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17 Apr 2007 : Column 14WH—continued
I have received complaints in my constituency about service reductions, but I will not expand on those now. As the Minster has acknowledged, there have also been justified complaints about treatment taking place in inappropriate settings; for example, when adolescents and children have been seen in adult environments. There is, of course, the unspoken difficulty that people are sometimes over-medicated in circumstances where
medication is not the sole or even the best answer to their problems. Although that may be the quickest way of dealing with such problems, it may not always be the best.
As my hon. Friend the Member for Twickenham pointed out with his economic hat on, the social effects are even worse. Billions of pounds are paid out in disability benefits and the Sainsbury Centre for Mental Health has said that 91 million working days are lost because of mental health problems. One third of all new claims for disability allowance are on the grounds of depression and anxiety. In the past, when the care model was the mental hospital, there were heavy, fixed and immovable costs that could not easily or covertly be adjusted. Now, in the community, it is far easier to adjust costs and, if necessary, reduce them.
It is good that there is more money—we must all admit that—but that money must be spent within a framework, monitored and assessed under performance management. That is the goal to which I think everybody aspires. We have not got there yet, and it is hard to see how payment by results will benefit. Obviously, we call for the performance of PCTs and mental health trusts to be better monitored, but their delivery on mental health services is somewhat hard to measure because some conditions are not curable, only manageable. The social background of different areas makes an appreciable difference. Clearly, if there is a lot of unemployment in the area, we expect a high rate of depression and anxiety to go with it.
Mental health is an area in which the voluntary sector can perform in different ways and places. The sector has a key and beneficial role to play in mental health, a field where imagination and innovation pay off. We are all familiar with some exciting and worthwhile projects involving mental health users and art. I also mention the increasing use of IT and software therapies. Years ago, a chap called Weizenbaum designed a programme called Eliza, which was supposed to act as a substitute for psychotherapy. One can download it and try it oneself. An odd feature of Eliza was that some people preferred the software to their own consultant psychiatrist. The computer never looked away and always gave a response, and it was always a remarkably tolerant and interested response. There are better examples, as much development has taken place in the field, but it indicates that innovation in mental health can make a substantial difference. However, it is often difficult to monitor and assess.
Professor Layard calls for concentration on the less acute sector, bearing it in mind that only one in two depressed people receive treatment and that only 8 per cent. see a psychiatrist, yet where pathways to work pilots have concentrated on the issue, substantial effects have been recorded. Therefore, he calls for an extra 5,000 psychological therapists and double the number of consultant psychiatrists. I think that we would all go for that, but the therapies must be tested—NICE has a key role there—and the services must be validated.
We are all aware of a number of counselling services of various kinds and qualities springing up in our constituencies. They are mushrooming. Some are very good, some are not so good and some are a waste of
time. It is important when services are offered that they are properly validated and assessed. The Department for Work and Pensions also needs to offer a more holistic service, particularly to the unemployed, because one thing people need before they can get back into employment is a boost in morale and maybe to address underlying psychological problems. There is some evidence that it is doing so. I went to my DWP office recently and found that that is precisely what is going on to get people off disability benefit and back into work.
Another Layard theme is that mental health should be seen as a social goal for the Government—what might be called the happiness agenda, whereby the Government are charged with the positive promotion and encouragement of a good and mentally whole life in the workplace, family and community. It is a tough task for the Government, I must say, though I record in passing that Plato regarded it as a fundamental chore of the state. As my hon. Friend the Member for Twickenham might know, Plato regarded the economy as something that the state would do better to butt out of and leave to the merchants, and the promotion of the good life as its fundamental aim.
Unlike my hon. Friend, however, Plato was a totalitarian. We must acknowledge that any liberal state allows for diverse concepts of the good life, and that many of those concepts will be contestable. However, it seems self-evident that where social conditions identifiably lead to unhappiness, removing those obstacles is a fairly important and uncontentious task for the state. That is the modest aim of a liberal state.
Apart from the wider goal of generating social happiness, which I have no doubt every Government have tried to achieve in some way, there is the more pressing need to improve existing mental health services. As my hon. Friend indicated in his introduction to the debate, there is an awful lot of work still to be done.
10.30 am
Tim Loughton (East Worthing and Shoreham) (Con): We have had a very interesting debate. I add my congratulations to the hon. Member for Twickenham (Dr. Cable). The timing of the debate is fortuitous. We shall be mental healthed-out by the end of the week: debate on the Mental Health Bill started yesterday, and as he mentioned, this is national depression awareness week, which is an initiative of SANE and the Depression Alliance.
The hon. Gentleman raised some good points and introduced a wide-ranging debate on the subject, unlike the limited one that we had yesterday on the Mental Health Bill. I am pleased that this debate is part of a profile-raising exercise for mental health, which is not a fashionable subject. As he rightly said, many people who suffer from mental illness will not be the first to admit their own problems, let alone demonstrate in the street, so it is incumbent on us as legislators and the representatives of those most vulnerable people to speak up for them. This debate is another good opportunity to do that.
All hon. Members in this Chamber and, I am sure, across the House know from their surgeries and constituency post of distressing cases of people who
suffer from mental illness but are unable to access services. I refer to two cases in my constituency. One constituent recently had a psychotic incident that involved the police. He was arrested and kept in the cells for five days before he was assessed by a mental health professional and then able to be sectioned to the Maudsley hospital. That is no way to deal with somebody with a disturbing illness.
Secondly, I had a very distressing case a couple of years ago of a father who had killed his own daughter. She had asked him to kill her because of her mental illnesses. She had just been thrown out of a local mental hospital. The help that she needed was not there, and the system failed her. That was a deeply tragic case, and the trouble is that there are too many such cases all over the country.
Whatever the Minister and the Government may say, mental health services remain the Cinderella service of the NHS. I was pleased that the hon. Member for Twickenham gave the figures. We know that extra money has gone into the NHS across the board in large portions, quite rightly, and that extra money has gone into mental health services, but the percentage of NHS funding going to mental health services has fallen during the past 10 years—it has not increased. That can only help to compound the stigma that is attached to mental illness.
I believe that every Member mentioned problems with deficits. Mental health was last in the queue to benefit from the Chancellor’s largesse, and now it is first in the queue when services are being asked to hand money back to pay for deficits in other parts of the health service. Mental health is suffering a double whammy: mental health trusts had to tighten their belts because of the present funding crisis, and they have to tighten them a second time to bail out other parts of the NHS. That really is not fair. Louis Appleby, the mental health tsar, said that acute trusts should be ashamed for taking money from underfunded mental health services. The Government have admitted that that is happening, but they must do something to ensure that it does not happen even more in the future.
As I said earlier, vacancy rates among mental health professionals are much higher than for the rest of the NHS, and there is a postcode lottery for services, particularly in talking therapies. Several Members mentioned the lack of availability of talking therapies such as cognitive behavioural therapy. The hon. Member for Twickenham was absolutely right to mention the depression report and the excellent work of Lord Layard. From an economic perspective, funding such services makes sense—the numbers add up. More than 1 million people are on incapacity benefit for a mental illness-related problem. A relatively short course of treatment, which would involve a relatively small amount of money, would have a success rate of around 50 per cent., as calculated by Lord Layard. We could get those people back into the economy and into employment, at great personal benefit to themselves and to the state and the NHS budget, so it has to make enormous economic sense.
We heard some interesting contributions in addition to those made by the hon. Member for Twickenham, who opened the debate. The hon. Member for Richmond Park (Susan Kramer), who is no longer in
the Chamber, spoke in an intervention about the Cassel hospital. It is unfortunate that she did not elaborate on that. I visited the Cassel hospital a little while ago. It is worrying that that excellent institution is facing a funding squeeze at the moment, particularly for the work that it does with mothers facing mental health problems—often being able to keep them with their babies. One in six women will suffer from depression around the time of a pregnancy. That is a largely unseen mental health problem, but it has enormous consequences. Four out of five women with babies are admitted to psychiatric hospitals without them. That can only engender greater distress in those women. The Cassel hospital has made great strides in being able to keep families together.
I reiterate the praise that the right hon. Member for Oxford, East (Mr. Smith) gave to staff and volunteers. There are enormous challenges and pressures for the staff working in mental health trusts around the country. We have some excellent mental health voluntary organisations, such as Rethink, SANE and MIND, which do fantastic work for the sufferers of mental illness.
Hon. Members were right to say that there is a continuing stigma attached to mental illness. I was interested in a local project in Oxford that the right hon. Member for Oxford, East mentioned, particularly as it deals with treating personality disorders, with therapeutic benefit, on, I would guess, a voluntary admission basis in many cases. However, the proposals in the Mental Health Bill for people with personality disorders would regard those people as largely untreatable. It is for that class of patients that the Government are now introducing community treatment orders, with no empirical evidence to underline their efficacy. There is no research internationally to suggest that such things work. The right hon. Gentleman’s constituents who are benefiting at the moment from the great advances and innovation in mental health treatment, particularly for personality disorder, could be subject to those community treatment orders. Nothing would deter them more from presenting in the first place for therapeutic treatment than the fear that they may be subject to some degree of compulsion. After last night’s debate, we face the bizarre prospect of Ministers saying, “We must have more compulsory treatment to guarantee treatment for those patients”. However, the compulsion is on the patient to receive the treatment, not on the mental health trust or the providing authority to provide it. The Government have got their priorities wrong.
I am worried about the sort of projects that the right hon. Member for Oxford, East mentioned, which are doing great work on a pilot basis, although funding is not guaranteed. For those projects, the prospect of people turning up in future could be greatly imperilled by coercive measures, which this Government seem hellbent on pushing through the House, that are having great ramifications outside.
The hon. Member for Sheffield, Hallam (Mr. Clegg) mentioned problems in his constituency with the deficit crisis. I know Sheffield well and I know the problems with the health service there. Too much is being done in the name of reconfiguration. In Sheffield there is a rather vague reconfiguration to save money, which is really what it is all about. The hon. Gentleman
mentioned prisons and he was right to do so, because the state of mental health in our prisons is an absolute scandal and is highly counter-productive. There are large numbers of prisoners suffering from mental health problems and there is a lack of integration to get them sorted out mentally before they can be properly rehabilitated and not reoffend. It is worse in young offenders institutions. I visited the young offenders institution in Feltham just a couple of months ago, where a lot of impressive work is going on. Again, though, it is a deeply depressing place. A lot of work is being done to try to address the mental health needs of young offenders there. The recidivism rate for young offenders who are sentenced to jail terms of less than 12 months is 92 per cent. A lot of that is due to not dealing with the underlying problems that may have led them to get into crime in the first place.
The hon. Member for Twickenham mentioned the problems of dual diagnosis. It is ridiculous that we do not have better inter-agency working, so that while we may be able to deal with a person’s mental illness we cannot deal contemporaneously with their alcohol or drug misuse problem. The two things are closely linked and we need far better progress on dual diagnosis. Whether the hybrid prisons will do anything about that I do not know; it sounds to me like another soundbite from No. 10, which the Prime Minister may hope will form part of his legacy, but which will not amount to much.
Mr. Olner, you are right to say that hon. Members have raised many questions about mental illness, which the Minister needs to answer. I ask her in particular to give detailed indications of what will happen to the CBT pilot projects in Newham, which I visited recently, and in Doncaster. There are fears that those will not carry on, despite the fact that they do great work. I should like her also to comment on the lack of progress in dealing with the black and minority ethnic community given that Matilda MacAttram, director of Black Mental Health UK, said recently:
“Absolutely nothing has changed for black people over the last 12 months”.
“The 2006 Bill as it is currently drafted will make this situation a lot worse. This calls into question the Government’s commitment to address race issues within mental health services.”
Many people in the black and minority ethnic community suffer disproportionately from mental illness. They suffer particularly from being disproportionately subject to sectioning and other coercive treatment, and the Government need to take that far more seriously.
There are many other things that we could say in a mental illness debate. I am glad of the opportunity to air problems within the mental health community and I shall not recount again the problems affecting young people and children, one in 10 of whom will now suffer some form of mental illness, with one a day in the past few years being admitted to highly inappropriate and intimidating adult mental health wards. As the Children’s Commissioner for England said recently:
“It wouldn’t surprise me if children leave adult wards worse than when they went in. Putting children in an age-appropriate and developmentally appropriate environment can only be better for them.”
Mental health needs to be a far greater priority than it currently is in the NHS and the Department of Health. It is a false economy not to make it a greater priority. It is one of the most challenging ticking health timebombs that we face in westernised countries. It is a particularly false economy not to take the subject of young people with mental illness more seriously. I hope that at last the Minister will treat that as a priority. She might start by guaranteeing that the Government will restore mental health funding in the NHS to the level that she inherited in 1997, which was much higher, in percentage terms, than it is now.
10.42 am
The Minister of State, Department of Health (Ms Rosie Winterton): I congratulate the hon. Member for Twickenham (Dr. Cable) on securing the debate. As he said, it is particularly relevant this week, and it provides a good opportunity to raise awareness of mental health issues in the House. Debates in the past couple of days have suggested how many Members of Parliament have relevant constituency cases: carers, families and patients are all very much affected when, as we know, about one in six adults at any one time report having a mental disorder, and one in every four GP consultations are directly related to mental health.
I shall deal, as other right hon. and hon. Members did, with some of the specific issues that the hon. Gentleman raised about Lord Layard’s report, but I want to deal with some wider issues first. It is important to start with the question of finance. There has been a consensus that extra money has gone into our mental health services. An extra £1.5 billion is now being spent on mental health services. According to the European Commission, and despite what the hon. Member for East Worthing and Shoreham (Tim Loughton) says, the proportion of the overall health budget devoted to mental health in the UK is among the highest in any EU member state. That extra investment has led to some great improvements, and I join my right hon. Friend the Member for Oxford, East (Mr. Smith) in paying tribute to the many staff in the mental health service who have made them possible.
The way in which some of the 700 new community teams work is completely different from the traditional delivery of mental health services. Teams work with people in their own homes and communities, reducing some of the stigma that many right hon. and hon. Members have mentioned. If we can treat people in their home environment, they will not have to be removed for the whole time to an in-patient setting, where it can be more difficult for them to make a recovery and where things can be more difficult for carers and families. There are also 14,000 extra staff working in mental health services, which, again, has made a difference.
It is also true, however, that mental health services in some areas have been asked to make a contribution to ensure that the overall NHS budget is put on an even keel. However, I should say two things about that. First, I have been absolutely clear that mental health services should not be asked to make a higher contribution than any other services in an area. For
example, if other trusts or primary care trusts have been asked to make a top slice of 3 or 5 per cent., mental health services should not be asked to do anything disproportionate, unless they, for example, contributed to the deficit in the first place. I am more than happy to take up any cases in which people think that mental health services have made a disproportionate contribution, and we have pursued every case that hon. Members have brought to my attention.
Let me add, however, that we have raised the profile of mental health services in recent years. They are no longer a Cinderella service, although they can be prey to raids on budgets if the NHS is not in overall financial balance. Many people who work in mental health services tell me that it is important for the NHS in their local health economy to be in financial balance because mental health services might suffer otherwise. Overall, therefore, mental health services staff want us to ensure that budgets are properly balanced so that they can plan services properly in the longer term.
Let me move on to some of the specific questions raised by the hon. Member for Twickenham. On GP contracts, we are developing quality and outcomes framework standards so that GPs can recognise and refer cases of depression and anxiety to the new services as they become available. Therefore, we are looking at issues relating to GPs, who play an important role. The new graduate workers who have been working out of GP surgeries have also been extremely important in delivering some of the psychological therapies that everybody has mentioned.
The hon. Gentleman also talked about the importance of multi-agency working and of looking at issues such as sheltered housing and social services support. The Government have tried to ensure that provisions such as local area agreements assist in that process and enable mental health care services and local authorities to pool budgets and staff in certain instances. In that way, they can provide the necessary support, which, as he rightly says, is extremely important for securing co-ordination at local level.
I pay particular tribute to my right hon. Friend the Member for Oxford, East, because it was his personal commitment that made some of the pathways to work projects so successful. There was a great breakthrough in considering the link between employment and mental health. There are too many instances in which, even if people did not start their unemployment because of a mental health problem, a mental health problem develops because of the stigma, discrimination and low self-esteem that accompany unemployment. Pathways to work projects have been important in that regard, as has consideration of how to get better links with jobcentres.
Dr. Pugh: People in the DWP have told me that, when they are successful in getting people off disability benefit and back into work, the savings for the Department revert to the Treasury and are not reprocessed into doing more of the same—not even a proportion of them. Is it worth investigating ways to incentivise those parts of the DWP that get people back into work after mental health problems, so that they do more?
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