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Ms Diana R. Johnson (Kingston upon Hull, North) (Lab): For three years, I was a member of the Mental Health Act Commission. I visited patients not only to check that they were legally detained under the Mental Health Act 1983 but to talk to them about their concerns. With that experience, I am pleased to be able to say a few words this afternoon.
Although as a Mental Health Act commissioner I was working at the acute end of mental health, dealing with people who were detained, it was interesting to talk to them about their pathways and how they ended up being sectioned. I visited not only NHS psychiatric facilities but private sector facilities. That was an interesting experience because, in some instances, the private sector can provide good facilities and meet needs where the NHS cannot.
The right hon. Member for Charnwood (Mr. Dorrell) mentioned that the view seemed to be that, prior to 1997, things were terrible and that, from 1997, suddenly things got a lot better. The focus on mental health services has increased since 1997. The investment has gone in since 1997. When we talk to the community and voluntary sector, it says that the joined-up thinking and the investment in mental health services in local communities has been staggering in some instances. From my right hon. Friend the Minister, we heard that there are 8,000 more psychiatric nurses, 1,200 more psychiatric consultants and 3,000 more psychologists. Those are real people providing a real service to our constituents with mental health problems.
The most important thing that Labour has done is the 1999 national service framework on mental health services, which set the gold standard for what we should be looking to achieve in all our mental health services. I want to talk about child and adolescent mental health services, women patients in mental health services and the NHS estate in terms of psychiatric units.
On children and young people, on Friday I went to a meeting of the Humber mental health trust, a three-star mental health trust that does excellent work. It said that, although the national service framework for adult mental health servicesit includes sections involving childrenwas a good start, we needed an NSF for young people. The chief executive said that the split between children and adolescent mental health services that goes up to 16 or 18 years of age was not providing the kind of care we should be providing for young people. We need a service that spans the age group from, say, 15 to 30.
We need to make sure that, for younger children who may come into contact with mental health services, their contact is community-based. We must keep young
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people away from the acute sector because it is not an environment where we want children and young people to enter unless there are extreme circumstances. The facilities are not suitable for them. There are some disturbed people in our facilities and we need to keep our focus on the community setting.
Getting in early is important. I was pleased to see that Sure Starts were putting emphasis on developing emotional well being in the support that they are providing to parents and carers of our youngest children. Such guidance to those who look after children uses creative activity to improve children's self-esteem, social skills and emotional well being. That is absolutely right. It is a stark fact that a child living in a low-income, lone-parent household is twice as likely to have emotional disorder as a child in a two-parent family on a reasonable income. There is a clear link with poverty and it is right that Sure Starts, which were based on the most disadvantaged areas, are putting the focus on emotional well being.
I want to talk about Mind, which provides excellent services across the country for people with mental health problems. In my constituency, the Linx project provides help with housing and independent living for young people who have shown the first signs of psychosis. Getting in early and investing early in our young people means, we hope, that they can go on living independent lives and putting their problems behind them.
We have heard about the massive investment in PCTs for mental health services and it is worth putting on record that £300 million has gone into PCTs and local authorities to improve child and adolescent mental health between 2003 and 2006. However, there are still some gaps. I visited Hull domestic violence refuge and was told by some teenagers that there were counselling facilities available to younger children to help them deal with the trauma they had experienced, but that there was nobody to provide teenagers with counselling. I hope that we put some work into that area. It may be that we invest now to save later on.
I want to pay tribute to the work done in Scotland in the one in four campaign, which is trying to remove the stigma from mental health. Hon. Members will agree that that is a good campaign. In Australia, the National Youth Mental Health Foundation has been set up and is looking to make sure that money is put towards young people suffering mental health problems. We need to ensure that particular resources are attached to making sure that those in the 12 to 25 age group get the help they need. Of course, the recently published Health White Paper will work to counteract the stigma of mental health.
I turn briefly to safety, which is a real issue for women in-patients in mental health facilities. As was pointed out earlier, there can often be a mixture of people with various mental illnesses and disorders on a given ward. It is important that women, who can often be very vulnerable, are provided with separate facilities. We have a commitment to providing gender-specific facilities and I hope that more resources will be put into providing them throughout the country.
We also need to consider the estate. Statistics show that only 35 per cent. of psychiatric intensive care units have en suite facilities, that 25 per cent. have no enclosed garden space and that 35 per cent. have no gender-
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specific facilities. We need to get these issues right. A decent standard of accommodation can have a very positive effect on the recovery of those suffering from mental illness or disorder. I am pleased to note the massive investment that has already gone into improving in-patient facilities, but there is still more to do.
I am pleased that we have made a positive start and it is indeed since 1997 that we have really focused on this issue. We need to keep working on provision for children and young people, because there is more to do in that regard. As part of our wider public health agenda, we need also to deal with the issue of emotional well-being throughout an individual's life.
Angela Browning (Tiverton and Honiton) (Con): During this debate, which I very much welcome, we need to reflect on the scale of mental ill health. We are told that one in five adults will experience mental health problems at some point in their life, which means that, of the 20 Members currently in this Chamber, four of us could well experience such problems. It is very unlikely that the same ratio of Members will experience any other type of health problem.
As with many other conditions, mental ill health does not affect just the patient. The impact on families, particularly the prime carer, is enormous; indeed, it is so great that, ultimately, it can affect both their mental and physical health, particularly if that patient has a long-term condition. Many of uscertainly mehave experienced at first hand in our families the agonising condition of mental ill health and its impact on people's lives. It is one of the most distressing conditions.
In discussing mental health, I want to focus on the two age extremes. Many Members have mentioned young people, and at that age suicide is an issue. The Mental Health Foundation and Mind have pointed out that the highest rate of suicide is among young men between the ages of 15 and 24, that 20 per cent. of all deaths among young people are through suicide, and that one in 10 of 11 to 25-year-olds self-harm. Given the scale of the problem, we have to find the answers and the policies to alleviate it. Behind those bare statistics are very real tragedies for the families concerned.
It would be remiss of me not to add one more statistic on behalf of a group of people whom I mention probably far too often in this House. However, I make no apology for doing so. A recent report by the National Autistic Society pointed out that the attempted suicide rate among adult sufferers of Asperger's syndrome is 8 per cent., which is very high indeed. When we consider, in managing such patients, how they reached the point of attempting suicide, there is usuallynot always, but usuallyan identifiable pathway in their relationship with the statutory services.
In the recent past, I have had more than one Adjournment debate on in-patient deaths within the Devon Partnership NHS Trust. I wish to put on the record that since I have raised the issue and some of the concerns have been addressed, we have seenunder the management of Mr. Iain Tully and his teama real rethink on why those tragic deaths occurred in our area. The mother of one of the young men who died showed me a plan of his relationships with statutory services
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during his long history of mental ill health. The relationship usually started well, but eventually failed. We euphemistically call that falling through the net, but too many young people do soespecially in their relationships with community services.
I wish to pick up a point made by the hon. Member for Northavon (Steve Webb). Often, the first professional a patient sees is their GP. I sympathise with GPs because they have an eight-minute slot in which to listen, assess and decide what to do. There are GPs in my constituencyand I am sure they are not uniquewho ask how they can do anything other than pick up the prescription pad at the end of the eight minutes. A prescription may solve a short-term problem, butand I mean no disrespect to GPsit does not address the underlying cause. Many of the young people who end up as suicide statistics do so because not enough time has been spent with them, there has not been enough continuity in their care and the people who could help are not out there in the community.
My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) pointed out that when people break their legs, they recover. Well, people do make full recoveries from certain types of mental illness, but mental health problems make people fragile. Such problems are often recurring. Also, when people present to GPs and other professionals, their instinct is often to conceal the underlying problem. It often takes many hours of discussion and counselling before even the best trained psychiatrist can start to identify the right approach for an individual. It is time-consuming, painstaking work that is very different from other areas of medicine. Therefore, while I understand the Minister's wish to put the statistics in the best light possible, we still have a huge way to go. The suicide statistics prove that.
At the other end of the age spectrum are the elderly. The mental health of many elderly people breaks down from a simple causesocial isolation. To put it more simply, the cause is loneliness. Many elderly people who are unable to get out and about, or whose family and friends have started to die off or have moved away, spend far too many hours on their own, and that inevitably leads to depression. As we know, depression is a spectrum. It can be intermittent and addressed by medication, but all too often it leads to more serious mental health problems. Depression is also a common side effect of other physical conditions, such as Parkinson's disease. It is extremely difficult to disaggregate the depression and the underlying mental health problems from the physical conditions in elderly people who are often not able to be very good self-advocates. I can think of some of my elderly relatives who always put on their best face when the doctor came to calla natural response for that generationeven though they had problems that the doctor needed to know about. It is a complex and grey area, which is not easy for professionals, let alone politicians, to enter.
More than 13 per cent. of the NHS budget is devoted to mental health services and I am concerned about care in the community. We have heard much about the packages to deal with people's physical needs, but if we are to move towards more people being cared for at home for longeras we certainly are in Devon
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especially when they are extremely dependent physically, their emotional and psychological needs must also be met; otherwise, many elderly people will develop serious mental health problems. All too often when serious problems occur, whether with younger people in suicide cases or with elderly people with mental illnessthe health service has to respond to a person in crisis. The statutory services have to respond suddenly to situations where, to put things in crude financial terms, much more money will have to be spent than if there had been regular, lower-level interventions at an earlier stage.
There is a dilemma. Health authorities and social services departments work on annualised budgets and the system mitigates against such regular interventions. It has to deal with people who are in crisis, so it is easier to pare off services and facilities that may be regarded as low level, even though they might have ensured that many people who appear in the crisis statistics had a better quality of life and did not succumb to mental illness. The fact that more people have been admitted to mental hospital since the implementation of the Mental Health Act 1983 is an indication that intervention takes place only when there is a crisis. We must address that issue. Crisis management is never the most effective outcome, for either the patient or the system.
As I said earlier, I served on the scrutiny Committee on the Mental Health Bill, so it would be remiss of me not to mention my grave concern about two aspects of the Bill; indeed, the Minister would expect me to do so. I still believe that the Government's broader definition of mental disorder is wrong and if the Bill is introduced I hope to put my case to the Minister even more robustly than in the past. I urge her to reconsider that aspect of the Bill.
My second concern relates to compulsion. We received evidence from the Royal College of Psychiatrists that, under the provisions, we should need to detain one in 2,000 people with no previous indication that they would cause severe harm. I realise that the proposal came from the Home Office rather than the Department of Health, but if we broaden the definition of mental disorder so that it is based not on clinical diagnosis but merely on behaviour, and if that is accompanied by wider provisions in civil legislation for indefinite detention, the infringements of civil liberties that we have discussed in this place in the past will be as nothing by comparison. If the Minister does not address that aspect of the Bill, the rebellion will not be merely in this and another place; people will march in the streets.
I urge the Minister to reconsider those two fundamental rights, on both of which the scrutiny Committee made firm recommendations. Together, those two aspects of the Bill will be a huge infringement of civil liberties.
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