Examination of Witness (Questins 180-194)
Ms Camilla Parker
30 NOVEMBER 2006
Q180 Earl of Dundee: But how would you
deal with the concept of well-being, for example? Well-being is
a sine qua non obviously but here it could come to
be a tricky customer. For within a strategy of mental health it
has got a foot in both camps. A man who is mentally ill, wants
to get better, and when he gets better he wants to take on well-being;
yet conversely a man who is not mentally ill also wants to develop
well-being. Therefore well-being itself has a foot in both camps.
However, we are told that a strategy which gives too much prominence
to well-being is going to include 25 per cent of the population,
so there is a dichotomy here. How would you deal with this and
how would you sharpen up on a definition of well-being to help
that strategy?
Ms Parker: I am not sure that at this moment
I could come up with a definition of well-being. What I would
say is that when we are looking at those issues what we are talking
about is prevention and trying to think about how people can really
think about their mental health, in the same way as they think
about their physical health, and the need to ensure that we look
after both. So I think that is important in terms of having a
broad concept. In that context, that works well because it is
trying to almost shift people's attitudes from mental health or
mental illness as being something that happens to other people
and is very scary, whereas if you start thinking about mental
well-being and how that is just as important as looking after
our own physical health, then that might start to engage people
with this concept and have some success in minimising the stigma
and discrimination. I am sorry, but I do not think I can come
up with a definition of well-being other than to put it in those
broad terms as to why I think it would be useful to have that.
Q181 Earl of Dundee: Those broad terms
that you have just expressed could be very useful in helping a
definition or clarification come into being. Perhaps one does
not have to think of particular definitions necessarily; what
we want to achieve is a good direction to the strategy.
Ms Parker: Yes, absolutely.
Q182 Earl of Dundee: What you have said
might be very helpful I should have thought.
Ms Parker: As I said, a concept of well-being
is incredibly important in terms of thinking about how we can
promote mental health and how we can ensure that people are more
willing to seek help at an earlier stage because they recognise
that as being important. We would minimise the stigma so that
that enables people to feel less uncomfortable about seeking help,
so looking at it from that point of view, a broad term of mental
well-being is a very useful one but, as I said, you then also
have to think about other contexts when we are thinking about
the use of compulsion. I would want to ensure that the criteria
are really tightened up in that area so that we have much clearer,
discrete definitions in terms of when we would use compulsion,
but that is trying to address something slightly different to
the well-being concept.
Chairman: We had some interesting evidence
last week from MIND about what people had discovered about the
various aspects of our lives that actually contribute to our feeling
of well-being. There was some interesting evidence and I am sure
you will find it interesting when the report comes out. However,
I am not going to distract us by going down that path now. Lord
Moser, we are talking here about people with learning disabilities
and the grouping of them with people who have mental health problems.
Q183 Lord Moser: In a way, it is the
same definitional problem once again. I have to confess ever since
we have started on this inquiry I have been totally uncertain
and confused as to what is in and what is out (and Professor Knapp
will presumably in due course tell us what the answer to that
is) so I was very surprised that in the Green Paper learning disabilities
make an appearance. This is a field that I used to have some connection
with so I know a little about learning disabilities, and I know
very little about mental ill health, but I find it very difficult
to understand—and you did mention learning disabilities
a moment ago—whether our inquiry deals with learning disabilities.
I do not believe it does. Within this context what is interesting
is whether from the human rights point of view these are two related
things that interest you and, if so, why?
Ms Parker: Yes, I would agree with you that
that is one of the areas where the Green Paper is not clear whether
it includes people with learning disabilities or not. I think,
on balance, I would like to see learning disabilities included
in that, and that again really goes back much more to thinking
about this being a strategy for Europe. It seems to be the case
that in some countries there is insufficient distinction between
the two groups, people with mental health problems and people
with learning disabilities, and indeed in some countries institutions
house both, so from a human rights perspective and from a European
perspective I would suggest that it is important to have both
groups in the strategy because both groups are the most marginalised
of an already margionalised group of people, ie people with disabilities.
I think it is really important to have something in the strategy
to recognise that those two groups of people do face very severe
human rights abuses, going back to the point about institutions
and being placed in institutions, such as the stigma and discrimination
that they face and the problems that they would have if living
in the community in terms of being able to work and to make a
whole range of decisions that many of us take for granted such
as the right to vote. So there are a whole host of human rights
aspects that are similar for people with mental health and for
people with intellectual disabilities. If I may go back again
to a European concern particularly for Central and Eastern Europe,
in many of those countries they have a system of guardianship,
which is nothing like our guardianship under the existing Mental
Health Act. It is about people being deemed to lack capacity,
and in some cases they are deemed no longer to have a legal entity
of their own. A guardian is appointed who then will make a whole
range of decisions on that person's behalf. Sometimes that might
be agreeing that the person goes into an institution. Another
example would be the barriers to employment that those people
who are placed under guardianship face. There is a lot of confusion
in many of the countries about whether or not someone under guardianship
can actually work or whether the guardian can agree to them working,
and clearly that is a major barrier for people who are subject
to guardianship to then go back into the community and actually
enter into employment. So I think there are very major barriers
that both groups face in terms of human rights abuses and also
being included in the community, which I think it would be very
useful to recognise in a strategy such as this. That is not to
say that their needs are the same but in terms of the barriers
I think they are similar.
Lord Moser: The last thing I wanted is
to argue with you but I found this rather confusing. From our
point of view, in my view at least, the more specific we can be
the better. What is true is that learning disabilities are disabilities,
so are mental health disabilities, so are a million other things.
What they have in common is that they are disabilities, but that
is no reason for including them. Secondly, it is obvious to me
that some learning disabilities are caused by mental ill health,
but so are many other things. It is again no argument for including
them because they are an effect of mental health. Most learning
disabilities that I know about have nothing whatever to do with
mental ill health, such as dyslexia which is the most common learning
disability. So I understand what you are saying but I still do
not understand really why it makes sense, certainly from our point
of view, to be all inclusive. However, I think I had better leave
it at that as just one reaction.
Q184 Baroness Howarth of Breckland: I
am just trying to get a greater clarity on this one. The learning
disability lobby in this country would argue very fiercely that
to include people with learning disabilities—and I mean
with the more severe learning disabilities than the ones Lord
Moser is talking about—is contravening their human rights
because they are not mentally ill. They might be mentally ill,
like anybody else might be mentally ill, but they are not mentally
ill per se. However, I understand what you are saying,
that people are already lumped together in other parts of Europe
and we have a different position here. I just wondered in terms
of taking a EU perspective in trying to deal with that issue whether
you had a way of taking that forward because it is quite a polarised
situation.
Ms Parker: I agree, it is a very difficult one.
On balance, I would suggest at this point (and because it is Europe
we are looking at) it would be good to have learning disabilities
within that strategy. Equally, I recognise the reasons for not
doing so because we are talking about a different group of people.
Going back again to the European aspect, one of the other concerns
I have about this strategy is that it does not seem to me to relate
as strongly as I would have hoped to the work that other parts
of the European Commission are doing on disability generally,
ie the Disability Unit and the Disability Action Plan, which very
much promotes the concept of independent living and access to
social care and support, which I would want to see including people
with mental health problems. However, it may be that people from
the learning disability sector would much prefer learning disabilities
to be placed within the Disability Action Plan. I would not have
an argument with that. I suppose my only point is to really ensure
that we all recognise what happens in relation to institutionalisation,
affects people, whether they have mental health problems or whether
they have learning disabilities, and this is what happens to people
in some parts of Europe, and to try and address that. If people
feel it would be far better to do that within the Disability Action
Plan, I would be very supportive. I just do not want them to be
left out, and that is what happens too often with people with
learning disabilities.
Q185 Baroness Neuberger: You have partly
answered the question about stigma and you have made it clear
that some understanding of the human rights of people with mental
health problems, if you actually have a human rights base for
understanding that, it might help them integrate better into the
community. You have certainly argued that making a statement of
the principles would make that very clear. Do you think there
is something else more specific that could be done within an EU
platform, particularly when you look at the issue of employment?
Do you think there is something more specific that could be done
given the difficulty of reporting across Europe and the difficulties
of people with mental health in getting and indeed staying in
work?
Ms Parker: I think that would be a very useful
area of work for the platform to look at, because I think there
is a will to try and make changes across the board. If we could
look at something as specific as employment, that could really
engage people and get people thinking about how we can move forward.
One example we do have is the European Directive on employment
which should already have been transposed within states' legislation
ie, they have taken the Directive and they now have legislation
which incorporates the requirements of that Directive. Where I
think it would be very useful, and could be a specific piece of
work for the platform to look at, is whether the legislation within
each country does, first of all, take on board the Directive and,
more specifically, does it ensure that people with mental health
problems are covered and then what is happening in terms of reasonable
accommodation, this concept of enabling people to get into employment
and getting employers to work with the employees about how to—
Q186 Baroness Neuberger: You mean that
flexibility?
Ms Parker: Yes, reasonable accommodation. Often
people think of it as making buildings accessible to people with
physical disabilities. Where it is more difficult, and obviously
from our point of view very important, is to think about reasonable
accommodation in terms of flexibility for people with mental health
problems. I think that would be a very useful piece of work for
the platform to discuss and engage in and come up with some very
clear ideas for helping employers to do that and ensuring that
individuals are aware of their rights and can seek to work with
employers in ensuring that there are more flexible working practices,
so I think that would be a very useful piece of work to be done.
Q187 Baroness Greengross: Obviously we
are a very diverse society from an ethnic minority point of view
but also in terms of age and gender and so on, and different groups
of people have different experiences. So what do you feel are
the most important things that the strategy should include to
cover those differences or should it just be one general strategy?
Ms Parker: Certainly in terms of looking at
the different groups that you might want to be thinking about
in terms of the mental health strategy, I think it is absolutely
crucial that we look at children and young people. Again just
looking at what is happening in the UK, I think there are figures
suggesting one in 10 children develop mental health problems,
so that is something that we do need to be taking seriously. If
you get into young people in care or in custody then those figures
rise very steeply, and that is something that should be of concern
to us. Again, I think looking at it from a European perspective,
we see children and young people placed in institutions, and that
is something of serious concern. That is because of a whole range
of things but one of the reasons is there is no support for parents
for caring for their children in the community. Women—yes
we need to look at that group in terms of mental health, but again
then you start having a very long check-list. Equally, we should
be aware of the issues relating to men and mental health and the
high rates of suicide we see, and I think that is across Europe.
Certainly there is a high rate of young men in the UK who take
their own lives under 25. While I am obviously conscious that
we could have a very long check-list, I think somehow within the
strategy there does need to be some recognition of the particular
issues that relate to particular groups. If we could do that in
a way that is manageable then I think that would be a very useful
point to include. Also in terms of ethnic minorities, again knowing
the situation in England where there is a high proportion of young
black men who are placed in hospital, often in seclusion and such
like, thinking about that as something that we do need to look
at and think about what is happening and how can we address that.
There are various areas that I think could be usefully highlighted
within a strategy, but clearly what that needs to do is highlight
those as issues and then really help states to look at what is
going on in their own particular country and think about what
is important to them. That is why, going back to the platform
and participation, it is going to be really important to involve
stakeholders because we are talking about a European strategy.
In order for this to be meaningful, it then needs to be carried
forward into each country and people need to take those points
seriously and work to address the areas of concern that have been
identified.
Q188 Earl of Dundee: It certainly does
and you mentioned young people in prison but generally the prison
population and their human rights and indeed the strategy for
people in prison with mental health problems is obviously a priority,
or should be, but how do you feel this issue should be addressed?
Should it be a specific area of concern? Should it be dealt with
in terms of human rights?
Ms Parker: Yes, it is an area of concern and
I think it should be in the strategy. I know that it is a serious
concern in the UK; I am not so aware of what the situation is
in other countries, but I suspect that we would find (if there
was any work around) that it is a similar concern in other countries,
so it is something, if that was the case, that needs to be addressed
both at national level and also within the European strategy.
From a human rights point of view, I think there would be questions
around how appropriate it is to place people with mental health
problems in a prison environment and should there not be a more
appropriate placement for those people, thinking about the adequacy
of care for prisoners and whether that is something that we do
need to address. I think work is going on at the moment to look
at what is happening within our prisons, but I think more can
be done and, as I say, from a human rights perspective one would
challenge whether or not people with severe mental health problems
should be in prison at all.
Q189 Chairman: A point which occurred
to me is if you start talking about specific groups with specific
mental health problems, is there a danger that the whole group
gets stigmatised? I have been driving through the streets of London
regularly and it is remarkable how often you see people from a
Caribbean background behaving in peculiar ways in the street.
I do not want to say more than that because I do not know what
the basis of their behaviour is. I have certainly seen a couple
of people who seem to me to be suffering from some kind of mental
disorder. You could see it, could you not, in the Daily
Mail "Persons of Afro-Caribbean background are much more
likely to have mental health problems than the rest of us",
and that could be used in a stigmatising way. I know you have
to treat people and it is a useful way of concentrating the mind
on where resources and action should be targeted, but how could
you escape from that kind of response in the general community?
It is a hard one, is it not?
Ms Parker: I think probably it is trying to
go back again to this idea—well, it is not an idea it is
factual in terms of one in four people may have mental health
problems at any time in their lives. I suppose the starting point
is trying somehow to get across that this is not something that
happens to "others". Any one of us or people one is
close to could develop mental health problems but that does not
mean they are no longer a person. It means they are having to
deal with some crises and could be very distressed, but they are
still a human being. How can we get that across, but then also
recognise that there are particular groups within our society
who face, on top of that, particular discrimination? I think that
is where when we are going into discrimination in this sense.
We should recognise that, again, we are all human and somebody
may face discrimination on the basis of their disability but they
may also face discrimination on the basis they are a woman or
on the basis of their sexuality, and it is recognising that people
can face multi-faceted discrimination and trying to work on a
basis that what we need to do is respond to individual needs,
not make blanket decisions and not have prejudice against people
because of, for example, their background, the colour of their
skin, or the fact they use a wheelchair. I am not sure I am answering
your question.
Q190 Chairman: I understand what you
are saying.
Ms Parker: It is a very complex question and
it needs to be unravelled how we all perceive each other and,
coming back to the human rights point, how we need to respect
each other as individuals.
Baroness Howarth of Breckland: And it
could be that black people are more noticeable because we notice
them.
Chairman: It could be that; I am simply
reporting an experience I have had.
Q191 Baroness Howarth of Breckland: It
leads neatly to my question because those are issues about how
we improve knowledge and understanding about mental health generally
in the EU context. It is said this might provide a considerable
opportunity for looking at knowledge right across the spectrum.
You have talked a lot about gaps and about things that we do not
know. If you had the opportunity to say what type of information
you would think was currently most deficit, what do you think
would be the priority for the EU? If you had a research budget
what would you spend it on?
Ms Parker: Top of my list would be looking at
how to develop best practice and disseminate best practice in
relation to the transition from institutional care to community-based
services. I think that is essential. Again, I am looking at it
from a European perspective. It seems to me that even when there
is a will on governments' part, there may be a lack of expertise.
This is a really huge transition, and in the UK we took a long
time in achieving that transition. I think trying to engage with
governments and share expertise, share learning, and again I would
like to stress that we have not got it all right in this country
and so it would be very much an exchange of information, but if
we could do something on that and really assist that shift, I
think that would be a very valuable and important piece of work.
Q192 Baroness Howarth of Breckland: You
are one of the few people we have had before us who has mentioned
children and young people. It happens to be my passion in mental
health. The transition for them is very different to the transition
for adults because it involves alternative forms of care other
than just accommodation and support; it involves good parenting
issues. How would you see the European Union getting into best
practice in those areas? We are not very good at it even here,
where we are putting young people into prisons with all of the
effects that has on them.
Ms Parker: Again, I guess my starting point
would be about exchanging information and best practice, and you
could have another piece of research looking at what is going
on in other parts of Europe and what is working and what is not
working. I certainly would agree with you that in this country
we have very serious problems at the moment in terms of ensuring
that children and young people who develop mental health problems
get services early on. Too often, things are left until they reach
crisis point. I realise I said that about adults but I think it
is a worse situation for children and young people. I think the
gap is the transition between children and adolescent mental health
services and adult mental health services. My understanding is
that for a lot of young people they find that they are not considered
to be eligible for adult mental health services and they get left
without support. From a legislative point of view there are also
issues around the Children Act 1989 and then looking at the community
care legislation that we have and again whether agencies such
as social care services are willing to take on and engage with
young people who perhaps received services as a child or young
person and then the question is are they eligible for support
as an adult. I would not pretend to be an expert on that, but
it does seem to me that is another area that we are struggling
with, and it would be interesting to find out whether other countries
in Europe have similar problems, and perhaps some of them might
have solved some of those very difficult issues.
Q193 Chairman: It is a question of different
models of mental health care provision and that is one of the
things we might find out more about and, as you say, the transition
between one model and another is always difficult in any health
care system. We have had this in other parts of the health care
system, so that is complicated in itself, to say nothing of the
funding problems of the transition, which is usually very expensive.
I think that is interesting. I think we have one last question
which is like asking you to reinvent everything you have said
really because what we are asking is how you view the human rights
issues surrounding the Government's intention to update the 1983
Mental Health Act. When we were looking at this question before
we started I suggested we might ask you to give a one paragraph
reply and if you wanted to write another 15 paragraphs, or whatever
it was, we would be very happy to have that from you. Some people
sitting around this table are just beginning to struggle with
this as it is just coming into the House of Lords now and we had
the second reading this week. So what do you feel about that particular
hot potato?
Ms Parker: I guess on the whole it is quite
disappointing that we have reached this point after many years
of consultation and people are still very unhappy with what is
being proposed. We have got a slimmer bill but it is not that
slim and I think many people are really very disappointed with
the fact that the proposals that have been taken forward are not
the ones that many people working within the mental health sector
would want. A lot of the good points of the draft 2004 bill have
been dropped, such as advocacy. Again, picking up on children
and young people; that is a huge concern in that there are no
safeguards, whereas there were at least some safeguards for children
and young people before. In terms of one of the core proposals,
the community treatment or supervision orders, this is something
that raises for me quite a lot of concern, and I think it is really
about how that would be put into practice, and I think in terms
of human rights how that would be implemented. I realise I am
repeating myself but I guess for me what is really crucial is
ensuring that people have access to the services that they need.
This Bill does not do that, the Government is very clear that
it does not do that, but that is where I think we could usefully
do more, given our focus, and I think in terms of human rights
that is something that will need to be looked at in closer detail,
particularly in relation to the implementation of the Act. I know
the Government has brought in some revisions that pick up on areas
that have been shown to be contrary to the European Convention
on Human Rights, and to that extent it is welcome but I am concerned
that this is not really going to address the real needs of people
with mental health problems.
Q194 Chairman: Thank you very much for
a very interesting evidence session. I think we have been very
lucky with all the people who have appeared before us so far,
and you are certainly one of a rather a distinguished group and
you have given us a lot of meat to think about. As I say, if there
are things that you wish you had said or things that you feel
you would like to say when you get back to your office, as it
were, do not hesitate to write us a letter and we can add that
into the evidence. Meanwhile on behalf of the Committee I would
like to thank you very, very sincerely for what you have given
us here this morning.
Ms Parker: Thank you very much for giving me
the opportunity to speak to you.
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