition and is living at home with his mother, who cannot find help at the weekend as she watches him decline into despair. Does the Minister think that it is good enough to have crisis intervention between 9 o’clock and 5 o’clock at weekends? Those are the hours at weekends when the crisis team operates in Tavistock, in my constituency. Someone who rings up at 10 past 5 will not get anybody at the crisis team and will have to ring DevonDoc, the out-of-hours doctors’ service. When this mother rang up DevonDoc, she was told, “Take him to A and E.” The A and E department is 25 miles away. She received no support at the weekend, and as a consequence, like some kind of fatal unravelling, that young man was eventually sectioned and found himself in hospital.
There is the anguished father whose son is drinking himself to death in front of his young children and an exhausted wife who has patiently tried through love and care to bring him round but can find no permanent and sustained assistance in my constituency or in my area. There is the autistic 30-year-old who, after school and college, has received no help, no provision and precious little understanding, and who is beginning to become depressed about the way in which he is treated, isolated in a small rural village. There are the families of autistic children, for whom every day is a battle to secure the education, speech therapy and occupational therapy that their child needs. Sometimes, there is no support even in the basic task of communicating with their children, who are insulated in a world that is impossible to penetrate. Those are the experiences of my constituents. I noted similar experiences of similar problems from the contributions of Liberal Democrat Members who represent rural areas such as mine, some just across the border in Cornwall.
To those watching from a distance in Cornwall and in Devon, the Minister’s speech will not have risen to the height of their problems and daily experiences. They simply do not have the services, or access to the services, about which the hon. Member for Hackney, South and Shoreditch (Meg Hillier) spoke a moment ago. They feel isolated, abandoned and alone. It is not good enough.
My constituents have begun to take into their own hands the power to do something about their problems. I am proud to be a trustee of a charity called “Make a Difference” in Tavistock. It is trying to fill the gap in provision that the service users whom I represent experience daily. It runs a café, a support group and a social network. That provision is barely supported by the responsible trust. Those who use the services and the volunteers who support them, often in their spare time from working for the trust, have taken the initiatives. I am therefore proud to be a part of that and proud of all those who are beginning to construct the foundations of recovery by taking into their own hands the power to do something about their problems.
However, the support for them is not there. The initiatives are the result of good will and voluntary action by people in the community who care. The Bubbly project provides a day centre for those with learning disabilities. Two desperate parents of a child with learning disabilities raised their banner in Torridge, in the part of north Devon that I represent, because day centres there have closed. Integration into community hubs and supported living initiatives have simply meant village halls, pubs and cafés. There is a groundswell of opinion that the policy is not working and is causing a large expansion of mental health problems.
One cannot close day centres, which were centres of excellence, energy and activity, and the hub of a social network for those with learning disabilities, and simply believe that, without providing huge amounts of extra resources for the infrastructure and the communities, there will be no problems. Parents throughout the rural areas that I represent are deeply concerned about the move towards community care and support in the community—it simply does not appear to be there. Those with learning disabilities are deprived of the genuine help that they can get from day centres. The Bubbly project therefore relies on the voluntary action of those who give their time, money and effort to attempt to set up something that should be the county council’s responsibility and that of the Devon Partnership NHS Trust, which is the mental health trust responsible in my constituency.
Those volunteer actions show the gulf that continues to exist for those with mental health problems in my constituency. It is not only those afflicted by psychiatric problems, but those with autism—as the Minister will understand—and those with a wide spectrum of mental health and learning disabilities whose urgent problems do not appear to be being tackled, at least in the rural area that I represent, by the Government’s policies.
I urge the Minister, in her efforts to introduce improvements, to examine specifically the genuine problems in rural areas. She mentioned rural areas almost in passing. I hope that she can pay specific attention to access to services, which constitutes a severe problem in the rural areas that I represent.
The pleas for better mental health services have come from across the House. We have just heard, quite rightly, about rural areas, and the hon. Member for Hackney, South and Shoreditch (Meg Hillier) represents an urban area, as do I. The whole of Britain has an interest in this subject.
Nobody knows what the exact figures are. The Library tells me that about one tenth of the world’s population suffer from mental illness and about one in six of the population of Great Britain are assessed as having neurotic disorders. The best figure that anyone can come up with is that one in four of us will, during our lifetimes, have mental illness at one time or another. Like, I am sure, other hon. Members, I did not need to become an MP to realise how crucial mental health services are, because I know that from the experience of people among my extended family and friends, and of people whom I associated with at college or worked with. Indeed, we all know the stories of people suffering from mental illness, sometimes with tragic results.
On 5 February, the Minister and I were in our places for an Adjournment debate that I initiated about mental health services in south London. On 12 January, the Secretary of State for Health had taken the decision to close the 24-hour emergency service at the Maudsley. In fact, it should have been closed by now, but its closure has been deferred. I shall return to that subject in a few moments, but I also want to link it to a few further points.
I join others in thanking my hon. Friend the Member for North Norfolk (Norman Lamb) for giving us the opportunity to put this subject on the agenda—and there is no argument but that this subject should appear more regularly on that agenda. I join others in thanking those who work in mental health services, whether in acute services, primary care services or intervention services. Those are all in my constituency: the Chaucer day centre; Guy’s hospital, which has mental health wards; and for people out in the community, the Sainsbury Centre for Mental Health is based there too—not to mention many academics working at King’s College, which has medical and dental schools.
Even with all that effort, there are some things that we have not sorted. I have a friend called John, whose daughter Alex is just about to take her finals at Liverpool university. She needed a cognitive behavioural therapist—a matter that I have raised in the House before—but it was impossible for her to get that service. For much of her time at university, she struggled on the edge of being able to cope. Happily, she has pulled herself through, but she had months of waiting before she could be properly treated.
I am conscious that we are bidding for more funds, and I make a special plea again for universities and colleges to be given the services that they need, so that young people do not have to wait so long. They are often at their most vulnerable in their late teenage and early adult years—girls as well as boys, although it is apparently more common for boys. Their whole future careers may depend on securing the help that they need.
My brother is a psychologist who works for the Government, specifically in the area of the armed services. He is part of the NHS services for the armed forces. However, we know from what happened at Deepcut and from other experiences that it is vital for the armed services and those in front-line jobs to have the proper back-up services that they need. I hope that in the bids for future funding, when we talk about defence budgets, we will include the facilities needed for all those people, whether they are serving abroad or at home, to have the necessary mental health support.
I hope that we get work force planning right. I accept what the Minister said about there being more psychologists, psychiatrists, and psychiatric and mental health nurses, but we have not been great in nurse work force planning over the last 20 years. We have not been great at doctor work force planning in the NHS either. We need to ensure that we have the people—and we need to include alternative therapies, too. I very much hope that the answer to the question that the Minister ducked is that a bid has been put in for more money for mental health services in the comprehensive spending review.
I want to end where I began. Last week, I attended a meeting at the Camberwell leisure centre, where the community was united in calling for a deferral of the decision to close the Maudsley’s 24-hour service. That was the united view of the communities across the political parties, and across both local councils. We have the best service in Britain, in the best mental hospital in Britain, in the area that has the most psychotic illness in Britain, not least because my community in Southwark—like that in the constituency of the hon. Member for Hackney, South and Shoreditch—has a very high number of African and Afro-Caribbean residents, which is one of the factors that add to the numbers.
I want to end with a quote from an e-mail that I received after the meeting that night, from someone who had been there. No one makes the plea for the Maudsley clinic not to be closed better than he does. He sent the e-mail to my office address at 2.47 in the morning of 4 May. He said:
I don’t know if you will remember me but I am the young man in the blue shirt from the Maudsley meeting. It’s 2.30 in the morning and I am spinning out, and feel in crisis, and the only thing that gives me the strength to hold on and get through this is knowing that in the Maudsley ED, I am not on my own. To know that there is unconditional support, 24 hrs a day, is the strand of hope that enables me to think there is something to believe in and rely on and trust, and I am not on my own. I can’t express in words how scared I will be without this service and I am not the only one. I have tried to kill myself twice before, and therefore I am at high risk of actually completing this act, and believe me this is the last thing I want. I want to be able to have a normal life, with my partner and 5 week old son, and I feel that this decision to close the emergency department has made this a less realistic target.”
I shall cut to the end of the e-mail:
“When you have a meeting with Ms Hewitt please show her this email, and if ever she has the bottle to meet service users, I’d welcome the chance to talk to her and explain how life is at the sharp end of the stick, and not in plush offices in Whitehall.
Here is someone who knows the value of mental health services. I repeat the plea: please do not close one of the most important ones in Britain; the alternative is no substitute.
It has been a long day, especially for those of us serving on the Mental Health Bill, who have been debating mental health issues for about seven solid hours. However, this does make up slightly for the recent dearth of health debates—[Interruption.] I was being ironic.
It is a pleasure to have the opportunity to sum up in this debate. It is not often that the Liberal Democrats find themselves in the position of having the last word and pontificating on other Members’ speeches, declaring them to be powerful or well judged or riddled with absurdity. I shall pass up that chance, however, not simply because I cannot remember other people’s constituencies, but because I want to focus on what are euphemistically called the service users of a service that no one wants to have to use, and on what this debate has shown about their plight. I am sure that hon. Members can accept that they have made powerful speeches without my having to point it out.
Poor mental health is, in its severest form, the most terrible suffering known to man. No one can ever escape the torture in their own mind. All of us enjoy varying degrees of mental health in our life, including stress, anxiety, depression and unreasoning fear—some of us who are serving on the Mental Health Bill have gone through all those stages just today. Too many people enjoy socially disabling and serious mental conditions, and some live an endless nightmare and a living hell, and experience gnawing fear and enduring despair.
Many hon. Members have talked in the debate about the stigma of mental health problems and the need to remove it. The reality is, however, that people who are in poor mental health cannot cope; their minds are in a mess, and people are right to query their ability to act and judge aright. The stigma is going to be properly addressed only by recognising that mental health is not something that we either have or do not have; it exists in degrees, and it varies, like physical health, over a lifetime. If today’s athlete can be tomorrow’s invalid, yesterday’s service users can be the counsellors of the future. A recent confidential poll established that 11 per cent. of Members of this House claim to have suffered mental health problems at some time in their life. Presumably they are coping better now.
Above all we need an understanding, and an education in mental health, for the whole nation. It was pointed out earlier by the hon. Member for North-West Leicestershire (David Taylor) that the media have an important part to play in that. We need to develop an appreciation of the fact that mental illness is not one illness but many, that being mentally ill is not about being dangerous but often perhaps about being too vulnerable or sensitive, that it is not the grossest form of abnormality but all too common, and that the person who claims to be in perfect mental health is possibly the most sadly deluded.
None of this is much about money, although the debate has focused pretty solidly on that at times. Let me say something about money, however. If we were not in our fairly mad world of politics, we would all admit some plain truths. We would admit that the Government’s spending on mental health has increased—we have acknowledged that, although it may not be in the motion—but also that spending as a percentage of total health spending has gone down, which is in the motion. We would admit that there have been forced cuts in mental health spending, as well as top-slicing. As a number of Members have pointed out, the budgets are easy to adjust. Service users are slow to complain when they do not receive their services, because they are slow to draw attention to their condition and how it is being dealt with.
We would also admit, honestly, that some exciting initiatives have been financed. The Minister mentioned computerised cognitive behavioural therapy. What the Minister did not mention, however, was that funding for children’s services has risen by only a paltry 4 per cent., and needs are growing by the day. Moreover, there is consensus across the Chamber that there is a problem with black and ethnic minority communities and the way in which the mental health services address their needs.
As has been made clear in the debate, addressing mental health problems means a huge win for society as a whole. Many benefit claimants, including increasing numbers of new claimants—that is quite important—are not at work owing to stress and anxiety. Professor Layard’s work, which has been mentioned frequently this evening, has been very helpful both in underlining that key finding and in suggesting remedies, and there is evidence in my constituency that the Department for Work and Pensions is acting on his comments. More provocative and difficult, however, is his suggestion that social planners should be mindful of the mental casualty rate in modern society, and should plan accordingly.
The so-called happiness agenda is attracting the attention of commentators and politicians alike, and I expect it to feature to some extent in the general election, but it is by no means easy to see how the state can conspire to make its citizens happy. Most states that have tried have failed, or have done positive harm. The pursuit of Utopia normally leads to tears; a more modest goal might be to remove some of the more obvious obstacles to public happiness.
If the Government increase funding, stop top-slicing, encourage people back into work, fight discrimination, increase public understanding, and fight stigma through programmes such as their laudable Salford's Health Investment For Tomorrow, or SHIFT, programme—under which £1 million a year is being spent on fighting stigma—they will have our support. They will also have our support if they concentrate on providing more good therapies, such as talking therapies, rather than the chemical cosh. However, even according to their own analysis, they should forget about payment by results.
The Department of Health said that introducing payment by results would be “a major achievement”, and that
“we are unaware of any country that has been able to implement this type of system”.
To introduce it to an NHS system that is weighed down, if not crushed, by change seems in itself to be deeply deluded, if not downright pathological. How would payment by results make it possible to encourage doctors to take on more incorrigible cases? Why would trusts want to devote time and money to expensive talking therapies as opposed to simple drug prescription? How would it be possible to encourage the more imaginative therapies that involve families, use art and drama, and so on? I think that the Government should put payment by results on the back burner, and leave it there.
The Minister did not talk much about our motion. Let us consider it now. Little, apart from its origin, should prevent all Members from voting for it. Do we not all recognise that there has been historic underfunding? Do we not all acknowledge the burden of mental illness on the benefits system? Is not the top-slicing of budgets a fact, and have not the Government promised that the budgets will be reinstated? Are not age-appropriate settings a problem? All that is in the motion. Did not the Select Committee on Health warn that cuts in mental health provision were dangerous? Are we not all for expanding therapy services?
Were we not in this particular institution, which has its own eccentricities, and indeed delusions, we would all agree and go home—but the Chamber is, after all, a peculiar place. It is one of the few places where it is not considered odd to be standing up talking at length to oneself. So we must divide, but before we do so, let me break my initial resolution and congratulate my hon. Friend the Member for North Norfolk (Norman Lamb) on a powerful speech. He drew attention to lack of equity of access—a charge that was not rebutted. He also drew attention to long waiting times—another charge that was not rebutted—and to genuine, although not universal, cuts. Again, that charge was not rebutted.
In the spirit of co-operation, I congratulate the Minister on surviving the day with customary charm and cheerfulness, although also with a peculiar and understandable obsession with amendments to the Mental Health Bill. Finally, I congratulate the hon. Member for East Worthing and Shoreham (Tim Loughton) on his combative manner, and on his marshalling of facts—and on surviving the day as well. I cannot for the life of me see why they should not all vote for this very sensible motion.
Whatever our differences might be on a range of issues, the subject of today’s debate should unite Members in all parts of the House. Mental illness is the unspoken, eerie reality that touches many more families in our society than we will ever know. It can be short term or chronic, and affect young and old, affluent and poor, and black and white. It has the capacity to destroy lives—not only those of the individuals with the illness, but those of family members who frequently feel lonely and lost as the person they love changes into a stranger in their midst.
At the beginning of the 21st century, mental illness remains a great stigma, as Members of all parties have said. It is possibly the greatest stigma. To some it is a sign of weakness, to others a source of shame. For far too many, it is a barrier to the life chances and economic activity that most of us take for granted. If we are frank, it fuels fear, sometimes based on ignorance, sometimes on prejudice and sometimes on reality.
The closure of many psychiatric hospitals in the 1980s and ’90s represented progressive policy which, sadly, was undermined by inadequate investment and support. By their actions, the then Tory Government tainted community care when, in a modern society, it should have been a beacon of individual human rights and collective civilisation and advance. As has been demonstrated in the debate on the Mental Health Bill, there has been through the ages, and there will always continue to be, a debate about the balance between the human rights of the individual and public protection, between the needs and wants of the service user and the views of family members, and between those whose focus is on the virtues of medication and others who stress the centrality of general well-being.
Balance is important in this debate. Beyond the patient is always a person with emotions, experiences, dreams, aspirations and fears—like the rest of us. Beyond the carer, is a mother, father, husband or wife who is confused, scared, lonely, perhaps hopeful, and sometimes optimistic. Beyond the victim is someone whose life has been shattered by someone with the label “mental illness”.
True leadership in this area requires genuine objectivity and a commitment to the following: to attack the stigma that consigns mental illness to the “underground” of our society; to fight for the voice of people with mental illness and their families to be heard above the general din of ignorance, or of a high-profile case that is the exception not the rule; to ensure that in every area of life, from relationships to employment, individuals have the chance to pursue their potential, irrespective of their illness; and to protect society from those who represent a danger to themselves and others, through health and social care—plus, if necessary, secure accommodation and appropriate treatment.
As Members have said, we as a society have a new phenomenon to cope with: the reality among many of our older population of Alzheimer’s and dementia, which ask new questions of both the health service and the social care system. Those developments reflect a demographic change that political parties that seek to take responsibility and govern in this country must seriously and fundamentally address.
On occasions such as this we must always celebrate the commitment, professionalism and dedication of front-line staff. They are too often the Cinderella of the health service and social care system. They work every day of the week, often in challenging and difficult circumstances, to enhance the quality of life of people who they know have lots of potential and talent, which historically has often been suppressed simply because of the label that mental illness brings.
I shall now respond to hon. Members’ contributions to the debate. The hon. Member for East Worthing and Shoreham (Tim Loughton) presented his usual humble and gentle self in the course of making his argument. We disagree with his claim that the proportion of overall health spend directed to mental health services has gone down under this Government. As for the record of the Government he supported, where I come from, a percentage of nowt is not very much. People remember the state in which the Conservative party left the mental health system—a Cinderella service in a grossly underfunded and neglected system—and the chaos and tragedies that ensued as a consequence of the Conservative Government’s control of our national health service.
The hon. Gentleman asked about psychological therapy pilots. In due course, we will look to expand those pilots, and we are making resources available for additional pathfinder sites this year. He and other Members rightly raised the question of child and adolescent mental health services. Early intervention to prevent deterioration in children and young people’s mental health is fundamental. I was amazed, however, that not one Opposition Member mentioned the dreadful state of CAMHS in this country only a few years ago. Significant additional resources and staff have been provided, with a much greater level of multidisciplinary working to bring together psychologists, nurses and professionals of different disciplines and teams. With that investment, at the end of December, 90 per cent. of primary care trusts had achieved the proxy targets that we set to define whether significant progress had been made on CAMHS. We believe that, by the beginning of April, the vast majority will have done so.
My hon. Friend will recall my bringing a delegation of CAMHS professionals from Leicestershire, led by my constituent, Dr. Ingrid Davidson, to meet him just a few weeks ago. Does he remember that their concern was that they felt pushed to the periphery of PCT priorities? As a Minister, how can he encourage PCTs to focus on the CAMHS aspect of mental health in a more positive and productive way?
My hon. Friend did bring a delegation and with those professionals made strong representations about the centrality and importance of CAMHS to the national health service in his area. The message is clear: the progress made in CAMHS in recent years must be sustained; it must remain an NHS priority. The fact that the target has been hit in most areas is no ground for complacency. We must continue the sustained investment and focus on CAMHS. Where sufficient progress has not been made, the message to the commissioners is that they must commission improving services for children and young people.
My hon. Friend the Member for Hackney, South and Shoreditch (Meg Hillier) made an excellent contribution. As she rightly said, it is important that within two years no one aged 16 or younger shall be placed on an adult mental health ward. The reason that we are more hesitant about 17 and 18-year-olds is that the issues are much more complicated. It would be highly irresponsible of Government to make a commitment in Committee or the House that, for all sorts of difficult and complex reasons in the real world, they cannot be sure of fulfilling. That would be dishonest and dishonourable. It is therefore right that my right hon. Friend the Secretary of State is considering the issue further.
My hon. Friend was also right to raise concerns about the disproportionate number of people from black and ethnic minority communities who use mental health services. That is a public policy challenge that every single politician in this House should seek to address. She was also right to draw attention to the innovative and exciting work taking place in her constituency on routes to employment by the Derman group and other organisations in the voluntary sector and in statutory services, which is making a real difference.
The hon. and learned Member for Torridge and West Devon (Mr. Cox) made a thoughtful and passionate speech about the real-life stories at the sharp end of the mental health system, and talked powerfully about the “make a difference” project and its important self-help work. However, I say gently to him that we must not mix up people with learning disabilities and people with mental illness, although some people are in both groups; he was at risk of doing that. I am happy to talk to him separately about issues affecting people with learning disabilities.
No, I cannot. I will speak to the hon. Gentleman separately.
The hon. Member for North South Work—[Interruption.] I meant the hon. Member for North Southwark and Bermondsey (Simon Hughes). You can tell that I am not from London, Mr. Speaker, which is not something that I am prepared to apologise for here or anywhere else. The hon. Gentleman was right to make the points that he made about universities and colleges and access to services for our armed forces. As for the emergency clinic in his constituency, his local community referred that issue to the Secretary of State, who asked for it to be looked at afresh and in a sensitive way. Such decisions are made on a local basis, as I understand it, and that is exactly what is happening. We do not control these decisions from offices, plush or otherwise, in Westminster and Whitehall. The Liberal Democrats always claim to be the party of maximum devolution—until it suits them not to be.
The World Health Organisation has stated objectively and independently that England has the best mental health services in Europe. However, we are not complacent;. We recognise that there is still a long way to go, but once again, in their motion and in this debate, the Liberal Democrats have launched an attack on the Government that not only fails to acknowledge the real progress that has been made in the past few years, but demands extra spending without any indication of where the resources would come from. So where would they come from—higher taxes, cuts to other parts of the NHS and social care budgets, or perhaps a combination of the two? The fact is there are no mystery options. That is the reality of responsible government—not the facile opportunism of “Focus” leaflets and permanent opposition.
Earlier this year, the Liberal Democrats’ Front-Bench health spokesperson, the hon. Member for Romsey (Sandra Gidley), gave the game away on their social care policy. She told a shocked Chamber how she regretted that her party had misled people in its last election manifesto by claiming to offer free personal care. Any party that can, by its own admission, so shamelessly exploit and mislead older and disabled people and their families cannot be trusted to champion the very real concerns of people with mental illness and their carers.
The Tories have form on mental health, having put vulnerable people in bed-and-breakfast hotels. Will we ever forget the shame of those consequences of Tory mental health policies in the 1980s and 1990s? In contrast, we will continue step by step to rebuild mental health services that reflect the realities and challenges of our modern society. I urge the House tonight to reject the Liberal Democrat motion and to—
Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.
Mr. Speaker forthwith declared the main Question, as amended, to be agreed to.
That this House welcomes the extra £1.65 billion spent on mental health services since 2001; supports the record number of staff working in mental health since 1997 including almost 9,400 more psychiatric nurses and over 1,300 more consultant psychiatrists; further welcomes the lowest suicide rates since records began; recognises the work of the 700 new mental health teams in the community; notes the national patient survey, which shows that 77 per cent. of community patients rate their care as good, very good or excellent; recognises that between 2001 and 2005 £1.6 billion capital was spent by mental health trusts on improvements to mental health wards; further welcomes the Government’s commitment to expanding access to psychological therapies; and further welcomes the Government’s Mental Health Bill, which will update the legislation to reflect advances in knowledge and new ways of treating people, particularly in the community.