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NHS Mental Health Care

Volume 592: debated on Wednesday 11 February 2015

I am delighted to be able to have this debate with you in the Chair, Mr Pritchard; I am sure that on this occasion you will not be disturbed by colleagues making signals to you, trying to stop you from calling me to speak. The debate is very important, and I have been trying to secure it for some time. It is fair to say that there is widespread concern about mental health services in this country, and concern about how things have declined. Promises have been made by successive Governments to take more interest in this issue.

Since 2010, there has been a steep fall in the number of mental health nurses. Up to 4,000 have been lost, leaving a skill gap within the NHS. Nearly 2,000 beds have gone, a drop of 6%, while demand has risen by up to 30%. The Government must ensure equal access to mental health services and that the right treatment is available for people when they need it. The Government and NHS providers must ensure a commitment to parity of esteem that is directly reflected in the funding of commissioning services, work force planning and patient outcomes, and must ensure there are enough local beds to meet demand.

Will the hon. Gentleman add to his list of requirements the needs in rural areas, which often compound the problems that he has talked about in relation to the loss of beds in hospitals and lack of alternatives? Often the alternative is a prison cell overnight, which is completely unacceptable.

Absolutely. I agree with that entirely and I will come to it when I talk about my own personal experiences of spending a long time in a mental hospital trying to recover from a mental breakdown. I know only too well the issues that the hon. Gentleman has raised.

The urgent action plan that is needed cannot be put off for another five years. It needs to be put in place and direct action needs to be taken. There must be a sustainable and long-term work force planning strategy that acknowledges the current challenges facing the mental health world at the present time. We cannot leave it. You yourself, Minister, stated that only 25% of young people with mental health problems have access to mental health services, which you described as “dysfunctional and fragmented”—

I am sorry. I was quoting the Minister, Mr Chairman. He stated that 25% of young people with mental health problems had access to mental health services, which he described as both “dysfunctional and fragmented”. That cannot persist. That cannot be right in a society that claims to care and aims to try to deliver services that are perfect for it. There are serious problems with mental health services and the way in which young people are treated. So many of them have ended up in prison, because there are simply no beds available.

If I may, I will talk about my own experiences. I was very fortunate. I will praise my own GP, Dr Chhabda, who was excellent and got me help. I have praise for Talking Change, where I had several sessions, and for Dr Barker and his intermediate crisis team at St James’s hospital. They were of enormous benefit to me. Subsequently, I was under the care of Simon Kelly, the psychiatrist who looked after me when I was in hospital for a long time.

What did I learn during that long period of mental illness? I learned about the stigma. When I was in hospital for several weeks with major heart surgery, the problem was obvious to people—I did not worry about telling them that I had had major heart surgery—but for the last two months of my being in hospital getting over a mental breakdown, I was worried about how I would explain to people where I had been. I was making myself ill with the worry of how I would explain to people that I, this strong person who could fight off most things, was suddenly unable to do so and had to seek help.

But I was not alone. The other people, who have become close friends of mine, were going through the same thing: the GP who did not know how he was going to go back to face his patients, and the dentist who did not know how he was going to work things out. Many other people, from different professions and none, were struggling with the reality of going home to face their immediate families with what had gone wrong with them, and there was little or no help coming from outside the hospital to give them the support that they needed.

In the rest of the time that I have in politics, and in the rest of the time that I am alive, I want to fight to lift once and for all the stigma attached to mental health issues and be proud to say that I was broken but I got fixed, because of the love and skill of the people who were there to help me.

Some of the people whom I met in hospital had travelled long distances. One was from the Minister’s own constituency in Norfolk. There was not a single bed available, from the coast of the North sea, where this person lived, to the waters of Southampton, where a place was available. That was the nearest place. They were transported down there and eventually transported back.

Other people I met in the hospital came from Truro. They had been brought from the furthest edge of our country to the edge of Southampton, because no bed was available. Ironically, when they arrived at the hospital, they came in an ambulance with a driver plus two nurses, and they stayed for four days. Then they were transported all the way back to Exeter, because a bed became available nearer there.

What sort of society are we living in? Somebody at the lowest ebb of their life is transported across the country, away from their family and support networks, because there are no beds available. The way in which people are treated is a national disgrace. We could see in the faces of the people that they knew it would not be possible for their families to come and visit them, because of the enormous distances involved. We have got to do something about that. We cannot allow that situation to persist.

There is the situation of somebody whom the NHS sends into a hospital for a detox programme. They are given a six-day detox programme, probably costing several thousand pounds, and then, on a Friday night, they are told that they have to go 50 miles up the road to spend two nights in a Premier Inn, with no support available over the weekend to help them. For anybody going on a full-time detox programme, the minimum time is 28 days. The NHS will spend a lot of money several times, but limit it to six days and then give the person little or no support when they are out. That cannot be right. No Government should be proud of the record that we have on mental health issues.

I am pleased to stand alongside my hon. Friend and I congratulate him on the debate that he has secured today. Mental health is one of the Cinderella conditions that people tend not to want to talk about, because of the stigma that my hon. Friend talked about earlier on. If someone has a broken leg, it is fine, but if someone’s mind is broken or there is a mental health issue, nobody wants to talk about it. It is easier to sweep it under the carpet.

Will the Minister understand that we really need to get to a situation in which the stigma is no longer there? All we need to do is to give people the help that they need—and, indeed, the hope that they need—as if they had a broken leg or a broken arm, so that they can get back to normal living.

I agree entirely. We lucky ones who are privileged and proud to be in this House of Commons must use whatever elements are available to us, whether in speeches here or outside this House, to do more to expose this issue.

I was fortunate because the people I was in contact with were able to put me through a series of different things. They saved my life—I have no doubt whatever about that. I could not stand my life any more and, like so many people, I realised that far too late. I had probably left it six months too late, and because of that my recovery took much longer.

There are others outside the system—people and organisations that try to help. They include Talking Change, which is in my constituency. However, I say to the Minister—through you, Mr Pritchard—that the crisis care service is at breaking point. Services are understaffed and under-resourced; they are overstretched. As for talking therapies, which a lot of people mention and which I have heard the Minister himself praise in the past, 40% of the people who want to use them have to wait more than three months just for an assessment, and that assessment is normally carried out on the telephone. I urge the Minister to try that interview over the telephone. Then, if they are lucky, they will receive some treatment, but one in 10 people wait more than a year to get even the chance to talk about the problems that have driven them to the edge of the abyss, so that they are living in total despair. In addition, a third of the people who are assessed have to wait more than three months to start the therapy.

I ask this Government and whoever is in power after 7 May to really mean what they say about mental health services. There is a crying need for that. When I heard the Deputy Prime Minister talk about mental health services, I thought, “Oh! Maybe we’ll get somewhere and something might happen.” I live in hope, but my experience—having looked into this issue in quite some detail—tells me that the same promises have been made many times during the past 20 years.

I was someone who felt that he could tough out most things, but in the end I had to succumb to the stress and strain I was under, to such an extent that I had no alternative but to seek real help. However, there are literally thousands of people out there who are affected. A quarter of the population of this country will come into contact with mental health problems at some time during their life. Unfortunately, so many of them are disappointed by what they get in the way of treatment from the NHS.

I apologise, Mr Pritchard, for not being here earlier; I was on the Heathrow Express and just could not get here any quicker, unfortunately.

I commend the hon. Gentleman for bringing this matter to the House for consideration. One in five elderly people will suffer from a mental or emotional breakdown. Such breakdowns are more prevalent among women, but the suicide rate among men is three times higher than among women. Given how we are, men, unfortunately, do not tell our stories in the way that we perhaps should.

The hon. Gentleman is putting forward a very strong argument as to why we need to focus within the NHS on those men who have difficulty addressing the issues of depression, anxiety and emotional breakdown. Does he feel that the Government need to have an educational strategy, one that encourages people and helps families and GPs in particular, so that men will discuss these matters with someone who will listen?

I could not agree more; it would make such sense for that to happen. The hon. Gentleman is dead right. It is vital for people just to have someone outside the family circle to talk to and open up to, and then later they can develop the inner strength to tell people, “Oh, by the way, it happened to me.”

I have no hesitation in believing and saying that we have got to do more, because a lot of the elderly people who the hon. Gentleman just mentioned were in a stressful situation long before they got to that age. I know, because I have met such people, both before my illness and subsequently.

We have to do all we can in this place not only to keep this Minister and this Government focused on this issue but to commit ourselves—as a Parliament—to fight this issue, on and on and on. There should be no neglect of people who suffer from a mental illness. If they receive help early enough, it will save the NHS a fortune, and if the treatment is thought through properly, which might include the NHS talking to people such as myself who have been through the system and seen the good and bad of it, maybe, just maybe, we might start to get things right.

Thank you very much indeed, Mr Pritchard, for calling me to speak. It is good to serve under your chairmanship.

I congratulate my hon. Friend the Member for Portsmouth South (Mr Hancock) on securing this debate; I know that he has been trying to secure such a debate for some time. I particularly congratulate him for speaking out about his own mental ill health, because it is at the heart of changing attitudes and addressing the stigma that he and other hon. Members have talked about that people who have been successful in life should speak out and explain that they themselves have suffered mental ill health. Every time someone speaks out about their own mental ill health, that makes it easier for a youngster to be open about their own issues and seek help. That is the critical change that is needed, so that mental health comes out of the shadows and we lose the embarrassment about discussing it.

I commend to hon. Members the brilliant campaign, Time to Change, which this Government have funded, along with Comic Relief. It is all about tackling stigma. Interestingly, attitudes are changing. They are being measured on a regular basis and the dial is moving; people feel more able to talk about their mental ill health.

I am extremely grateful to the Minister for what he has just said. When I was 27, I had depression for a year. I did not know where I was; I did not know whether I was going to come through it. It was awful. I received support from a lot of people who loved me and who got me through that particular period. Then I became an MP and eventually Deputy Speaker of the House of Commons.

The one thing that we must give people is hope, and I hope that the Minister’s response to this debate will be one not only of understanding—he has already expressed that—but of hope for people out there and their families, who look on, feel dejected and want support.

I totally agree. I hope to be able to convey some sense of optimism, actually, because, despite all the challenges that my hon. Friend the Member for Portsmouth South referred to, there are very some exciting things happening, which are laying the foundations for genuine equality for mental health. We have legislated in this Parliament for parity of esteem, but to be honest I am not interested in empty rhetoric—our words must mean something for people in need of help.

My hon. Friend referred to many aspects of the system that need to improve significantly. I will deal briefly with one—the issue of beds. We must be a bit nuanced here. It is absolutely clear that when there is a moment of crisis a bed must be available, and available locally. Incidentally, we should also look at places such as recovery houses. Increasingly, there are lots of third sector organisations that provide recovery houses around the country and it is often better for people to go into a place such as that than to be an in-patient admission, which might not be the best thing therapeutically for them. But the idea that in a middle of a crisis someone is shunted somewhere else in the country, or even put into a police cell, is really an outrage in a civilised society.

The interesting thing is that when I came into this job I realised more and more that I was operating in a fog. The data that we are absolutely used to when it comes to physical health, and the scrutiny of that data and evidence, have simply been lacking when it comes to mental health. Traditionally, we have not collected the information about access to services and what is happening to people on the ground, and that has been a fundamental issue that I have sought to address.

On out-of-area placements, I had no idea from the data that came to me about what actually happens around the country. Last week, we finally got the first sight of real data, which will now be provided on a regular basis, so that we can hold trusts to account if they fail to meet local need. The fascinating thing is that there are many trusts around the country that have no out-of-area placements at all under existing financial circumstances, while there are others that completely fail and are sending many people out of area. We need to understand why that is happening and address the causes, whether they are in commissioning, in the provider organisation or because of lack of funds, because some areas have demonstrated that that is not necessary.

I entirely accept the idea that, when a bed is needed, a bed needs to be found. However, that person is at the very start of the crisis that made them seek help. They are shifted several hundred miles across the country, settled in and then, because the NHS suddenly finds a bed available half way back to their home, they are moved there without being given a chance to get used to the idea that they are getting help.

My hon. Friend does not need to convince me of that. I am completely with him and I am determined that we should eradicate this practice, which is unacceptable for people in a moment of crisis.

The use of police cells is a practice that has always gone on. Actually, because of the crisis care concordat that we published last February, for which 20 national organisations came together to set standards for crisis care in mental health for the first time ever, this year we will see a 50% reduction compared with two years ago in the number of people going into police cells. That is a real advance. We must go further and completely eradicate under-18s going into police cells. We have said that we want to ban the use of police cells for under-18s and to make such use an exceptional event for anyone else.

I want to try to deal with what we are doing to convey a sense of optimism, because I think that we are now on the right track. My hon. Friend painted a picture of the situation. There is, in my view, discrimination at the heart of the NHS, where people who suffer from mental ill health are disadvantaged compared with those with physical health problems. That must end. Access and waiting time standards were introduced in the past decade, so those who are thought to be suffering from cancer get to see a specialist within two weeks. Why does a youngster who suffers a first episode of psychosis not get that right? We cannot begin to justify that. We are therefore introducing, for the first time ever, access and waiting time standards in mental health from April so that, for a youngster suffering a first episode of psychosis, the standard will be to start treatment within two weeks. We will start with 50% of people and progressively increase that.

My hon. Friend talked about psychological therapies. There will be a standard of access within six weeks for 75% of people, with a 95% backstop to start of treatment within 18 weeks. That is what transformed care in physical health in the past decade. As Sir Mike Richards, who was the cancer tsar in the last decade, said to me, we can achieve the same transformation in mental health by applying the same rights of access that we have had in physical health for some considerable time. That complete imbalance of rights between mental and physical health dictates where the money goes, and that must end.

I will be very quick. This issue is made worse: Mind carried out a survey of all local authorities in England and found that, on average, they allocated just 1.36% of their public health budget to help people avoid developing mental health problems. Some planned to spend nothing at all. I want to see the Minister put pressure on local authorities to have such programmes that may, just may, keep people alive.

Indeed, I have done exactly that. The sense is that this issue is hidden away from public view. It is not recognised that there is an extraordinarily powerful invest-to-save argument to be made, as my hon. Friend said. If we invest in public mental health and early access to therapies, whether psychological therapy or therapy for eating disorders or psychosis, there will be a return on that investment, but, critically, the individual will be helped to recover and to be able to lead a good life again. That is the challenge that we face.

Alongside announcing the first ever waiting time standards, we published a vision for making them comprehensive throughout mental health in the next five years. I want all parties to commit to implement those standards through the next Parliament so that, just as Sir Mike Richards suggested, we can achieve genuine equality for those who suffer mental ill health.

The crisis care concordat set standards for what should happen in a crisis. Across the country, we are seeing a dramatic reduction in the use of police cells, which is a very good thing. We are investing more in liaison psychiatry so that for the first time those who turn up in A and E suffering from mental ill health get access to someone who knows something about it. At the moment, people often turn up in A and E and find that they cannot see anyone with the relevant specialism. That must end, so we are investing in liaison psychiatry.

On children and young people, which my hon. Friend raised in particular, I set up a taskforce last summer, bringing in experts from outside Whitehall such as YoungMinds, the campaigning organisation. We have engaged with young people. The taskforce will publish a report soon. That is the opportunity to fundamentally modernise children’s and young people’s mental health services.

There is a funding issue. More funding is needed—some areas of the country have cut investment ridiculously in young people’s and children’s mental health services—but there is also the question of how the money is spent. Such services are commissioned in a horribly fragmented way and there is not nearly enough focus on what can be done in schools to build resilience and focus on mental well-being. If we were to do that much more effectively, we could stop the deterioration of health.

On liaison and diversion, it is a scandal of our time that so many people suffering from mental ill health end up in prison, largely because their illness drives offending behaviour. Yet so many of those people have never had access to the sorts of therapies that could help them to recover. When someone who is suffering from mental ill health turns up at a police station or a court, liaison and diversion is all about diverting them into treatment. We have 25% of the country covered now and we will cover more than 50% from April with a view to covering the whole country by 2017. No other country in the world is doing that on such an industrial scale, and we should be proud of that.

On access to psychological therapies, which my hon. Friend talked about, waiting times are far too long; that is why we are introducing a maximum waiting time standard. However, in 2010 about 300,000 people got access to psychological therapies. This year that figure will hit about 900,000—a tripling of that number.

It does, absolutely. The next challenge is to bring the improving access to psychological therapies programme into line with Jobcentre Plus. We are working on that, with pilots around the country. It is ridiculous that there are so many people out of work, languishing on benefits through no fault of their own because of their mental ill health and not getting access to the therapies that could help them recover. That has to change. We must link mental health services much more closely with employment services, schools and the criminal justice programme.

There are significant areas where mental health services fall short and, as my hon. Friend rightly said, they have always done so. However, as the Minister responsible, I am on a mission—[Interruption.]

I congratulate my hon. Friend and I think that we are on the way to achieving genuine equality for mental health.

Sitting suspended for a Division in the House.