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Health: Parity of Esteem

Volume 765: debated on Tuesday 20 October 2015


Asked by

To ask Her Majesty’s Government what progress has been made in establishing parity of esteem between mental and physical well-being.

My Lords, we are committed to improving mental health services, putting them on a par with physical health services. We have already expanded our world-leading psychological therapy services. This approach is now being emulated internationally. For example, Sweden is now running a pilot project in Stockholm based on IAPT principles. We have also introduced the first ever access and waiting times for mental health and changed people’s attitudes towards mental health.

Thank you. Will the Minister study the Mindful Nation UK report, published today by the Mindfulness Initiative and the All-Party Group on Mindfulness? It shows that mindfulness-based cognitive therapy—MBCT—recommended by NICE 10 years ago for recurrent depression, can provide cost-effective interventions for a range of mental and physical health conditions. In fact, almost four in five GPs want to recommend MBCT, but only one in five has courses available in their area. Expanding mindfulness provision in the NHS could save £15 for every £1 spent. Also, I ask the Minister, mindfully, to look at the evidence in the report suggesting that mindfulness-based interventions could provide powerful support and engender compassion to help those thousands of health workers who are fraught by some of the stresses of working in the National Health Service today.

I look forward to reading the report; perhaps the noble Lord would like to send me a copy. I cannot comment specifically on mindfulness, but there is no doubt that talking therapies are having a big impact. The evidence shows that some 45%, perhaps up to 50%, of people who have been introduced to IAPT talking therapies—CBT, psychotherapy and the like—have experienced considerable improvements.

My Lords, my understanding was that, in an effort to ensure parity of esteem between physical and mental health, clinical commissioning groups were directed to increase spending on mental health in line with the increase in their 2015-16 budgets. What evidence and assurances can the Minister give that that has taken place?

NHS England is committed to ensuring that every CCG in the land increases its spending on mental health. The general allocation to CCGs was 3.7%, and the CCGs’ commitment to spending 4.6% of their allocation on mental health will hold NHS England to account for achieving that.

My Lords, the NSPCC report on achieving emotional well-being among young people in care found that 45% of them experience mental health problems, many of which continue to remain undiagnosed. It recommends that those young people should have not only an automatic physical health assessment but an automatic mental health assessment. Will Her Majesty’s Government consider introducing legislation to give that right to all young people as they enter care?

I am not sure that legislation is necessarily the right way forward, but perhaps we can pick up that issue with NHS England to ensure that it is written into the NHS mandate for next year. It is certainly something I will explore with them. It is worth noting that we are spending £94 million a year on IAPT for children, and we have increased spending on tackling eating disorders in young people by £150 million over the course of this Parliament. We are beginning to rectify what has historically been an area of huge underfunding of mental health for young people.

My Lords, I support the plea from the noble Lord, Lord Stone, to my noble friend on mindfulness. We have a very active mindfulness group in this Parliament and I hope that my noble friend will encourage all colleagues to sample it for themselves.

When people present at a GP surgery with mental health problems, there are still far too many GPs who reach for the prescription pad. If we really are to get parity of esteem, GPs need more training in mental health and need to be able to access referrals close to their surgery for talking therapies and other such solutions, rather than just reaching for the prescription pad.

My noble friend makes a very good point: reaching for medication is often not the right way forward. I am not sure how much time in the undergraduate syllabus is reserved for mental health training. However, I know that a considerable amount of time is set aside for it, so that people who decide to become GPs will have had some training in mental health before they qualify. Only last week, I was talking to Clare Gerada, who was the president of the Royal College of General Practitioners. She said that she thought the best combination of all was for a GP to have studied psychiatry as well.

My Lords, it is encouraging to hear the new Government continue the priority that the coalition Government gave to improving mental health access for everyone, and specifically for children. I am also encouraged to hear the Minister talk about waiting time targets. However, surely true parity of esteem will be reached when we have targets for CCGs and, if they miss them due to lack of funding and the appointment targets are missed, that is publicised in the same way as missed A&E targets.

That is a very interesting point. We have three principal targets for mental health: two relate to IAPT and the other to access for those who have their first psychotic episode. Clearly, we do not yet have the range of targets for mental health that we have for physical health, although the introduction of those three targets this year is a big step forward. It is important that the targets should be based around outcomes rather than funding.

My Lords, the five-year investment in child and adolescent mental health services is welcome, but the scale of the problem of achieving parity of esteem is huge, as a recent NSPCC report clearly showed. It stated that out of over 186,000 cases referred by doctors from 35 mental health trusts, nearly 40,000 children received no help at all. The investment equates to barely over £1 million per clinical commissioning group each year. Does the Minister believe this is sufficient not only to tackle the chronic bed shortage and the distribution of such beds across the country, but to develop comprehensive prevention and early intervention programmes?

The noble Lord makes a good point. I may get these figures wrong, but I think the total spend on mental health across the country is about £11 billion a year, and spending on children and young adolescents is under £1 billion—around £700 million. Therefore, under 10% of the total spend goes on young people. On the face of it, that looks to me to be far too low. That is why the last Government committed to increase that spending by £1.25 billion over the course of this Government and put another £150 million into tackling eating disorders.