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House of Lords Hansard
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Mental Health Services
19 May 2020
Volume 803

Private Notice Question

Asked by

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To ask Her Majesty’s Government what steps they are taking (1) to protect, and (2) to support, mental health services (a) during, and (b) after, the COVID-19 pandemic.

The Question was considered in a Virtual Proceeding via video call.

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My Lords, the NHS has issued guidance to services to support them in managing demand and capacity across in-patient and community mental health services. Services have remained open for business as usual as a result. We remain committed to the additional investment in mental health services set out in the NHS long-term plan. We have provided an additional £5 million to mental health charities to support their work during the pandemic.

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My Lords, the Royal College of Psychiatrists warned last week that the nation faces a mental illness “tsunami”. Those on the front lines of our health and social care services have gone above and beyond to tackle this dreadful virus, but now may themselves face significant mental health problems. Thousands have lost colleagues, endured serious illness or experienced major trauma. Will the Government commit to investing in a world-class mental health response to Covid-19, including by setting up specialist support services for those on the front line of our NHS and care services, mirroring the services available to our armed services personnel?

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I join the noble Baroness in paying tribute to those working in mental health in the NHS. They have kept services running in extremely difficult circumstances and their impact has been extremely powerful. Although we are aware of the deep threat of a mental health tsunami, as was warned, the evidence to date is that these people have done an amazing job of addressing the concerns of those who are suffering under coronavirus and the lockdown.

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My Lords, does the Minister accept that the implications of the Covid-19 pandemic include loneliness, a sense of entrapment, income and employment insecurity, substance abuse, relationship problems, bereavement and other factors that are liable to be severe? Resources will be needed for many interventions. Is he aware of the growing evidence base on the important benefits of the arts and creativity for mental health? What plans do Ministers and NHS England have to accelerate the spread of social prescribing, supporting people with mental health conditions to engage creatively with the arts, culture and nature?

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My Lords, I completely recognise the noble Lord’s warnings. He rightly warns about the huge pressure of lockdown on people, and rightly mentions the benefits of the arts—particularly social prescribing, of which I am particularly supportive. I pay tribute to the Permanent Secretary of the Department of Health and Social Care, who has allowed me to bring Tilly, my working cocker spaniel, into the office to provide me and my fellow workers with some kind of support from an animal. I know that canine support is valuable. We are working hard to support the kind of social prescribing of which the noble Lord speaks.

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My Lords, this is an interesting area which I was concerned with both in my former role as Victims’ Commissioner for England and Wales, and personally. As well as viewing mental health services through Covid, we must recognise the risks to pre-existing services, which were an underfunded postcode lottery with not enough qualified professionals. Our front-line workers are now dealing with a pandemic that none of us could envisage. Will the Minister speak to the Secretary of State for Health to ensure sustainable funding for access to mental health services, and that support is given to mental health workers, who will be the front-line workers again? We must ensure that people’s ability to access the services does not just become a tick-box system governed by an algorithm within an app. There has to be sustainable funding for a least five years to invest in the care and support needs of the most vulnerable in society.

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I recognise the insight of my noble friend Lady Newlove, who speaks from experience of these matters. I reassure her that the funding in place from the long-term plan for mental health has been substantial and will support a dramatic change in mental health services. We will be supporting mental health workers who, as my noble friend says, have delivered under difficult circumstances. Their creativity is demonstrated by the introduction of video and other technical facilities to keep mental health services going during the lockdown. I pay tribute to their inventiveness and creativity at this time.

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My Lords, is data on mental health support, A&E presentations, referrals to community mental health services, crisis resolution callouts and detentions under the Mental Health Act being collected during this period—yes or no?

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My Lords, I understand that it is a firm “yes”, but I will check that answer and revert to the noble Baroness if there is any different information.

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My Lords, yesterday the Guardian reported a study by Public Health England which showed that agency staff working between multiple care homes in London were unwittingly spreading Covid-19 during the surge of the pandemic. Given the evidence of the vulnerability of those receiving care, which includes working-age adults with mental health needs, is there really a commitment to parity of esteem between physical and mental healthcare? Why has the testing strategy not been amended properly to cover these groups?

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The noble Baroness rightly points to one of the most difficult aspects of the Covid epidemic—the itinerant staff who pass from one vulnerable person to the next. We recognised this issue at the beginning and put money in to try to ameliorate it. When testing was expanded weeks ago to key workers, it was deliberately targeted at these staff and this continues to be prioritised.

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My Lords, children’s lives have been disrupted, not only educationally but socially and emotionally, as friendship patterns have changed. The Minister will know that these relationships can be fragile but are essential to good mental health and well-being. What are the Government planning to do to provide additional support to schools to help with the problems they will inevitably encounter when children return?

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The noble Baroness is entirely right. I am living with four children who are greatly distressed at losing their friends and not being able to stay in touch in the way they would like. We will undoubtedly need to provide support to schools to cover a list of mental health issues. The Secretary of State for Education is working on plans for that.

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My Lords, as a nation, a vast number of us have seen our mental health deteriorate during the coronavirus crisis, so the challenges facing our mental health services are even greater than they were before. Surely we need a strategy to take us through the Covid-19 pandemic that takes account of the most welcome promises in the NHS long-term plan and addresses and scrutinises the impact of the pandemic on mental health and learning disability settings, including the impact of the temporary measures in the emergency legislation. Such a strategy must address how and when the DoLS legislation will be rolled out, and when and how the Government will bring forward reforms arising out of the review of the Mental Health Act. Does the Minister agree that these are the key ingredients of such a strategy? When will we see progress in this area?

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The noble Baroness is right: the Covid epidemic will throw a spotlight on our mental health provision. That provision is already benefiting from an extra £2.3 billion a year by 2023-24. We have already brought forward the 24/7 crisis lines that were due to be delivered in 2023-24, and I think there is a good case for bringing forward other parts of our mental health strategy to address mental health issues during the Covid epidemic. Undoubtedly, we will focus very shortly on ways of doing that.

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The Stevenson-Farmer review of 2017, which was set up by the then Prime Minister, recommended strengthening the 1981 health and safety regulations on mental health first aid. Will the Government commit to picking up those recommendations and implementing them?

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The noble Baroness raises an important point. I will confess that I am not, and will not pretend to be, completely across the matter she raises, but I will write to her with a clear answer.

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My Lords, I declare an interest: my daughter Natasha is an art therapist and co-founded the charity Arts Therapies for Children, which works in 19 schools. The impact on the mental health of children brought up where domestic abuse is the norm is sadly clear; it is all they know, and often they think that the problems encountered are their own fault. It is during these years that they develop and learn how to value themselves and others. Therefore, the impact of domestic abuse can lead to a skewed view of who they are, which can be taken into adulthood. Will my noble friend the Minister ensure that resources are targeted at supporting charities and mental health services that work with these vulnerable children?

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I pay tribute to exactly the sort of charity that my noble friend’s daughter works in. They provide invaluable and often unseen benefits to society. We have already made available considerable financial support for similar such charities. If my noble friend would like to write to me with the details of the one he described, I would be glad to consider it. Undoubtedly, these charities will play an important role in dealing with mental health issues of the kind he describes during the mop-up after Covid.

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My Lords—

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I am sorry, but I think we have lost the connection. I will call the noble Baroness, Baroness Verma, and then come back to the noble Lord.

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Will my noble friend assure me that all communities will be able to access appropriate mental health services? What work is being done to speak to local women’s and girls’ groups in the ethnic-minority communities, where language and access to online services may often be a barrier?

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One thing that Covid has thrown a light on is that digital communications have been greatly improved; the use of video conferencing in mental health services is one of the things that have helped. Groups that do not have access to video conferencing need to be reached in other ways. We are working on using telephones and community outreach to do that. My noble friend is entirely right that this needs to be a focus of our work.

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I return to the noble Lord, Lord Ramsbotham.

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My Lords, does what the Minister has said apply to prisons and probation?

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I pay tribute to the Prison Service, which in extremely difficult circumstances has managed to provide pastoral care and clinical segregation in our prisons in a way that has completely outperformed expectations. The effect in prisons has been profound and the mental health of prisoners is concerning. The degree of lockdown in prison cells is an awful aspect of this disease, and undoubtedly we will have to work very hard to manage and deal with the mental pressures on prisoners, which are extremely unfortunate.

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My Lords, the time allowed for this Question has elapsed. The Virtual Proceedings will now adjourn until a convenient point after 12.45 pm for the Motion in the name of the noble Baroness, Baroness Stedman-Scott. Proceedings in the Chamber will be taken at a convenient point after 12.30 pm.

Virtual Proceeding suspended.