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NHS: Mental Illness

Volume 739: debated on Tuesday 17 July 2012


Asked By

To ask Her Majesty’s Government what is their response to the report How mental illness loses out in the NHS, published by the London School of Economics and Political Science on 18 June.

My Lords, we agree with the report’s insistence on both the importance of investment in mental health services and on the necessity of treating mental ill health as seriously as physical ill health. Our mental health strategy, No Health Without Mental Health, makes our commitment to these principles clear, and we are soon to publish an implementation framework that will help to embed them in NHS practice.

I thank the Minister for that Answer. I remind the House that during the passage of the Health and Social Care Bill it was agreed that mental health should have the same, equal status as physical health. In that light, at present the 50 outcomes of the NHS outcomes framework include no health outcomes for the millions of people with clinical depression or crippling anxiety disorders. Do the Government have any plans to change that and, if so, when will they change it? When will we see mental health outcomes appear in the outcomes framework?

My Lords, we have deliberately taken a generic approach to the NHS outcomes framework. That said, the framework for 2012-13 contains three improvement areas relating specifically to mental health: premature mortality in people with serious mental illness; employment of people with mental illness; and patient experience of community mental health services. Therefore, the noble Baroness is not quite right in what she has just said. Many of the indicators in the outcomes framework relate to all patients, including in relation to safety incidents, for example, or experience of primary care. Improving outcomes for people with mental health problems will be a crucial element of success.

My Lords, five out of the six recommendations of this excellent report by the noble Lord, Lord Layard, and his colleagues emphasise the importance of IAPT, an excellent initiative begun by the previous Government, which is being built on by the coalition Government. However, from the time of the previous Government to now, I continue to receive reports that psychotherapy departments, particularly those that provide non-cognitive behaviour therapies such as art therapies, psychodynamic psychotherapy, group analytic psychotherapy and family therapy, are closing down or are unable to get contracts. Can my noble friend help me to understand why that might be the case since, while CBT is valuable and helpful in many circumstances, it is not the only approach to treatment that has been demonstrated to be helpful in those who need psychological therapies?

I am very happy to take the advice of my noble friend, who is of course an expert in this area. Historically, it is true to say that access to talking therapies in the broadest sense has been very poor. That is why we have invested £400 million in rolling out the IAPT programme, which makes available a range of NICE-recommended therapies to a much larger cohort of people. However, I will take my noble friend’s point away and, if I can throw any light on the issue that he has raised, I will gladly write to him.

My Lords, I, too, commend the report. What action would the Minister expect in response to two of the recommendations that relate to training? First, there is the recommendation that an automatic component of general practice training in future should include mental health. Only a minority of GPs currently receive any training in mental health. Secondly, with respect to the current recruitment crisis in psychiatry, it is recommended that we recognise that psychiatrists have an essential leadership role to play in mental health care.

My Lords, as regards GPs, the Royal College of General Practitioners has identified improved care for people with mental health problems as a priority within its enhanced GP training programme, which forms part of the college’s proposals for a new evidence-based four-year programme of training.

As regards the workforce issues, I am aware that there is concern about recruitment into psychiatry. My department and the Royal College of Psychiatrists are looking into this matter. The royal college has established a task force to make recommendations to improve recruitment, and it is investigating the factors before medical school, during medical school, during foundation training and in core and higher psychiatric training so as to get to the bottom of the issue as best it can.

My Lords, one of the important recommendations in the LSE Centre for Economic Performance report, which led to this Question, concerns the attitude of other doctors to psychiatrists and the issue that that has in relation to recruitment. The report says that,

“it is routine for”,

surgeons and physicians,

“to make derogatory remarks about psychiatry, which affects not just psychiatrists but also their patients”.

I wonder whether the noble Earl has any answer to that.

The short answer is no, I do not. However, I am aware that the royal college is actively investigating this issue within the terms of its task force, to which I referred in my answer to the noble Baroness, Lady Hollins.

My Lords, is the noble Earl able to deal with two blatant forms of age discrimination? The first is that the talking therapies are very often denied to older people; pharmaceutical alternatives are cheaper. The other is that, when a diagnosis of dementia is made, the way in which services are organised now means that those services have to be funded by local authority social care rather than the NHS. Given that dementia is a terminal disease, does the noble Earl not feel that this is unfair?

My Lords, yes, and we have laid great emphasis on the need to bear down on unreasonable discrimination against elderly people. The noble Baroness is aware that the requirement to reduce inappropriate anti-psychotic medication for the elderly is a key part of the Prime Minister’s dementia challenge. Therefore, I identify completely with the remarks of the noble Baroness on that issue.