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Mental Health

Volume 789: debated on Tuesday 27 February 2018


My Lords, with the leave of the House, I will repeat as a Statement the response to an Urgent Question given by my honourable friend the Parliamentary Under-Secretary of State for Mental Health and Inequalities in the other place. The Statement is as follows:

“The Government welcome the CQC’s latest annual report, which it produced as part of its statutory duty to monitor how mental health providers exercise powers and discharge their duties when people are detained under the Mental Health Act.

We are committed to ensuring that the Mental Health Act works better for patients and their families, and that is why we have commissioned an independent review led by Professor Sir Simon Wessely, who will make recommendations in the autumn.

We are also investing more in mental health than ever before—spending an estimated record £11.6 billion this year. We have seen that the number of detentions under the Act has been rising year on year: it rose 2% last year and 9% the year before that. We also know that black people are disproportionately affected. These were both driving reasons for the Prime Minister’s decision to call for a review of how the entire Act is operating.

This Government have already acted when they saw that the Act was not working properly. Last year we legislated to make it illegal to use police cells as places of safety for children under the Act, and to ensure that police officers consult health support staff before using their detention powers.

Sir Simon, his vice-chairs and the independent review’s team are consulting actively and widely with service users and professionals and today are taking part in a major stakeholder event in Newcastle. Indeed, I welcome the fact that the CQC takes care in its report to state:

“We have confidence that the independent review’s solutions-focused approach to identifying priorities, based on the feedback and experiences of people across the country, will offer a review of the MHA that has the confidence of patients and professionals”.

The CQC is of course directly involved in the review. The CQC’s report has found examples of good practice, but we recognise that more needs to be done to ensure that people’s voices are heard and their rights respected. Where possible, we expect all patients to be involved in their care planning, and we expect that providers should consider how best to do this in light of the CQC’s recommendations.

In the spring, the review will provide an interim report identifying priorities for its work. It will then develop a final report containing detailed recommendations on its priorities. The final report should be delivered by autumn 2018.

There are problems with the Act and we will address them. But we should remember that today, no one gets sent to an asylum only to disappear within its walls. There are regular reviews, clear rights of appeal, and checks to ensure that people are lawfully detained, only in order to get the treatment they need. But our society is changing the way we think about mental illness, and we do want to ensure that people have as much liberty and autonomy as is possible”.

I thank the Minister for her Statement. I declare an interest as a lay member of a CCG.

I think we would all agree how disappointing the CQC’s Mental Health Act report is, given that the CQC found that there has been limited—or no— improvement in key concerns which it raised in previous years, and given that the number of people detained under the Mental Health Act continues to rise. Added to that, last week’s analysis by the Royal College of Psychiatrists found that mental health services have less money to spend than they did in 2012. That does not weigh with what the Minister was saying about the amount of money going into mental health services. How will the department address that failure? I accept that there is a review going on. That is very important and we support it. There could not be a better person to lead it than Sir Simon Wessely—there is no question about that. However, there seem to be some immediate problems, one of which is whether the money allocated to mental health services is actually spent on mental health services. What do the Government intend to do about that? Indeed, will the Government pledge to ring-fence mental health spending so that the money is not siphoned off to be used elsewhere in the system?

I thank the noble Baroness for her question, and indeed, some of the CQC report is disappointing. That is why it is so important that it is working with Sir Simon’s review to feed its thoughts into the review. I know that he will take a terrific interest in what it says.

As to ring-fenced funding, there was an overall increase in spending of £11.6 billion, which was up 8.4% since 2014-15. NHS England has strengthened the mental health investment standard in its planning guidance. This means that as of 2018-19, every CCG will be required to increase its spend in excess of its overall increase in funding. Commissioners must be given the freedom to make decisions about the needs of their population. At the moment, we believe that the investment standard strikes the right balance in allowing that freedom while ensuring that crucial mental health services are properly funded. However, I believe, as the noble Baroness said, that the review will look into this. It is very important that the money going to the commissioners is spent on what it is meant to be spent on.

My Lords, the consistent theme running through the findings of the CQC report is that patients are not being fully involved in decisions about their care. A particularly worrying concern was whether clinicians are recording evidence of their conversations with detained patients about their proposed treatment, particularly about whether the patient has consented, refused to consent or, indeed, is incapable of consent. In too many cases it is clear that this is simply not happening. Given that the ability to impose medication is unique to the Mental Health Act, could the Minister say what steps the Government will take to ensure that this is addressed as a matter of urgency? I do not think that this can wait for the review, good as I am sure it will be.

I thank the noble Baroness for her question. I think that we will have to wait for the review. An interim report will come out in the spring and then the final review will come out in autumn 2018. At the centre of that review will be the rights of the patient. It is very important that the patient is taken along by healthcare professionals in the process in terms of how they want to be treated. This will be one of the highlights of the review.

My Lords, what can be done to encourage those who do not wish to come to terms with the possibility of their situation to make it as painless a journey as possible to assessment and assistance?

That is always a very difficult problem; it is difficult for the carers and the loved ones of the person concerned, as well as for those who are involved. As the noble Viscount will know, it is hoped that a person seeking mental health help will be able to go to their GP and get the help that they need. If they are seriously ill, a different process can take place through which they can be put into a place of safety to be assessed and looked after in a greater way.

My Lords, the Minister will know that many mental health problems arise at a young age—some 50% before the age of 14. The excellent Green Paper on child mental health is ambitious for change. However, only 7% of the overall mental health budget is spent on children, although children make up 20% of the population. How will the Government address that?

The noble Baroness is absolutely right: early intervention is essential. The Green Paper is very much welcome. Its proposals are supported by a commitment of more than £300 million of additional funding, and there will be a brand new workforce supporting schools to intervene early before specialist mental health services are needed. We are working with the Department for Education, incentivising each school to have a designated senior mental health lead, in addition to our current programme of rolling out mental health first aid training to every school across the country. We are currently consulting on the proposals and have received more than 1,000 responses. We are aware that the responses from specialist child and adolescent mental health services are a concern, so we will pilot a four-week waiting time in this area.

My Lords, I declare my interest as chair of the National Mental Capacity Forum. One difficulty for the police is that they are often called when someone is acutely disturbed, and they have to deal with the situation as it arises. In some police forces in Wales, particularly in Gwent, there has been an active programme to educate the police. Are there plans to involve the police at a national level in the review of the Mental Health Act? If not, they will end up being the front-line person who is called on to cope with an acutely distressing situation.

That is true. It is often unfair to ask the police to deal with such a situation. Police forces are now meant to have a liaison officer to take with them and that is working quite well. However, as the noble Baroness said, this will also be looked at in the review because, quite often, the police are the first ones called to go to someone’s house, and it is important that they have with them someone who is trained and knows how to deal with the particular person.

My Lords, can the Minister say how far the Government have taken into account some of the recent research looking into the earliest indicators of mental problems in children and, therefore, the ability to intervene early?

I thank the noble Baroness for the question. The issue of early intervention is part of the Green Paper and we are looking into it. As we know, there are children in primary schools who are suffering from mental health issues, so it is important that we have mental health first aid training in every school across the country. This will obviously take time because people need to be trained to deal with this particular situation.

My Lords, around 50,000 people a year are detained in mental health institutions and the rise in the past few years is worrying. It is not perfect to be detained under the Mental Health Act and to be locked away but at least there are some protections in the Act for such individuals. However, what about the tens of thousands of people who are de facto detained—that is, those who are locked in nursing and care homes and cannot leave—but who do not have the protections of the Mental Health Act because they are not detained? Will the review look at that issue?

Yes. I can say categorically that the review will look at that issue because it is important. As I said in the Statement, people do not go into asylums and are not locked away. There are no such things as asylums—I should not even use that word. People do not go into mental health institutions without being looked after and reassessed to find out what care they need. However, the issue will be looked at in the review.

My Lords, at the moment people can be detained under the Mental Health Act simply by virtue of having a learning disability with behavioural associations. A significant number of people are thus detained, and delayed discharges are notorious. I know the review will look at this issue—I have certainly discussed it with Sir Simon Wessely—but to what extent has the Transforming Care programme succeeded in speeding up the discharge of people who have been detained through the development of skilled and adequate community treatment and support?

I do not have the figures so I will have to get back to the noble Baroness. As she pointed out, however, the idea is that people should be discharged into the community. I will get back to her on the numbers.