Skip to main content

Mental Health Care

Volume 536: debated on Monday 21 November 2011

Motion made, and Question proposed, That this House do now adjourn.—(Stephen Crabb.)

Thank you for calling me to initiate tonight’s Adjournment debate, Mr Speaker. May I alert the Minister who is responding this evening to an excellent report published today by Mind entitled, “Listening to Experience—An Independent Inquiry into Acute and Crisis Mental Healthcare”? That paper comprises more than 350 interviews with people who have experience of acute and crisis mental health care. I say to the Minister—although he probably knows this—that the report makes for very difficult reading. However, there is also room for huge optimism.

I am delighted to be joined tonight by the hon. Member for Ashfield (Gloria De Piero) and my hon. Friend the Member for Harrogate and Knaresborough (Andrew Jones), who will be making brief contributions. I have also given permission for a few of my chosen and near colleagues to make brief interventions because I know how much the issue matters to them.

We need a new approach to the provision of mental health care in this country. Provision should be based on compassion, understanding and respect. That is what comes out of the Mind report and the 350 voices it contains. It should not be a punishment to be mentally ill, but too often it is. People who suffer from mental illness feel hugely excluded from mainstream society, and we need to approach them in a compassionate way. We need to reach out to them and draw them near, not push them away.

My hon. Friend is making a powerful case. The report is shocking in many ways. Does he agree that, if we are to develop a compassionate model of mental health care, we should focus on providing talking therapies more extensively to those people who come into the acute and crisis environment, so that they can be seriously helped with the conditions they present?

My hon. Friend makes a fantastic point and is a fantastic attendee of the all-party group on mental health. He has a great interest in this area and I will come on to answer his point directly in a few moments.

Over the past 30 years, we have made fabulous progress in moving away from the use of asylums, although we have had problems in doing that. We have talked about care in the community but, too often, the community has not been there to provide that care. We must continue to address that. In closing the asylums, we must remember that there is still a need for accommodation when people are in severe crisis. I do not like to talk about beds or hospital wards, but we do need accommodation. Sometimes, people are so ill that they need to be hospitalised and looked after, but in a caring environment.

I am concerned that, with the closure of small acute wards, we are moving towards having much larger hospital environments. Some of those are, without doubt, excellent. However, as the report identifies, some of them have too many of the characteristics of past asylums. As I said, being ill should not be a punishment. It concerns me greatly to read of people going to institutions where they fear for themselves and are frightened daily. How can someone start to recover from a mental health crisis when they are terrified every day in their environment? Many of the report’s respondents said that institutions were so terrifying that staff seemed to spend most of their time trying to stop nasty things from happening. We must get away from that. We have made progress, but we are not doing so at a fast enough pace.

Let me move away from discussing hospitals. Sometimes people need to leave their home. Therefore, we need settings that can take people out of their home, but that are not traditional mental health hospitals. In the report, I came across two fantastic initiatives. I knew about one because it is being pioneered in Hertfordshire, but another one I did not know about: crisis housing. That means that, when someone is at home and having a crisis, they do not have to go to hospital. They recognise that they are having a crisis, as do the people who work with them, and they can be sent to a home where they can go for just a few hours—four, five or six—to talk through their concerns with people who can understand what they are going through because, often, they have experienced mental illness problems themselves, so they are talking to their peers. Alternatively, they can spend up to three or four days there to get through the period of acute crisis, so that their equilibrium is coming back and they may be able to go back home and face the world again. Crisis housing sounds like a fantastic innovation, because we have to get away from the idea that when someone is terribly ill the only place for them to be is in a traditional mental health hospital. They may need a bed, but it does not have to be in a hospital.

The other thing that has caught my attention, and is being pioneered in Hertfordshire, is the idea of host families. This is a fantastic initiative that people have been developing in France and that Hertfordshire is leading the way on in this country. If someone is not really up to being at home with their family or looking after themselves, they need some extra support. There are families out there who will take them into their home and allow them to become part of their everyday life. Those people may well, and probably do, have experience of dealing with mental health illness themselves. They may be in recovery, they may have recovered, or they may have a child, a brother or sister who has been in these very dark places, so they understand and know what their house guest is going through. This is a fabulous way of providing support. It can last from three weeks to 12 weeks, and it is there to make these people feel part of a working, functioning family community. They have responsibilities and chores, but they are given the support and love that they need to make progress.

However, those solutions may not be right for everyone, and many people will, on occasion, need to be hospitalised. The report identifies that many tens of thousands of people each year go into a hospital setting. I hope that we can reduce that overall number. Nevertheless, we need accommodation to look after them. As I said, too much of the small traditional accommodation has been shut down. That has been positioned as an unalloyed good thing: “Hooray, we’ve got rid of mental health beds; hooray, we don’t need them any more; hooray, the community can pick up all these people.” In fact, the community is not always in a position to pick them up. Crisis helplines that are meant to be running for 24 hours a day often run for only part of the day, and that is simply not good enough. A mental health crisis does not happen between 9 am and 5 pm; it is just as likely to happen between 9 pm and 5 am. We have to accept that the community is not always there for those people. Now that we have closed these beds, which were often in very small wards very close to people’s families, too often people who are committed into an acute environment can be sent up to 200 miles away from their home and from the people who care for them and can nurture them and provide them with support. To me, that is not progress.

We are now moving towards having larger mental health units. As I have said, some of those are very good but, as the report identifies, many are not. The threshold for being admitted to acute care is now so very high, because there are so few beds to accommodate people, that only the most ill people get into hospital. I have to say that, too often, their experience is pretty frightening and pretty unpleasant. I am not calling for less accommodation, but I am calling for us to do things differently, so that when we, as a society and as communities, are put in charge of people with a severe mental health problem, we go out and embrace them. We do not put them in a frightening environment where the doors are locked, where they are restrained, often face down, where they are terrified, and where they feel under pressure and in danger of being assaulted; we create environments where they can go and get well. With the mentally ill, we are not mending bones. I do not want to stick people in bed for 20 hours a day and put their leg in a brace. We are not doing that; we are not in that business. What we are in the business of doing is putting people in an environment where they can get well; where, as my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) said, they can talk through their problems; where they can come to terms with their problems; where they can speak to people who have been where they have been, then recovered and gone on. That is the kind of environment that we need to create in the acute setting.

That calls for a radical approach. Perhaps we have to stop talking about hospitals and beds, and instead start talking about accommodation and wellness centres, where people can go to get well and where they feel relaxed, comfortable and safe so that they can focus on themselves and their own mental health. When people have a mental health crisis, all too often they are simply terrified and feel that the world is against them. If somebody who is feeling like that is put in one of these institutions, I am sure that it does their mental health no good at all.

What is my hon. Friend’s experience of youngsters who have to go to such hospitals and who find themselves in mixed-age wards?

That is a very important area. Great strides are being made to end mixed-sex and mixed-age wards. How terrifying it must be for a young person to be in such an environment for the first time with people of all ages, with all types of experiences, illnesses and conditions. That is not acceptable, particularly if that young person is 200 miles or more from their family. That is not a way to treat people.

As I have said, being mentally ill is not a crime. We need to reach out and embrace these people, and we need to hold them close. We need to create environments where they can get better and focus on themselves. Talking therapies have a huge part to play in that. This is a fabulous report because it focuses on the areas of weakness in the current system. That provides the Government and Back Benchers with an opportunity to work together to get it right. I will now sit down and allow the hon. Member for Ashfield to join in.

I thank the hon. Member for Broxbourne (Mr Walker) for allowing me to contribute to this debate. I also congratulate Mind on the work that it has done. Its report today reveals some harsh realities about how we deal with mental health in this country.

I have learned a lot about mental health care, or the lack of it, in the short time that I have been the MP for Ashfield. I have also learned about mental health through my own experiences because a family member has struggled with his battles. I will talk a little about that later.

It was not long after I became the MP for Ashfield that the Rokerfield day care centre was threatened with closure. I spoke to its users. One man told me that the day care centre was his family, that the other users were his siblings and that the staff were his parents. A woman told me that she would not be here if Rokerfield had not been there for her. I hope to goodness that she is still with us. Sadly, Rokerfield and many day care centres like it are no more.

Something else that I have learned about recently through this job is the serious shortage of beds in psychiatric wards and the struggle to get emergency treatment. I sat open-mouthed in a meeting the other week as I was told that a shortage of beds meant that patients who were seriously ill and needed to be admitted immediately sometimes had to be taken miles away. The process was explained to me. If there is no bed locally, they start making calls. With each call, the bed gets further away. Before they know it, they are talking about a bed 100 miles away. When I heard that, I felt sick.

I will briefly explain why that made me feel sick. A close relative of mine had many spells in a psychiatric ward. I made many visits to the ward. Each time was a trauma for my relative and for the family. I never once considered that he could have been taken miles away. The two bus rides and the long walk up the hill, sometimes in the winter months, were distressing enough for me. People do it for peace of mind and to show that their relative is loved. I have heard harrowing tales from Mind about patients who have been transferred from their local area by ambulance or police car because there were not enough local beds.

I will end by echoing the call by the inquiry for

“a culture of service and hospitality”.

I thank Mind for its work. The Minister has responded to the report by saying that he will work with Mind to improve services. We will keep him to his word.

I thank my hon. Friend the Member for Broxbourne (Mr Walker) for so generously allowing me time in the Adjournment debate that he has secured. He and I have spoken about mental health provision several times before, although not, I believe, in the Chamber. We have spoken particularly about our concern that mental health provision is a Cinderella service in the NHS.

I wish to highlight an issue of access in my constituency, which is the closure of the Hawthorn day unit in Harrogate. When that happened, I had a meeting with the users of the unit and their carers. It was emotional and powerful meeting—one of the most powerful that I have attended since starting as an MP. The users, who had no obligation to attend, spoke openly and powerfully of their experiences and the struggles they were facing, and they were brave to do so.

The unit that closed provided a safe haven for those who really needed somewhere secure, because those facing mental health issues still face some stigma and discrimination in this country. It also helped by providing users with support to ensure that they took their medication, and it offered them the compassion and respect that my hon. Friend talked about. I have been in regular contact with the users since the unit closed, and I am very pleased that this week, we have secured a meeting between the users and the chief executive of the NHS foundation trust, which will take place in my office in about three weeks. I am hopeful that we will see the unit reopened.

I close by congratulating my hon. Friend on all he does in highlighting mental health issues around the country, and on speaking so passionately and with such determination and eloquence this evening. I also say to the Minister that I read the publication “No health without mental health”, which was published in February, and was very encouraged by it. I thought it represented great progress.

I start by congratulating my hon. Friend the Member for Broxbourne (Mr Walker) on securing the debate and on pursuing this issue through the all-party group on mental health and other channels for a considerable time. His good fortune in securing the debate tonight is particularly timely given the publication of Mind’s report this morning. I congratulate him doubly on that successful coalition of events that have led to the debate.

I, too, have had the opportunity to study the report, “Listening to Experience”, published by Mind, and I certainly share many of the sentiments that have been expressed in this brief debate. The report undoubtedly shines a spotlight on what is good about our acute and crisis mental health services, what is unacceptable, what is bad and what we can do to make them much better. It brings together the results of an independent inquiry, as we have heard, and it is fundamentally about ensuring that we listen to voices that are all too often overlooked and ignored.

I welcome the report. It is challenging, and some of the unacceptable practice that it describes is frankly harrowing. Many of its important conclusions reflect the aims and ambitions of our cross-Government mental health strategy, “No health without mental health”. More than that, it reinforces why it is right that our broader health and social care reform agenda focuses on patients being treated in a way that respects their dignity, protects their human rights and promotes flexible and creative commissioning solutions that are tailored to meet individual and local needs. The key is ensuring that services are genuinely personalised.

The provision of safe, modern, effective mental health services that offer patients real choice is, and remains, a Government priority. We expect the treatment and care of patients to be provided in the most appropriate therapeutic environment for them. My hon. Friend rightly referred to the concern expressed in the report that acute beds are not always available when needed. The hon. Member for Ashfield (Gloria De Piero) spoke about her own experience and her concerns about the journeys that some people have to make to find facilities, which is clearly unacceptable.

I want to make it absolutely clear that commissioners and providers have a responsibility to ensure that acute beds are available for those who need them. They should also ensure that the needs and wishes of patients, families and carers are not only sought but taken into account when decisions are made about community or hospital-based treatment. Distance and journey times are very serious issues that need to be properly taken into account in those commissioning decisions.

The quality, innovation, productivity and prevention programme, which is sometimes known as the Nicholson challenge, has targeted both reductions in bed days and—I stress—out-of-area admissions. Through a more effective acute care pathway, we can expect to achieve better patient experience of care, which means care that better reflects patient preferences, including being cared for at home if possible. That contributes to a more productive use of NHS resources to ensure that we drive up quality.

Specialised mental health community teams—crisis resolution home treatment, assertive outreach and early intervention in psychosis—provide care to service users and families in community settings. The crisis resolution home team performs a key role in supporting people at home, which often averts the need for an in-patient stay, acts as a gatekeeper for all those requiring access to in-patient services or other emergency care and supports early discharge, when appropriate.

The team is part of an integrated acute care system. It is affected by, and has an effect on, that system and beyond, especially the in-patient service and day hospital and community mental health teams. For example, patients with early onset psychosis benefit from early intervention services, and assertive outreach engages with severe and persistent mental disorder such as schizophrenia. That shared approach in system delivery is already beginning to show results, because 10,300 new patients with early diagnosis of psychosis were engaged with early intervention in psychosis services this year, which is the highest ever recorded figure. Overall investment in key mental health teams has also increased. In the last year, crisis resolution home treatment teams carried out 131,450 home treatment episodes for 106,790 patients who would otherwise have been admitted to hospital, an increase of 3.2% over the previous year.

I do not want my remarks in response to the important debate that my hon. Friend the Member for Broxbourne has secured to suggest that the Government are complacent. Mental health is a priority for us. The strategy that I mentioned earlier, and not least the spending review decisions that we made last year, make clear our commitment, especially as regards improving access to talking therapists for people with severe mental illness. However, there is always room to improve, and there is a need to listen to, understand and act on the experience of patients.

Mind’s report helpfully highlights four key areas: humanity, commissioning for people’s needs, choice and control, and reducing the medical emphasis in acute care, which is very much like the well-being concept that my hon. Friend has discussed. In mental health services, it is vital to balance patient autonomy with patient safety, which is often a source of debate in the Chamber. We need to ensure that that is done in an appropriate way, but it can be a challenging balance to strike. However, the solution to the problem does not lie with heavy-handed or coercive approaches. A wealth of research, guidance and good practice, much of which is cited in Mind’s report, offers practical strategies that can contribute much to ensuring that patient care is conducted in the humane, caring and respectful fashion described by my hon. Friend, envisaged in Mind’s report and espoused in the Government’s vision for mental health services.

The Mental Health Act 2007 code of practice is clear on the need to seek all alternative measures before adopting control and restraint or seclusion procedures. Restraint should be the last resort, never the practice of first choice. The code also emphasises the importance of providing support to patients after using control and restraint, seclusion or long-term segregation, and of reviewing such incidents to enable staff to learn from them.

The Mind report rightly draws attention to the importance of ensuring services meet the needs of black and minority ethnic communities. The Government’s mental health strategy acknowledges the lower well-being and higher rates of mental health problems that some BME groups suffer. The strategy is explicit on ensuring that health promotion and ill-health prevention approaches are targeted at high-risk groups, which means that programmes must be delivered in such a way that they are accessible to families from BME groups. Such approaches will lead to a narrowing of the health inequality gap.

There is no doubt that good data play a critical part in driving improvement—the report highlights that—which is why the mental health minimum dataset already has a good level of information on the ethnicity of patients, and why the annual mental health bulletin includes rates of access to services by ethnic groups and describes the ethnic profile of people spending time in hospital and being detained.

We will build on those measures. The mental health minimum dataset will go further, because for the first time it will be possible to analyse the full patient pathway, showing what happens to different groups of people before and after hospitalisation. This dataset has been identified as the single source for national statistics about the use of the Mental Health Act in the future, and the NHS information centre will launch a consultation next spring to determine exactly what information will be useful—I hope that hon. Members and others following the debate will take the opportunity to feed into that. The ability to compare and demonstrate differences between localities is an important way of driving improvement in services.

I am most grateful to the Minister. I want to put it on the record that since our last exchange on this subject on 10 November more data have come from the Hampshire trust, which intends to close more than one third of its acute in-patient beds, confirming that although only a minority of patients admitted to acute beds were detained patients, they stayed for longer, and that at any one time about half the beds, if not more, were occupied by detained patients. Does the Minister agree that if excessive numbers of beds are closed, the opportunity for a non-detained patient to find a bed will be disproportionately reduced?

I certainly agree that we need to look carefully at the data. My hon. Friend was right in his Adjournment debate on 10 November to highlight these issues and potential discrepancies, and I shall certainly take a close look at the data to which he has referred.

I am anxious to ensure that Mind and other key stakeholders play a part in identifying how the information that I have referred to can best be analysed and presented. As I have said, those data will be particularly useful in supporting commissioners in developing the kind of flexible and creative commissioning solutions that Mind and my hon. Friend the Member for Broxbourne have described so well.

The drive to improve the quality of services and reduce inequalities lies at the heart of our commissioning reforms. For the first time, the Secretary of State for Health, the NHS Commissioning Board and clinical commissioning groups will be under a legal duty to have regard to health inequalities in both access to and outcomes from health care. This legal duty will hardwire reducing health inequalities into the system. It not only obliges the Secretary of State to act, but obliges them to demonstrate that they did so and with what result. That is a powerful incentive for change.

Mind rightly emphasised the importance of choice, which I strongly endorse. That is already being demonstrated through several initiatives, including the improving access to psychological therapies programme for children and adolescents and for adults, the extension of the personal health budgets programme for people with mental health problems to increase choice and control and the development of adult and children mental health tariffs. We believe that choice of consultant or other professional-led teams should extend to mental health to achieve the parity of esteem expected by the mental health strategy, and we will work with key stakeholders to develop the proposals and look at ways of implementing our plans.

We recognise the benefits that mental health patients can receive from support and mentoring from peers, which was touched on in this debate, as well as the contribution from things such as crisis housing. To that end, I am working with colleagues on the ministerial working group on mental health to make these more widespread.

In conclusion, I thank my hon. Friend and others who have intervened and spoken briefly in this debate. I shall write to my hon. Friend the Member for Harrogate and Knaresborough (Andrew Jones) to pick up on his particular point. I very much welcome Mind’s report for its clarity and for the useful contribution that it makes to our shared aim of improving acute and crisis services, and I shall meet it to discuss its report and how we can take its recommendations forward in delivering the Government’s mental health strategy. The Government remain committed to achieving their overarching goal of better mental health outcomes for everyone. Our strategy sets out what everyone needs to do to realise that goal, and by working together we can make a long-lasting difference to the quality of life of people with mental health needs.

Question put and agreed to.

House adjourned.