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Let me deal with the areas to which I referred. Although real-terms spending has increased, the proportion of NHS spending given to mental health services has fallen from 14 per cent. of the total spend in 1997 to 11 per cent. today. I appreciate that the situation presents real challenges, but I am trying, in a mature way, to point out that at a time when concern about the need for mental health services is rising and there is an increased prevalence of mental health problems in our society, we should collectively be worried that the proportion of total health spending going to mental health is going down. For example, the mental health of children and teenagers in this country has declined over the past 30 years, although, interestingly, the prevalence has remained relatively stable in other areas. The Nuffield Foundation has found that the prevalence of behavioural problems has doubled over 25 years while that of emotional problems such as depression and anxiety has soared by some 70 per cent. It is especially striking that the prevalence of mental health problems has increased at a time when economic conditions and physical health have improved. It appears that this is the emerging health problem of our age.
Meg Hillier (Hackney, South and Shoreditch) (Lab/Co-op): I am interested in the hon. Gentleman’s comments about the figures on the prevalence of mental health problems among teenagers. Is he suggesting that such problems have increased by the amount that he mentions, or has the recording of problems among people of that age group increased? Also, what would his party do to increase funding for mental health? Which area of health funding would he take the money from to increase funding for mental health?
Norman Lamb: The hon. Lady makes a fair point; in part, the increase may be down to an increased recording of problems, but certainly the Nuffield Foundation concluded that there was increasing prevalence. I am not here to suggest any simplistic solutions. If there is an increase in the prevalence of such problems among teenagers, I should have thought that we could agree, across the parties, that we all ought to try to address it.
Chris Bryant (Rhondda) (Lab): Will the hon. Gentleman give way?
Norman Lamb: I have tried to be generous in giving way, but I would prefer to make a little progress. I will perhaps give way later. I shall come back to the issue of teenagers later, but surely it is tragic that youngsters often do not get access to the support that they need. We know all too well the price that we pay, and more particularly that they pay, if they do not get effective early intervention. We need only look at the problems in our prisons and consider the fact that 80 per cent. of women in prison suffer from mental health problems. That is quite apart from the reduced life chances, in terms of education, for youngsters who suffer from mental health problems in their teenage years.
The second and related point is that despite the increased investment, which we acknowledge, we have a long way to go if we are to ensure consistent access to high-quality services across the country in both rural and urban Britain, and for all sections of society, including ethnic minorities.
Mr. Jim Devine (Livingston) (Lab): I am grateful to the hon. Gentleman for giving way; he has been very generous. He talks about access. I was part of a primary care psychiatric team in a previous job, and I was allowed to admit and see patients. Why does his party support giving that role back to doctors? If the role is given to the whole mental health team, that would deal with the issue of access.
Norman Lamb: I am not sure that what the hon. Gentleman says is entirely accurate, but I note the point that he makes, and I take it seriously. He obviously speaks from experience.
Julia Goldsworthy (Falmouth and Camborne) (LD): My experience contrasts completely with that of the hon. Member for Livingston (Mr. Devine); outreach teams have real difficulty reaching people. A friend of mine had a daughter who was suicidal. That daughter was at home and in serious danger of injuring herself—she subsequently committed suicide—and her husband, who also has mental health difficulties, was told to try to restrain her for a minimum of two hours, because that was how long it would take to send someone out, as a shift change was taking place. That is the kind of difficulty that is being faced on a day-to-day basis. There is a real difficulty in terms of capacity.
Norman Lamb: I am grateful for that telling intervention. My hon. Friend tells an incredibly depressing story about her friend’s circumstances. My experience is of North Norfolk, a very rural area. For people with mental health problems who live in a village, the support that is on offer is often threadbare or non-existent, and the sense of isolation is very real. That experience is common to many parts of rural Britain, where people who suffer mental ill-health have problems accessing support services.
There is clear evidence of unequal access to services for ethnic minorities. The Sainsbury Centre for Mental Health concluded that investment in community-based services would free up millions of pounds that is currently spent on African and Caribbean people in psychiatric hospitals and secure units. Such people are six times more likely to be in medium-secure units than white people in our capital city. There are all sorts of reasons for that discrimination within health services— [Interruption.] Well, it does amount to discrimination, because those people are far more likely to suffer compulsion than white people are. We need to find the reasons for that and to address the issue. We have to ensure that the early intervention services, which ethnic minority communities often cannot access, are there for them.
The Government have rightly made a commitment to securing race equality in mental health services, but progress has been too slow. There is evidence that mental health facilities continue to be the poor relation to acute services, not just in relation to ethnic minorities, but generally. A Mind survey found dissatisfaction with the state of repair on wards, and the Healthcare Commission found that mental health facilities had markedly poorer standards of cleanliness than acute hospitals. There can be no justification for mental health patients being treated less favourably than patients in any other acute unit.
Steve Webb (Northavon) (LD): To reinforce my hon. Friend’s point, does he share my concern that people with mental health problems often have worse problems with their physical health than people who do not have mental health problems? Their mental health problems often mean that they do not access physical health services, and that reinforces the disadvantage that they already have.
Norman Lamb: There is a clear correlation between mental health problems and physical health problems, and I am grateful to my hon. Friend for reinforcing that point.
One of the most serious continuing failings of mental health services is that services for children and teenagers are too often inadequate. Last summer, it was revealed that the Government’s key targets for children and young people accessing psychiatric care would be missed. In a quarter of the country there is no emergency help for teenagers suffering a psychotic crisis or severe depression. Far too many 16 and 17-year-olds continue to end up in adult psychiatric wards when they are compulsorily sectioned, and I realise that Ministers agree with me on that point. I am sure that we can all agree that that is completely unacceptable in this day and age, but it is still happening.
Meg Hillier: The hon. Gentleman did not have the advantage of attending the Mental Health Bill Committee this afternoon. We heard the Minister of State, Department of Health, my right hon. Friend the Member for Doncaster, Central (Ms Winterton), give serious assurances that the Government would come back to the House with amendments on how to tackle precisely the issue that he mentions. It is a shame that this debate curtailed debate on the Mental Health Bill this evening.
Tim Loughton (East Worthing and Shoreham) (Con): That is not what the Minister promised.
Norman Lamb: I am grateful for the intervention of the hon. Member for Hackney, South and Shoreditch (Meg Hillier). There seems to be some dispute about exactly what the Minister did commit to, but perhaps we will hear from the Minister herself later. I will address the issue of the massive under-provision of psychological therapies in detail later.
My third concern relates to what the Select Committee on Health described last December as the “simply unacceptable” cuts that have resulted from the financial crisis that has afflicted many parts of the NHS. In many parts of the country, valuable support services have been lost, and that has affected some of the most vulnerable members of our society. Rethink has estimated that some £60 million of cuts have been made to mental health services, not as a result of financial crises within mental health trusts, but as a result of primary care trusts cutting block grant funding for mental health.
Mr. David Anderson (Blaydon) (Lab): On cuts, does the hon. Gentleman agree that local authorities are key providers of mental health services, yet authorities such as Newcastle city council, which is controlled by the Liberal Democrats, have deliberately taken the party political decision not to increase council tax above inflation, and have therefore cut social services budgets, including the budget for mental health funding?
Norman Lamb: I said earlier that I hoped we would all take the view that the issue was too important for cheap political point-scoring. My concern is about the funding of mental health services within the NHS; that is what the debate is all about. I want to raise a specific and important point about the impact of payment by results. In a survey by the Sainsbury Centre for Mental Health last year, two thirds of mental health trusts said that the introduction of payment by results for acute services was causing a diversion of funds from mental health. Acute trusts are now incentivised to do more work because of payment by results—payment following patients—but that does not apply in mental health services, and primary care trusts therefore seek to make savings elsewhere. Mental health is exactly the sort of soft target, which the Select Committee on Health identified in its report last December, that has suffered cuts as a result of the crises experienced by many PCTs. The Committee was right to criticise the impact on soft targets such as mental health. Surely, it is unacceptable that people suffering from mental health problems should pay the price for financial crises in the health service.
As for my own experience of the impact of cuts in Norfolk, the mental health trust has suffered a cut in funding from Norfolk PCT. Recently, I met some GPs who told me that they had referred a number of youngsters so that they could receive mental health support such as anger management, cognitive behavioural therapy and so on. In each case, they were told that there was no service available for those people. They said that the situation was the worst that they had ever experienced in their time working as GPs, which is surely a cause of concern. The Heron coach was a wonderful initiative that provided a movable drop-in service for people in rural North Norfolk. It moved around rural areas during the week, providing a local access point for people suffering from depression, anxiety and so on.
I was looking at the internet today, and I discovered that in 2003, the mental health trust lauded the initiative as something that provided services to people in remote rural areas. In 2006, the service was lost because of the cut in funding, again making people in remote rural areas more isolated. I remember a woman who came to see me in my village advice surgery last September. She had struggled just to drive up to the village in her car, and she was at a loss to know what she would do without the support of that service, which had provided such valuable support until then.
May I move on to the fourth issue that I wish to raise—the economic impact of mental health problems for both the individual and society, and the need for Government Departments to work together much more effectively to ensure that resources are used to optimum effect? May I respond to interventions from Government Members, by saying that to a large extent that is about using resources more effectively, rather than simply increasing them? Lord Layard focused on that in “The Depression Report” last June. He highlighted the waste of talent and the loss to the economy of the extraordinary numbers of people who are left stranded on incapacity benefits—people who could be successfully treated but who do not gain access to psychological therapies. One million people are on incapacity benefits as a result of mental health
problems, and 30 per cent. of new applicants for incapacity benefits have a mental illness. Half the people on long-term incapacity benefit suffer from depression. Those are extraordinary figures: the human cost is massive, not just for the person suffering but for their families, too, and there is distress and deprivation. For children and teenagers, depression and anxiety often stop them learning, and condemn many of them to limited life chances as a result.
The Minister of State, Department of Health (Ms Rosie Winterton): May I just press the hon. Gentleman again on that point, because he will know that Lord Layard’s report calls for 10,000 more psychologists? Why, therefore, did he vote against the Government proposals to give more powers and responsibilities to people such as psychologists? He voted against that, so I cannot understand how he ties it in with supporting Lord Layard’s report.
Norman Lamb: That is a complete confusion of the issues, and the Minister knows that. It has nothing at all to do with the case for increasing investment to provide the therapies that people simply do not receive at the moment. The Minister does herself an injustice by making that somewhat disingenuous point.
Tim Loughton: May I uncharacteristically help the hon. Gentleman, because the situation is slightly unfair? The Minister mentioned things that have come up in our debates on the Mental Health Bill. The hon. Gentleman may well wish to ask her why she is not prepared to give psychologists the additional powers necessary to enact sectioning in the first place, only to renew sectioning after the statutory period. She is the one who should answer those questions, not someone who has not been privy to proceedings on the Bill in Committee.
Norman Lamb: I am grateful to the hon. Gentleman for coming to my aid. I will be interested to hear what the Minister has to say in response to the point that he made.
Chris Bryant: I wholly agree with the hon. Gentleman’s point about incapacity benefit, and the way in which it weighs down in particular constituencies. In my own area, 21 per cent. of people of working age are on incapacity benefit, more than 50 per cent. of them for mental health reasons. I am concerned about how we are going to raise the capacity of mental health services fast enough to be able to meet demand so that we stop people just popping pills to deal with mental health problems, and provide more talking therapies, as we find it very difficult to fill vacancies.
Norman Lamb: I appreciate the hon. Gentleman’s intervention, and he makes a valid point. Our case is simply that a great deal of priority needs to be given to expanding capacity, because—I shall come to this later—the National Institute for Health and Clinical Excellence itself concluded that we can make a real difference if we can increase capacity.
I want to focus on not just the cost to individuals but the cost to the economy. Layard estimates that the total loss of output as a result of depression and chronic anxiety is £12 billion a year or 1 per cent. of national
income. Despite that, however, people are not receiving the help that they need. What is missing? As I said in response to the hon. Member for Rhondda (Chris Bryant), NICE has issued guidelines stating that psychological therapies should be available to all people with depression and anxiety disorders or schizophrenia, unless the problem is very mild or recent. However, there are not enough therapists, as the hon. Gentleman highlighted. As a result of the inadequate number of therapists, waiting times are often very long—nine months is common—and often there is no therapy available at all, so GPs in those circumstances have no option but to prescribe drugs or to offer no help at all. GPs themselves acknowledge that they over-prescribe drugs in circumstances in which they would prefer to refer their patient for therapy which, however, is not available. Only one in four people suffering from depression or chronic anxiety receive any kind of treatment. That is a scandal in this day and age, and it needs to be addressed.
The Government make much of their commitment to choice in health care, yet for those people there is no choice at all, unless they can afford to opt out. If they can afford to do so, they can gain access to the therapies that we are discussing. We are spending a fortune on benefits, and the economy is suffering a loss of billions of pounds in lost output. Therapies are available that have a proven track record and which are recommended by NICE, yet most people who could benefit and who could be helped back to work cannot get the help that they need. Lord Layard estimates that an effective course of therapy costs about £750, which is about what it costs in benefits and lost taxes every month that someone remains out of work.
I acknowledge that the Government are pursuing pilots—the Minister referred to that in a recent Westminster Hall debate—and that the number of those pilots is expanding, but progress is too slow. Imagine the outcry that there would be if there were NICE guidelines on, for example, cancer treatment that were being ignored across much of the country. There would be an enormous outcry—rightly so—and it would achieve a response. We owe it to people with mental health problems to demand exactly the same response that people who suffer from cancer and other physical conditions can get from their politicians. This demonstrates yet again the extent to which this is a Cinderella service. Implementing the guidelines requires a significant increase in the number of therapists—Layard estimates a figure of about 10,000. It will take time—he reckoned seven years—but he argues that the cost would be totally offset by savings in benefits and increases in tax revenues.
Another area that the Government need to deal with relates to stigma associated with mental health. In New Zealand, a Government programme to tackle stigma appears to have been very successful. They have invested in the job of reducing the stigma of mental illness. Persuading employers to take on people who have had mental health problems is sometimes a significant challenge, but it has had some effect in New Zealand. I urge the Government to look closely at what they have done and to pursue a similar route in this country.
Ms Diana R. Johnson (Kingston upon Hull, North) (Lab):
Instead of looking as far away as New Zealand, would the hon. Gentleman care to look at what is happening in Hull? Mind in Hull runs a project working
with employers to get alongside them and persuade them to take on people with mental health difficulties. It works with employers for a considerable amount of time to support them and the person concerned. That is an excellent example of the voluntary sector working alongside the NHS in the wider sense of mental health services.
Norman Lamb: I am grateful for the hon. Lady’s intervention. She makes a valuable point about the enormously beneficial and positive role that the voluntary sector can perform in working together with employers and statutory agencies, for example to reduce stigma in mental illness. It sounds like an extremely impressive project, and I am grateful to her for alerting me to it.
David Taylor: The hon. Gentleman refers to stigma. Does he accept that there is still a great deal that the national media can do in terms of how they describe and portray the problems associated with mental ill health? It is not that long since The Sun described a crisis that Frank Bruno was going through with the headline, “Barmy Bruno lashes out”, or something similar. The outcry from the population and their readership was such that they had to pull that headline, and later editions of the paper were rather more balanced in tone. Does he think that the media can do a lot more to address the stigma that still exists in society?
Norman Lamb: That is an extremely important point. There is often enormous hypocrisy in the media when they, on the one hand, argue the case for better resources for mental health but, on the other hand, behave in that pretty disreputable way. The challenge is there for all of us to work to reduce stigma, and the media are very much part of that.
We need a renewed focus on mental health. The Government need to remedy the damage that has been done in the past two years as a result of deficits.
Mr. Ivan Lewis: I agree with most of what the hon. Gentleman has said, which is extremely reasonable. However, as he reaches the end of his remarks, the question that he still has not dealt with is where the additional resources are coming from, which taxes will be put up, and which parts of the NHS will be reduced to take account of the additional resources needed.
Norman Lamb: The Minister is suffering from the problem of having left the Chamber for a short while; perhaps he can consult with his colleagues. The argument that Layard put forward is one example of how resources can be better used to achieve beneficial results.
The Government need to remedy the damage done by deficits over the past two years and to acknowledge that and to commit to ensuring that that damage is remedied. They also need to be honest enough to recognise that there is a long way to go before we achieve consistent access to services and choice for people in the treatment that they receive. That must be a priority. The Government have to be much smarter at joined-up government. We can achieve the great prize of helping so many people to get better, helping them back to work, and benefiting the economy by ensuring that they have access to the therapy that NICE recommends. Surely we have a duty to those people who suffer in silence and in isolation.
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