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Even with all that effort, there are some things that we have not sorted. I have a friend called John, whose daughter Alex is just about to take her finals at Liverpool university. She needed a cognitive behavioural therapist—a matter that I have raised in the House before—but it was impossible for her to get that service. For much of her time at university, she struggled on the edge of being able to cope. Happily, she has pulled herself through, but she had months of waiting before she could be properly treated.
I am conscious that we are bidding for more funds, and I make a special plea again for universities and colleges to be given the services that they need, so that young people do not have to wait so long. They are often at their most vulnerable in their late teenage and early adult years—girls as well as boys, although it is apparently more common for boys. Their whole future careers may depend on securing the help that they need.
My brother is a psychologist who works for the Government, specifically in the area of the armed services. He is part of the NHS services for the armed forces. However, we know from what happened at Deepcut and from other experiences that it is vital for the armed services and those in front-line jobs to have the proper back-up services that they need. I hope that in the bids for future funding, when we talk about defence budgets, we will include the facilities needed for all those people, whether they are serving abroad or at home, to have the necessary mental health support.
I hope that we get work force planning right. I accept what the Minister said about there being more psychologists, psychiatrists, and psychiatric and mental health nurses, but we have not been great in nurse work force planning over the last 20 years. We have not been great at doctor work force planning in the NHS either. We need to ensure that we have the people—and we need to include alternative therapies, too. I very much hope that the answer to the question that the Minister ducked is that a bid has been put in for more money for mental health services in the comprehensive spending review.
I want to end where I began. Last week, I attended a meeting at the Camberwell leisure centre, where the community was united in calling for a deferral of the decision to close the Maudsley’s 24-hour service. That was the united view of the communities across the political parties, and across both local councils. We have the best service in Britain, in the best mental hospital in Britain, in the area that has the most psychotic illness in Britain, not least because my community in Southwark—like that in the constituency of the hon. Member for Hackney, South and Shoreditch—has a very high number of African and Afro-Caribbean residents, which is one of the factors that add to the numbers.
I want to end with a quote from an e-mail that I received after the meeting that night, from someone who had been there. No one makes the plea for the Maudsley clinic not to be closed better than he does. He sent the e-mail to my office address at 2.47 in the morning of 4 May. He said:
“Simon,
I don’t know if you will remember me but I am the young man in the blue shirt from the Maudsley meeting. It’s 2.30 in the morning and I am spinning out, and feel in crisis, and the only thing that gives me the strength to hold on and get through this is knowing that in the Maudsley ED, I am not on my own. To know that there is unconditional support, 24 hrs a day, is the strand of
hope that enables me to think there is something to believe in and rely on and trust, and I am not on my own. I can’t express in words how scared I will be without this service and I am not the only one. I have tried to kill myself twice before, and therefore I am at high risk of actually completing this act, and believe me this is the last thing I want. I want to be able to have a normal life, with my partner and 5 week old son, and I feel that this decision to close the emergency department has made this a less realistic target.”
I shall cut to the end of the e-mail:
“When you have a meeting with Ms Hewitt please show her this email, and if ever she has the bottle to meet service users, I’d welcome the chance to talk to her and explain how life is at the sharp end of the stick, and not in plush offices in Whitehall.
Yours sincerely,
Ruben Nedas.”
Here is someone who knows the value of mental health services. I repeat the plea: please do not close one of the most important ones in Britain; the alternative is no substitute.
9.36 pm
Dr. John Pugh (Southport) (LD): It has been a long day, especially for those of us serving on the Mental Health Bill, who have been debating mental health issues for about seven solid hours. However, this does make up slightly for the recent dearth of health debates— [ Interruption. ] I was being ironic.
It is a pleasure to have the opportunity to sum up in this debate. It is not often that the Liberal Democrats find themselves in the position of having the last word and pontificating on other Members’ speeches, declaring them to be powerful or well judged or riddled with absurdity. I shall pass up that chance, however, not simply because I cannot remember other people’s constituencies, but because I want to focus on what are euphemistically called the service users of a service that no one wants to have to use, and on what this debate has shown about their plight. I am sure that hon. Members can accept that they have made powerful speeches without my having to point it out.
Poor mental health is, in its severest form, the most terrible suffering known to man. No one can ever escape the torture in their own mind. All of us enjoy varying degrees of mental health in our life, including stress, anxiety, depression and unreasoning fear—some of us who are serving on the Mental Health Bill have gone through all those stages just today. Too many people enjoy socially disabling and serious mental conditions, and some live an endless nightmare and a living hell, and experience gnawing fear and enduring despair.
Many hon. Members have talked in the debate about the stigma of mental health problems and the need to remove it. The reality is, however, that people who are in poor mental health cannot cope; their minds are in a mess, and people are right to query their ability to act and judge aright. The stigma is going to be properly addressed only by recognising that mental health is not something that we either have or do not have; it exists in degrees, and it varies, like physical health, over a lifetime. If today’s athlete can be tomorrow’s invalid, yesterday’s service users can be the counsellors of the future. A recent confidential poll established that 11 per cent. of Members of this House claim to have suffered mental health problems at some time in their life. Presumably they are coping better now.
Above all we need an understanding, and an education in mental health, for the whole nation. It was pointed out earlier by the hon. Member for North-West Leicestershire (David Taylor) that the media have an important part to play in that. We need to develop an appreciation of the fact that mental illness is not one illness but many, that being mentally ill is not about being dangerous but often perhaps about being too vulnerable or sensitive, that it is not the grossest form of abnormality but all too common, and that the person who claims to be in perfect mental health is possibly the most sadly deluded.
None of this is much about money, although the debate has focused pretty solidly on that at times. Let me say something about money, however. If we were not in our fairly mad world of politics, we would all admit some plain truths. We would admit that the Government’s spending on mental health has increased—we have acknowledged that, although it may not be in the motion—but also that spending as a percentage of total health spending has gone down, which is in the motion. We would admit that there have been forced cuts in mental health spending, as well as top-slicing. As a number of Members have pointed out, the budgets are easy to adjust. Service users are slow to complain when they do not receive their services, because they are slow to draw attention to their condition and how it is being dealt with.
We would also admit, honestly, that some exciting initiatives have been financed. The Minister mentioned computerised cognitive behavioural therapy. What the Minister did not mention, however, was that funding for children’s services has risen by only a paltry 4 per cent., and needs are growing by the day. Moreover, there is consensus across the Chamber that there is a problem with black and ethnic minority communities and the way in which the mental health services address their needs.
As has been made clear in the debate, addressing mental health problems means a huge win for society as a whole. Many benefit claimants, including increasing numbers of new claimants—that is quite important—are not at work owing to stress and anxiety. Professor Layard’s work, which has been mentioned frequently this evening, has been very helpful both in underlining that key finding and in suggesting remedies, and there is evidence in my constituency that the Department for Work and Pensions is acting on his comments. More provocative and difficult, however, is his suggestion that social planners should be mindful of the mental casualty rate in modern society, and should plan accordingly.
The so-called happiness agenda is attracting the attention of commentators and politicians alike, and I expect it to feature to some extent in the general election, but it is by no means easy to see how the state can conspire to make its citizens happy. Most states that have tried have failed, or have done positive harm. The pursuit of Utopia normally leads to tears; a more modest goal might be to remove some of the more obvious obstacles to public happiness.
If the Government increase funding, stop top-slicing, encourage people back into work, fight discrimination, increase public understanding, and fight stigma through programmes such as their laudable Salford's Health Investment For Tomorrow, or SHIFT, programme—under which £1 million a year
is being spent on fighting stigma—they will have our support. They will also have our support if they concentrate on providing more good therapies, such as talking therapies, rather than the chemical cosh. However, even according to their own analysis, they should forget about payment by results.
The Department of Health said that introducing payment by results would be “a major achievement”, and that
“we are unaware of any country that has been able to implement this type of system”.
To introduce it to an NHS system that is weighed down, if not crushed, by change seems in itself to be deeply deluded, if not downright pathological. How would payment by results make it possible to encourage doctors to take on more incorrigible cases? Why would trusts want to devote time and money to expensive talking therapies as opposed to simple drug prescription? How would it be possible to encourage the more imaginative therapies that involve families, use art and drama, and so on? I think that the Government should put payment by results on the back burner, and leave it there.
The Minister did not talk much about our motion. Let us consider it now. Little, apart from its origin, should prevent all Members from voting for it. Do we not all recognise that there has been historic underfunding? Do we not all acknowledge the burden of mental illness on the benefits system? Is not the top-slicing of budgets a fact, and have not the Government promised that the budgets will be reinstated? Are not age-appropriate settings a problem? All that is in the motion. Did not the Select Committee on Health warn that cuts in mental health provision were dangerous? Are we not all for expanding therapy services?
Were we not in this particular institution, which has its own eccentricities, and indeed delusions, we would all agree and go home—but the Chamber is, after all, a peculiar place. It is one of the few places where it is not considered odd to be standing up talking at length to oneself. So we must divide, but before we do so, let me break my initial resolution and congratulate my hon. Friend the Member for North Norfolk (Norman Lamb) on a powerful speech. He drew attention to lack of equity of access—a charge that was not rebutted. He also drew attention to long waiting times—another charge that was not rebutted—and to genuine, although not universal, cuts. Again, that charge was not rebutted.
In the spirit of co-operation, I congratulate the Minister on surviving the day with customary charm and cheerfulness, although also with a peculiar and understandable obsession with amendments to the Mental Health Bill. Finally, I congratulate the hon. Member for East Worthing and Shoreham (Tim Loughton) on his combative manner, and on his marshalling of facts—and on surviving the day as well. I cannot for the life of me see why they should not all vote for this very sensible motion.
9.45 pm
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis):
Whatever our differences might be on a range of issues, the subject of today’s
debate should unite Members in all parts of the House. Mental illness is the unspoken, eerie reality that touches many more families in our society than we will ever know. It can be short term or chronic, and affect young and old, affluent and poor, and black and white. It has the capacity to destroy lives—not only those of the individuals with the illness, but those of family members who frequently feel lonely and lost as the person they love changes into a stranger in their midst.
At the beginning of the 21st century, mental illness remains a great stigma, as Members of all parties have said. It is possibly the greatest stigma. To some it is a sign of weakness, to others a source of shame. For far too many, it is a barrier to the life chances and economic activity that most of us take for granted. If we are frank, it fuels fear, sometimes based on ignorance, sometimes on prejudice and sometimes on reality.
The closure of many psychiatric hospitals in the 1980s and ’90s represented progressive policy which, sadly, was undermined by inadequate investment and support. By their actions, the then Tory Government tainted community care when, in a modern society, it should have been a beacon of individual human rights and collective civilisation and advance. As has been demonstrated in the debate on the Mental Health Bill, there has been through the ages, and there will always continue to be, a debate about the balance between the human rights of the individual and public protection, between the needs and wants of the service user and the views of family members, and between those whose focus is on the virtues of medication and others who stress the centrality of general well-being.
Balance is important in this debate. Beyond the patient is always a person with emotions, experiences, dreams, aspirations and fears—like the rest of us. Beyond the carer, is a mother, father, husband or wife who is confused, scared, lonely, perhaps hopeful, and sometimes optimistic. Beyond the victim is someone whose life has been shattered by someone with the label “mental illness”.
True leadership in this area requires genuine objectivity and a commitment to the following: to attack the stigma that consigns mental illness to the “underground” of our society; to fight for the voice of people with mental illness and their families to be heard above the general din of ignorance, or of a high-profile case that is the exception not the rule; to ensure that in every area of life, from relationships to employment, individuals have the chance to pursue their potential, irrespective of their illness; and to protect society from those who represent a danger to themselves and others, through health and social care—plus, if necessary, secure accommodation and appropriate treatment.
As Members have said, we as a society have a new phenomenon to cope with: the reality among many of our older population of Alzheimer’s and dementia, which ask new questions of both the health service and the social care system. Those developments reflect a demographic change that political parties that seek to take responsibility and govern in this country must seriously and fundamentally address.
On occasions such as this we must always celebrate the commitment, professionalism and dedication of front-line staff. They are too often the Cinderella of the health service and social care system. They work every
day of the week, often in challenging and difficult circumstances, to enhance the quality of life of people who they know have lots of potential and talent, which historically has often been suppressed simply because of the label that mental illness brings.
I shall now respond to hon. Members’ contributions to the debate. The hon. Member for East Worthing and Shoreham (Tim Loughton) presented his usual humble and gentle self in the course of making his argument. We disagree with his claim that the proportion of overall health spend directed to mental health services has gone down under this Government. As for the record of the Government he supported, where I come from, a percentage of nowt is not very much. People remember the state in which the Conservative party left the mental health system—a Cinderella service in a grossly underfunded and neglected system—and the chaos and tragedies that ensued as a consequence of the Conservative Government’s control of our national health service.
The hon. Gentleman asked about psychological therapy pilots. In due course, we will look to expand those pilots, and we are making resources available for additional pathfinder sites this year. He and other Members rightly raised the question of child and adolescent mental health services. Early intervention to prevent deterioration in children and young people’s mental health is fundamental. I was amazed, however, that not one Opposition Member mentioned the dreadful state of CAMHS in this country only a few years ago. Significant additional resources and staff have been provided, with a much greater level of multidisciplinary working to bring together psychologists, nurses and professionals of different disciplines and teams. With that investment, at the end of December, 90 per cent. of primary care trusts had achieved the proxy targets that we set to define whether significant progress had been made on CAMHS. We believe that, by the beginning of April, the vast majority will have done so.
David Taylor: My hon. Friend will recall my bringing a delegation of CAMHS professionals from Leicestershire, led by my constituent, Dr. Ingrid Davidson, to meet him just a few weeks ago. Does he remember that their concern was that they felt pushed to the periphery of PCT priorities? As a Minister, how can he encourage PCTs to focus on the CAMHS aspect of mental health in a more positive and productive way?
Mr. Lewis: My hon. Friend did bring a delegation and with those professionals made strong representations about the centrality and importance of CAMHS to the national health service in his area. The message is clear: the progress made in CAMHS in recent years must be sustained; it must remain an NHS priority. The fact that the target has been hit in most areas is no ground for complacency. We must continue the sustained investment and focus on CAMHS. Where sufficient progress has not been made, the message to the commissioners is that they must commission improving services for children and young people.
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