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8 May 2007 : Column 113

After hearing the hon. Gentleman’s speech, I have much nicer things to say about the hon. Member for North Norfolk (Norman Lamb). However, he was disingenuous about the percentage fall in health funding. As my right hon. Friend the Minister said, overall NHS funding increased from £44 billion to £76 billion over the period in which there was the drop in funding that the hon. Gentleman highlighted. However, that drop in funding relates to hospital services. If I have time, I will mention some of the issues surrounding hospital and community services.

The hon. Gentleman also talked about the important issue of the incidence of teenage mental health problems, which we have discussed during our consideration of the Mental Health Bill. However, surely the situation is arising because there is a greater recognition of the problems among young people, for which we should all be grateful. I hope that we can reach a consensus on tackling the situation.

During today’s Committee proceedings on the Mental Health Bill, we had an interesting and informed debate about children on adult mental health wards. Among the Labour Committee members who spoke—forgive me, Mr. Deputy Speaker, if my memory is not entirely accurate at this late hour—were my hon. Friends the Members for Rhondda (Chris Bryant), for Bolton, South-East (Dr. Iddon) and for Stafford (Mr. Kidney). They put it on the record—many of us who did not speak agreed with them—that they were firmly in favour of children not being put on adult mental health wards, but indicated that they trusted my right hon. Friend the Minister following her promise to consider the matter again. They listened sensibly to her comments about why simply accepting the Opposition proposals would cause difficulties. It is easy to make cheap points, but being in government is about delivering real results for children on adult mental health wards, the mental health service users in my constituency and any of us who might need to use mental health services in the future.

The hon. Member for East Worthing and Shoreham talked about the use of mixed wards. I have met mental health service users in my constituency a couple of times. When the question of mixed wards came up during my most recent discussion with them, I was surprised that everyone in the room—men and women from a range of backgrounds—indicated that they were in favour of mixed wards. They said that it meant that their lifestyle while detained was more normal, as they mixed with people of the opposite gender; being segregated and separated added an extra difference to their already different lifestyle while on the hospital ward. That may not be a universal view, but we should listen to the service users. As I have said before in debates in the House, we too often do not hear the voice of the user. We may be here to legislate, but in this debate we should listen to the voice of the user.

Adam Afriyie (Windsor) (Con): Sadly, I am not a member of the Committee that is examining the Mental Health Bill in detail, but I have written many articles and a chapter of a book on the subject of mental health. Is the hon. Lady seriously suggesting that mental health patients would prefer to be in mixed wards with other patients with specific mental health conditions? Is she really suggesting that that should happen? That is certainly not a reflection of anything that I have learned on the subject.

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Meg Hillier: I am not suggesting anything; I am telling the House what mental health service users said to me. They did not mean sleeping in beds next to each other. They meant being on mixed wards, but a mixed ward very rarely means people of different sexes sleeping next to each other in a bay, or sharing a bathroom. They specifically said that they wanted to socialise and mix with people of the opposite gender during their detention period. They have said that to me as their MP, and I think that it is right to pass those comments on to the House.

Tim Loughton: On that logic, does the hon. Lady think that the Government’s boast of having achieved 99 per cent. single-sex wards—that figure is wrong anyway—is a sign of failure?

Meg Hillier: I will not get drawn into a debate about mixed and single-sex wards; I am simply reporting the views put to me by mental health service users in my constituency, and I think that it is important that those views are put to the House. The hon. Gentleman may want to make mischief with that, but I am simply reporting the views of one group of mental health service users to whom I spoke.

It is important to put on the record once again the many challenges that face residents and mental health service users in my constituency. People in Hackney are three times more likely to be admitted to hospital with schizophrenia than people across England as a whole. Some 40 to 45 per cent. of people detained in the City and Hackney mental health services area, mainly male, are from African and Caribbean groups, yet those groups represent only 22 per cent. of the population. Black people in England and Wales are three times more likely than the rest of the population to be admitted to hospital. Overall, African and Caribbean people, and particularly black people born in London, are 10 times more likely to be given a diagnosis of schizophrenia. We know that there are many factors involved in that. Like the hon. Member for East Worthing and Shoreham, I do not believe that the Mental Health Bill will tackle the problem; that is not what the Bill is about. There are many issues that we need to address if we are to tackle the problem. In Hackney, the problem is partly unemployment, but it is also the issue of there being many migrant communities, lots of single people, a high population density and a high turnover of population. People are without the social and support networks that there are in other parts of the country.

The 2006 “Count me in” census survey found that black and mixed race in-patients were 85 per cent. more likely to be detained, and Asian, Chinese and other in-patients were 50 per cent. more likely to be detained than white people. White people made up 43 per cent. of the total in-patient population but only 30 per cent. of the detained population. Black people were 35 per cent. of the total in-patient population, but 46 per cent. of the detained population. To put it another way, rather starkly, there were 50 per cent. more black detained in-patients than white detained in-patients, despite there being more than 24 per cent. more white people. We should all ask ourselves why that is, and we need to recognise in this debate that there are challenging issues. The issue is not about what
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was done by one Government or another, but about service provision, social and health care provision, and tackling the barriers.

I am a race equality champion for the Commission for Racial Equality, and the commission says that there are a number of barriers. It highlights user ignorance, which can be due to language and literacy difficulties—which I often come across in my constituency—cultural differences related to religion, gender and work patterns, or different needs. In some areas, the location of service delivery is a factor. That is probably not so much the case in Hackney, where everything is on the doorstep, but I hear what hon. Members have said about rural areas; I can imagine the many difficulties that are faced there. Again, I stress the fact that many of those problems will not be solved by the Mental Health Bill, and it is not on to suggest that they will be or to conflate the issues. I started to look at the Bill precisely because of my serious concern about the huge impact on many of my constituents of those inequalities, and I concluded that it will not solve them. Nevertheless, it is an important Bill, which is why I became involved in the Committee considering it.

I join my right hon. Friend the Minister in congratulating the crisis and early intervention teams, whose work in Hackney and elsewhere is critical in tackling the long-term, challenging issues that people with mental health problems face. We should reach people before they are admitted to hospital. As I said today in a speech in Committee, more advocacy support is needed for mental health users and patients so that they can access services. I commend my local mental health trust, which is working to make sure that users are better empowered to be their own advocates. The Mind mental health user group meets fortnightly to raise issues directly with everyone from service providers to people such as me, their MP, about what needs to be done. It is right that we should recognise that people are people: they have their own views, and are not just users of mental health services.

Mrs. Madeleine Moon (Bridgend) (Lab): Does my hon. Friend agree that there has been tremendous progress in the past four years in the way in which mental health service users regard their MP as someone who works for them and is an advocate for them? Many people with mental health problems would never have dreamed of approaching their MP before, but the advocacy groups in our communities have given them strength and the belief that, yes, they can move forward and campaign for themselves.

Meg Hillier: I hope that that is the case but, overall, an MP’s role in the life of someone with a mental health problem is probably less useful than the other services to which I have alluded. Clearly, however, we all have a role to play.

Advocacy services in my constituency include Derman, which works with Turkish and Kurdish groups, and plays a particularly useful role in dealing with both language and cultural issues. It helps psychiatrists meet mental health service users in situ with their families so that they can better understand the cultural and familial set-up. The Revolving Doors
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agency is not in my constituency, but it is renowned for dealing with difficult issues and chaotic lives to make sure that people reach services that they might not otherwise reach. The Psychiatric Rehabilitation Association is based in my constituency and was set up in 1959—it is no coincidence that that was when the first Mental Health Act was introduced. The Chinese Mental Health Association, too, is important.

Time is short, so I shall not go into the investment that the Government have put into mental health services. I shall merely put it on the record, as my right hon. Friend the Minister dealt with it. However, I wanted to pick up the issue of incapacity benefit, which was raised by the hon. Member for North Norfolk. He was right to highlight it, because it is an important issue. Hackney, South and Shoreditch is the constituency with the second highest number of incapacity benefit claimants in London, and it has the 31st highest number nationally. In my constituency alone, 7,400 people are on incapacity benefit, 63 per cent. of whom are under 50, which clearly indicates that a significant number of people have problems that are not connected with being old and tired from work, or worn out and disabled in that way. Their mental health problems often stem from other problems such as substance abuse. We need to consider the way in which jobcentres deal with people with mental health issues. The time scales involved in requiring people to return to work and the understanding of episodic mental health problems are often severely lacking. I spoke to a user who told me that if they went along on a good day, the person at the jobcentre would say, “You’re fine. Why can’t you work?” Understanding is not always forthcoming, and we all need to work to highlight the issue and encourage employers in our constituencies to recognise that they can employ someone with a mental health problem, as long as they make sure that they have the right support.

A report by the Office of the Deputy Prime Minister on mental health and social exclusion highlighted the need for services to support people with mental health problems back into employment, and it discussed the need to provide a supportive environment with flexible schedules. In the United States, which is not always a model for good practice in mental health services, a project of individual placement and support programmes succeeded in placing more than 50 per cent. of people with severe mental health problems in employment. It was not rolled out more widely, but it compares favourably with the UK, where only 21 per cent. of people with mental health problems are in employment. That is a shocking figure, and we should all think about it—how can we raise the profile of the problem and tackle it? In my constituency we have Routes 2 Employment, which is a project—the first of its kind in the UK—to help people with mental health problems back into work. It works with employers to ensure that they know how to support such people.

While we are looking, rightly, at putting more into community services, we must not take our eye off the ball of the important and sometimes necessary provision in a psychiatric ward. For some patients, that is the best option. I look forward to community treatment orders, which, interestingly, have received widespread support among professionals and users in my constituency, but we must be careful not to view them as an alternative to proper hospital provision.
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Psychiatrists should not have to release people before they are ready, because that only exacerbates the problems that they can face in the future.

I cannot finish without highlighting the fact that although my local primary trust, City and Hackney Teaching PCT, and my local trust, Homerton University Hospital NHS Trust, have each balanced their budgets in every year since their inception, save for a small deficit of less than 1 per cent. for Homerton hospital in the last financial year—Hackney had its budget top-sliced because a small percentage overall of other NHS trusts did not balance their budgets. Last time I raised this on the Floor of the House, the Minister of State, my hon. Friend the Member for Leigh (Andy Burnham), promised that the money would be returned to Hackney sooner than expected. I wrote to him but I still have no precise date. It may be a tough call to ask him to give me a date here and now, but I am still pursuing getting that money back for Hackney so that we can spend it on, among other things, the decent mental health services that people in my area deserve.

9.21 pm

Mr. Geoffrey Cox (Torridge and West Devon) (Con): Like the hon. Member for North Norfolk (Norman Lamb), I speak from a rural perspective. Not for the first time, I am standing in this House, having just listened to a Labour Member talking about the services available in her constituency, and feeling that I inhabit a different world. The Minister has been very helpful in the past when I have had cause to raise issues relating to different health problems in my constituency. I know from that contact with her and with Ministers generally that they are invariably decent and well-intentioned people. I make no bones about conceding that I am sure that the Government intend to try to raise standards in this field, to promote its profile and to invest in it.

However, I have to say to the Minister, with great respect, that as I listened to her speech I was struck by the enormous gulf between the tone and tenor of her remarks and the urgency of the problems that I experience in the surgeries that I conduct every week in my constituency. These are all real cases. There is the frightened child with anorexia who finds herself in a ward with adults. There is the schizophrenic 19-year-old who will not take the drugs to control his condition and is living at home with his mother, who cannot find help at the weekend as she watches him decline into despair. Does the Minister think that it is good enough to have crisis intervention between 9 o’clock and 5 o’clock at weekends? Those are the hours at weekends when the crisis team operates in Tavistock, in my constituency. Someone who rings up at 10 past 5 will not get anybody at the crisis team and will have to ring DevonDoc, the out-of-hours doctors’ service. When this mother rang up DevonDoc, she was told, “Take him to A and E.” The A and E department is 25 miles away. She received no support at the weekend, and as a consequence, like some kind of fatal unravelling, that young man was eventually sectioned and found himself in hospital.

There is the anguished father whose son is drinking himself to death in front of his young children and an exhausted wife who has patiently tried through love
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and care to bring him round but can find no permanent and sustained assistance in my constituency or in my area. There is the autistic 30-year-old who, after school and college, has received no help, no provision and precious little understanding, and who is beginning to become depressed about the way in which he is treated, isolated in a small rural village. There are the families of autistic children, for whom every day is a battle to secure the education, speech therapy and occupational therapy that their child needs. Sometimes, there is no support even in the basic task of communicating with their children, who are insulated in a world that is impossible to penetrate. Those are the experiences of my constituents. I noted similar experiences of similar problems from the contributions of Liberal Democrat Members who represent rural areas such as mine, some just across the border in Cornwall.

To those watching from a distance in Cornwall and in Devon, the Minister’s speech will not have risen to the height of their problems and daily experiences. They simply do not have the services, or access to the services, about which the hon. Member for Hackney, South and Shoreditch (Meg Hillier) spoke a moment ago. They feel isolated, abandoned and alone. It is not good enough.

My constituents have begun to take into their own hands the power to do something about their problems. I am proud to be a trustee of a charity called “Make a Difference” in Tavistock. It is trying to fill the gap in provision that the service users whom I represent experience daily. It runs a café, a support group and a social network. That provision is barely supported by the responsible trust. Those who use the services and the volunteers who support them, often in their spare time from working for the trust, have taken the initiatives. I am therefore proud to be a part of that and proud of all those who are beginning to construct the foundations of recovery by taking into their own hands the power to do something about their problems.

However, the support for them is not there. The initiatives are the result of good will and voluntary action by people in the community who care. The Bubbly project provides a day centre for those with learning disabilities. Two desperate parents of a child with learning disabilities raised their banner in Torridge, in the part of north Devon that I represent, because day centres there have closed. Integration into community hubs and supported living initiatives have simply meant village halls, pubs and cafés. There is a groundswell of opinion that the policy is not working and is causing a large expansion of mental health problems.

One cannot close day centres, which were centres of excellence, energy and activity, and the hub of a social network for those with learning disabilities, and simply believe that, without providing huge amounts of extra resources for the infrastructure and the communities, there will be no problems. Parents throughout the rural areas that I represent are deeply concerned about the move towards community care and support in the community—it simply does not appear to be there. Those with learning disabilities are deprived of the genuine help that they can get from day centres. The Bubbly project therefore relies on the voluntary action of those who give their time, money and effort to attempt to set up something that should be the county
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council’s responsibility and that of the Devon Partnership NHS Trust, which is the mental health trust responsible in my constituency.

Those volunteer actions show the gulf that continues to exist for those with mental health problems in my constituency. It is not only those afflicted by psychiatric problems, but those with autism—as the Minister will understand—and those with a wide spectrum of mental health and learning disabilities whose urgent problems do not appear to be being tackled, at least in the rural area that I represent, by the Government’s policies.

I urge the Minister, in her efforts to introduce improvements, to examine specifically the genuine problems in rural areas. She mentioned rural areas almost in passing. I hope that she can pay specific attention to access to services, which constitutes a severe problem in the rural areas that I represent.

9.29 pm

Simon Hughes (North Southwark and Bermondsey) (LD): The pleas for better mental health services have come from across the House. We have just heard, quite rightly, about rural areas, and the hon. Member for Hackney, South and Shoreditch (Meg Hillier) represents an urban area, as do I. The whole of Britain has an interest in this subject.

Nobody knows what the exact figures are. The Library tells me that about one tenth of the world’s population suffer from mental illness and about one in six of the population of Great Britain are assessed as having neurotic disorders. The best figure that anyone can come up with is that one in four of us will, during our lifetimes, have mental illness at one time or another. Like, I am sure, other hon. Members, I did not need to become an MP to realise how crucial mental health services are, because I know that from the experience of people among my extended family and friends, and of people whom I associated with at college or worked with. Indeed, we all know the stories of people suffering from mental illness, sometimes with tragic results.

On 5 February, the Minister and I were in our places for an Adjournment debate that I initiated about mental health services in south London. On 12 January, the Secretary of State for Health had taken the decision to close the 24-hour emergency service at the Maudsley. In fact, it should have been closed by now, but its closure has been deferred. I shall return to that subject in a few moments, but I also want to link it to a few further points.

I join others in thanking my hon. Friend the Member for North Norfolk (Norman Lamb) for giving us the opportunity to put this subject on the agenda—and there is no argument but that this subject should appear more regularly on that agenda. I join others in thanking those who work in mental health services, whether in acute services, primary care services or intervention services. Those are all in my constituency: the Chaucer day centre; Guy’s hospital, which has mental health wards; and for people out in the community, the Sainsbury Centre for Mental Health is based there too—not to mention many academics working at King’s College, which has medical and dental schools.

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