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Mr. Andrew Smith (Oxford, East) (Lab): Mental health is a vital part of NHS provision, and it does not always get the public or parliamentary attention that it warrants. I congratulate the hon. Member for Twickenham (Dr. Cable) on securing the debate and, together with Government business managers, making this week something of an exception.
I want to take the opportunity to thank the staff working in the mental health services in my constituency, in the Oxfordshire and Buckinghamshire Mental Health Partnership NHS Trust, and to draw particular attention to areas of work locally that are topical and relevant as the House moves to consider the Mental Health Bill, which received its unopposed Second Reading last night.
As the hon. Gentleman said, there are huge humanitarian and economic consequences of mental ill health. I would also urge that in the difficult choices facing the NHS in managing its budgets, even expanding budgets, full weight is given to the needs of mental health patients who, because of continuing stigmathat must be challenged at every opportunityand their own situation, are not in a position to mobilise the sort of public pressure that is often brought to bear in other areas of NHS services and funding. In the past, I have spoken out against damaging pressures and unfair cuts in our local mental health budget. My right hon. Friend the Minister will recall responding to one such debate on the Floor of the House last year.
Let me also say, and I am sure that the hon. Member for Twickenham will accept this point, that there is an important distinction to be drawn between mental health trusts having to cut back to meet deficits elsewhere in the NHS that are not of their making and service reorganisation within the mental health care sector which, although often controversial, can be justified because it enables service improvements to be made ensuring that more care is available to more people more quickly and more appropriately for their needs. Examples of this in our own mental health care trusts are the much-needed extension of crisis services, and the development of early intervention services which allow more people to be treated outside hospital. Both improvements were funded by cost savings last year.
The Oxfordshire and Buckinghamshire trust is also able to look forward to the opening of a women-only forensic unit at Littlemore later this year, which will provide a dedicated and much-needed service for women across the Thames valley who are currently being looked after in mixed-sex wards or in distant secure units. Other local innovations that are improving provision include the bridge-builders service operating from the acute day hospital at the Warneford. It helps people to make that crucial move back towards independent living and employment which benefits their health, their family and the wider community. There is no doubt that if we are to help more people either get off incapacity benefitthat has been referred toor avoid getting on to it in the first place, mental health support, advice and counselling have to be right up there with other rehabilitation services and work much more closely with Jobcentre Plus and other employment providers than they have in the past.
I want to focus particular attention on an especially important innovation that has been piloted in Oxfordshire and a number of other trust areas. I commend it to the Minister as appropriate for extension across the country. I refer to the complex needs service, started four years ago, which meets the needs of people with a range of personality disorders and with tendencies towards self-harm, attempted
suicide, chronic relationship problems and drug and alcohol abuse. The service operates in close partnership with the voluntary sectorin our case, with Mindand works to treat personality disorders through a therapeutic community of members.
The results of the service, which operates from a dedicated centre in my constituency, are encouraging. I have met patients who have greatly benefited from the services approach. Indeed, their personal testimony, as they literally put their lives and personalities back together and rebuild their self-esteem, gives an inspiring picture of what modern mental health services and their dedicated staff at all levels can achieve. The evidence is that people using the service spend less time having in-patient treatment, can be discharged faster from their community health team and make 65 per cent. fewer visits to their GP than prior to their treatment. That is also an important consideration when we bear in mind that as many as 40 per cent. of visits to GPs are directly or indirectly related to mental health.
The service shows an important way forward. My understanding is that although it has been funded as a pilot, there is still uncertainty over its longer term funding. I hope that the Minister will be able to tell me in her closing remarks that she recognises the benefits of that approach and that she can reassure the complex needs teams, in our area and elsewhere, that the success and benefits that they are bringing to patients will be matched with longer term funding.
I dare say that as part of her answer the Minister will say that the money is there in PCT baselines, but I am told locally that that money is hard to identify and findand, of course, it can all too easily be subject to other pressures. I urge the Minister to highlight the funding available, supplement it when necessary and do anything else that she can to push forward that important and valuable approach. As I am sure she recognises, such services will be very important in making a success of the provisions in the Mental Health Bill, demonstrating that real and effective help can be provided to people who in the past have risked being seen as untreatable, or who have not had the treatment most effective for their needs.
On a related issue, I congratulate our mental health care trust and Oxford university on having been awarded a £500,000 research grant to enable them to examine how community treatment works out in practice. That was announced last month by Professor Louis Appleby, the national director for mental health. The study will consider who gets community treatment orders and what the benefits are. That research is very important, because supervised community treatmentpart of the Mental Health Bill that will be subject to much more discussion as the Bill proceedsneeds to work properly. It must ensure not only that the community has proper protection from the minority of patients who present a risk, but that people with mental health problems are given the chance to rebuild their lives, for which family, social contact and employment are vital.
I am following closely what the right hon. Gentleman is saying; the project in his area sounds very interesting. However, does he not agree that the Government have now commissioned research
into the effectiveness of community treatment orders on the back of international research that has not been able to give any empirical evidence for their efficacy? Would the Government not do better to wait until that research has come up with positive results before going ahead with legislation that would enforce the orders, which may have a detrimental effect on some patients with personality disorders who at the moment are benefiting because they are treatable?
Mr. Smith: The Government would be vulnerable to criticism from another direction were they to embark on legislative innovation in this area without properly monitoring and learning from the experience of such work as it progresses. The hon. Gentleman is right to say that lessons must be drawn from research elsewhere in this area and from international experience. This dedicated research project is invaluable because, like mental health services themselves, research into mental health issues has often been a poor relation when comparisons are made with other areas of medicine. The new funding is all the more welcome for that.
My final point relates to a national concern. This is not a particular issue in my area, because it has a specialist adolescent unit. I understand that as many as 1,000 children and adolescents with severe mental health care problems are placed on adult psychiatric wards each year. We all agree that that is unsatisfactory. Those young people need to be able to be referred to specialist provision. Again, that will be debated further elsewhere as the Mental Health Bill proceeds, but will the Minister tell us what progress is being made in tackling that pressing matter? Mental health services need to cater properly for the needs of the whole community and we all agree that children and adolescents are a high priority in terms of our fulfilling that responsibility.
The Government have made good progress in mental health policy generally. I note what the hon. Member for Twickenham said about the share of the budget, and I shall always be to the fore in arguing that mental health services need to be given proper priority, as, I am sure, will the Minister. Equally, as my hon. Friend the Member for North-West Leicestershire (David Taylor) pointed out, we should recognise just how big a funding increase has taken place under this Government£1 billion in real terms since 2001. In many areas, mental health provision is being transformed beyond all recognition for the better, notwithstanding the pressing concerns and pressures that have arisen from tackling deficits.
I commend the innovations that are taking place locally, and congratulate the staff who are working in mental health. All too often they fail to get the public recognition that they deserve, partly because of the stigma in this area. In a minority of cases, staff face the risk of abuse, and their contribution should be properly recognised.
My right hon. Friend is right to pay tribute to staff in the mental health sector of the NHS, but will he also pay tribute to the role of volunteers? He talked about social contacts. Good numbers of befriending groups and others play a huge part in the recovery of patients who are emerging from periods of mental ill health. Will he acknowledge that such an
approach is often an effective way forward and that it does not cost a great deal to train volunteers to have that type of role?
Mr. Smith: I strongly agree with my hon. Friend. I should include the work of the voluntary sector in the praise that I have been giving to staff. I referred to the importance of Minds contribution to the complex needs service that I was advocating. My constituency has an excellent initiative called Restore, which helps people to move forward through training programmes and work experience. It has dedicated employment advisers who help people, often those with acute conditions, to rebuild their lives, their social contacts and their family involvement and, in many cases, to move forward to employment. Progress is being made, although there is lots more to do.
Mr. Nick Clegg (Sheffield, Hallam) (LD): I thank my hon. Friend the Member for Twickenham (Dr. Cable) for securing the debate. He has a long and distinguished interest and expertise in this area, which was fully on display in his articulate exposition. I should like to raise two matters. The first has not been mentioned but is of enormous national interestthe provision, or lack of it, of mental health services in prisons. Secondly, I should like to dwell on the experience of the changes and cuts being introduced into mental health service provision in Sheffield, as an example of some of the knock-on pressures that have been mentioned.
It is difficult to see much of a silver lining in the increased public attention on the state of our prisons in view of the burgeoning overcrowding crisis in the prison system, but if there is a silver lining, it is that more public and press attention has been focused on conditions in prisons. One fact that has finally been given a little more exposureit deserves still more, in my viewis that there is a huge number of people in prison with acute mental health conditions who are simply not receiving the treatment they require. It is reliably estimated that one in 10 of the prison population are identified as functionally psychotic. Prisoners are seven times more likely to commit suicide than the general public. As the Corston report on womens prisons highlighted last month, 80 per cent. of women in prison are diagnosed with mental health problems. The scale of the problem is enormous. On that, we can all agree.
I want to press the Minister to expand on what I thought was an extremely encouraging break with Government rhetoric and policy in a paper on the criminal justice system as a whole. Forgive me: I do not have the precise title of the document to hand. It was published, I think, two or three weeks ago by No. 10, and the Lord Chancellor was active in the press, expounding its virtues. In that paper, which was a fairly wide-ranging and somewhat motley gathering of different observations on the criminal justice system, there was an extremely significant allusion to the need to develop what the document called hybrid prisons.
If I understand it correctly, the purpose of hybrid prisons would be to relocate offenders with acute mental health problems from the closed prison estate to
specialised hybrid prisons, where of course incarceration could continue but treatment could be effectively provided. That seems to me to be a very important and promising, although extremely vague, new direction of travel in the Governments utterances on this major issue. I urge the Minister to explain whether she is aware of quite what the Government have in mind when talking about hybrid prisons, what plans are in place to develop hybrid prisons and what resources would be found to do so.
At the moment, £1.7 billion has been earmarked to expand the prison population by about 8,000 placesplaces, incidentally, that will not come on-stream until about 2011-12, by which time, judging by current rates, the prison population will have well surpassed that increase of 8,000 places anyway. In common with the conclusions of the Corston report, it would make a great deal of sense to reflect on whether it would be more sensible to spend that money on specialised hybrid prisons and secure and semi-secure mental health treatment facilities, so that the very significant number of offenders in prison with acute mental health conditions could be moved from the closed prison estate into facilities more suited to their needs.
Dr. Pugh: My hon. Friend has introduced a very important and much overlooked theme. I think that we all accept that prison is not conducive to mental health and well-being in any sense whatever and particularly in the case of women. Has he any statistics that reflect the difference between the people who arrive in prison with a mental health problem and those who develop a mental health problem in prison?
Mr. Clegg: No, in short, I do notthe statistics on this issue are quite patchy. Similarly, little empirical work is being done, for instance, on the link between the failure to treat mental health conditions in prison and rates of reoffending, which have increased dramatically in recent years, as we know. Quite a lot of empirical work therefore needs to be done to complete the picture.
Time is short, so let me move on to my second point. The right hon. Member for Oxford, East (Mr. Smith) rightly alluded to the fact that all sorts of controversies and debates may arise if changes are required to the provision of mental health services. Such changes can take place within the parameters of competing judgments about the best way in which to provide mental health services. Things become altogether more fraught, however, when changes appear to be forced through because of the knock-on effect of financial pressures, particularly on primary care trusts.
The primary care trust in Sheffield has mooted several extremely controversial changes, although it has at least been open enough to say that they are almost entirely driven by the financial pressures on its own account. None the less, that may have a dramatic and disruptive knock-on effect on the mental health service in Sheffield, which has been a Cinderella service for some time. It is widely recognised among practitioners and patients in Sheffield that mental health in the city has not been given the priority that it deserves. It is all the more incomprehensible to them, therefore, that extremely controversial changes are being rushed through as a result of financial pressures that have nothing to do with the mental health care trust.
The manner in which the changes have been floated and introduced is a model of how not to persuade the public, political stakeholders and workers in the mental health sector that changes are required. In substance, the consultation document, which I have in my hand, amounts to no more than two and a half pages of sweeping recommendations, which is clearly insufficient to explain the wide range of proposed changes. The consultation period has also been somewhat rushed, while the consultation document is vague to the point of being vacuous. It makes several claims about a renewed reliance on GPs, community-based services and social day care and on reducing acute in-patient beds. In other words, it pursues the general drift away from hospital-based treatment and towards various forms of what might euphemistically be called community-based treatment. It also fails to explain how the money will be saved, in what time scale and to what end.
Unsurprisingly, the reaction in Sheffield has been universally hostile, and the Minister may be aware that Labour Members from other Sheffield constituencies have, like me, been active in asking the primary care trust to withdraw the consultation document altogether. Last Friday, all Sheffield Members were informed by letter that the consultation document would not be withdrawn. Ironically, we received another letter at the same time telling us that the PCTs financial position would be wonderfully restored to good health in the next few months, which raises the question why it needs to impose this set of disruptive proposals on the mental health sector in Sheffield.
Mr. Bill Olner (in the Chair): Order. May I ask the hon. Gentleman to bring his remarks to a close? Some very good questions have been posed to the Minister, and I want to ensure that she has time adequately to respond to them.
Mr. Clegg: I will indeed bring my remarks to a close, Mr. Olner. I realise that the Minister cannot comment on the specific local circumstances that gave rise to the situation in Sheffield, but I hope that she will agree that it is difficult for the public or, indeed, political stakeholders in places such as Sheffield to feel that their voice is being heard if, as in Sheffield, the primary care trust is impervious to the most elementary forms of public and political accountability. In Sheffield, that is reflected in its extremely poor, thin and rushed consultation document, which will have very disruptive effects on mental health service provision in the city.
Dr. John Pugh (Southport) (LD):
I congratulate my hon. Friend the Member for Twickenham (Dr. Cable) on opening up a huge and important debate. As he said, mental health issues affect nearly everyone, and I was reminded of that acutely the other day. I was on the phone in my surgery discussing amendments to the Mental Health Bill with my hon. Friend the Member for Romsey (Sandra Gidley) when a regular client who has mild paranoia appeared at the counter. He believes that a member of the House of Lords is out to get him by perpetually sending thugs to his area and he renders himself homeless on a fairly systematic basis. He writes three letters a week to me and has seen every Member
in the north-west, including the Leader of the House. He also thinks that his phone calls are being intercepted and that the legal profession is corrupt. Not all of his views are necessarily delusions, but they certainly make a prima facie case for further inspection. His doctor referred him to the psychiatric service, which reported that he was an interesting man with no particular problems, which somewhat disappointed me because he is an elderly man and at some point his behaviour is likely to have adverse effects on his physical health as well as leading to a further deterioration in his mental health.
Mental illness is not exactly the same as, or simply a sub-group of, physical illness. Although it is often politically correct to say otherwise, that is not actually true. However, like physical illness, it covers a huge spectrum of conditions that can be chronic or acute, or chronic and acute, as is obviously the case with schizophrenia. Mental illness is socially disabling to a varying extent and affects personal autonomy, capacity, insight and behaviour to different degrees depending on the ailment. Sometimes the causes are known and sometimes they remain hidden and await further research. Equally, cures in the mental health field are sometimes quite well established, sometimes utterly absent and sometimes quite uncertain. Therapies are mixed and varied, and include the chemical, behavioural, personal and family based. There are few quick fixes and few long-term guarantees.
What is universally true is that there is a stigma associated with mental health and a questioning of the competency, reliability, and predictability of the behaviour of those suffering from mental health problems. As many hon. Members have said, that results in the clamour for better services and complaints about poor services being somewhat muted. Obviously, those who are, in many respects, the most troubled will complain the least, which means that mental health is a relatively soft target for underfunding, for cutsalthough of a fairly covert natureor for virement to other services where people clamour with greater force.
It has quite accurately been pointed out in this debate that the share of NHS funding for mental health has fallen, although it must be admitted, as the Minister will no doubt say, that total funding has appreciably risen. It is still the case that raids from the regional authorities are relatively common, and the fact that it is easy for trusts to maintain a balance shows how easy it is to adjust their costs and to cut services where financial need arises. That often results in a slow response and long wait for psychiatric services, which is one of the most prevalent and pervasive complaints that I receive about mental health services. When there is an issue and people need help it is difficult to get past first base and there is a long wait to receive regular attention from a consultant psychiatrist.
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