Paul Burstow
I note that the Minister paid close attention to that intervention and I am sure the hon. Gentleman will enjoy the exchange of correspondence on the matter.
I want to discuss the health care aspects of parity of esteem. Curiously, not all general hospitals have 24/7 access to a mental health liaison service offering immediate support, yet we know that when that works well it can make a big difference to the quality of care, help to reduce the length of stay in hospital, especially for older people, and generate savings four times greater than the cost of running the service. There are good examples of where this has been done, particularly in Birmingham, and it is odd, given such obviously compelling evidence, that it has not yet been taken up more widely.
The Minister of State, Department of Health (Norman Lamb)
I completely agree with my right hon. Friend. There is some very good practice, including RAID—rapid assessment interface and discharge—at Heartlands hospital in Birmingham, but there are too many places where there is a complete absence of such services. The starkest aspect of the lack of parity of esteem is that there is a good emergency service—it may be under pressure but it is there—for people with physical health problems but not for those with mental health problems. That has to be addressed.
Paul Burstow
I am grateful to the Minister. Perhaps in his own speech he can say a little more about how we might better incentivise this change. Despite the compelling economic and medical benefits, these services are still not being provided widely enough.
Paul Burstow
The hon. Gentleman makes a good point. Indeed, that has been part of the approach taken in the talking therapies strategy, which is about moving the resource to where it will make the most difference at an earlier stage, and helping to promote recovery in the first place.
The Minister said that the emergency service is a stark example of where parity of esteem has not been achieved, and I want to give another example. The Royal College of Psychiatrists and its president, Sue Bailey, have been looking, on behalf of the Department of Health, at the whole issue of parity of esteem and what practical steps could be taken to address it, and it has recently published work on that. How can it be right, for example, that a recommendation by the National Institute for Health and Clinical Excellence on the availability of a drug is a must-do for the NHS but a NICE recommendation on the availability of therapies is not? This means that evidence-based non-pharmacological treatments that are clinically effective and cost-effective are often left unimplemented. I hope that that bias will soon be brought to an end.
The same can be said for access standards. There has rightly been uproar when even small changes occur in the amount of time people wait to attend accident and emergency departments. NICE has said that a person experiencing a mental health crisis should be assessed within four hours, yet only one in three people is so assessed. I am puzzled by the decision not to set a 28-day access standard for therapy, because the NHS constitution should embody parity of esteem, and that is a tangible way it could do so. Having said that, I take heart from the revised NHS constitution handbook, which said albeit it in a footnote:
“The Mandate indicates that we will consider new access standards, including waiting times, for mental health, once we have a better understanding of the current position. We need to do this work and consider carefully the implications of introducing any new standards, before we can make any firm commitments in this area.”
Why on earth is this problem still not being understood? Why do we need yet more reviews? Will the Minister give an indication of the time scale?
Norman Lamb
We clearly need to understand the scale of the problem of access. It is a bit shocking that we do not know the figures across the country for the number of people waiting and how long they are waiting. The mandate of the commissioning board requires that it must establish that and then set access standards. That is really important work, because there is a legal obligation to seek to meet the requirements of the mandate.
Mrs Moon
The hon. Gentleman is right that a number of universities are doing excellent work in this area. The centre at Oxford has done wonderful research, as have Bristol and Manchester. I have referred several times to King’s college London because of its expertise in defence medicine. I am not denigrating the work that is taking place elsewhere; I am merely highlighting the importance of the work at King’s college London.
The King’s college London research has looked at the importance of decompression, whereby serving members of the armed forces have the opportunity to spend time together and take part in physical activity before they reach home. That has made a huge difference in the mental health outcomes of serving personnel.
Interestingly, the research has identified the groups that are most at risk of problems. They are not those who have served for the longest or most frequently in the armed forces. They are the early service leavers—those who leave the service shortly after their initial training. The risk is higher among those who fulfil combat roles. We forget how small a percentage of our armed forces is made up of people who go out through the gate and pursue combat roles. That work is of great benefit to the military, but it is also important that it is sustained and utilised in our wider understanding of mental health.
I want to talk briefly about TRiM, which is about trauma resilience. It was developed and utilised by the Royal Marines. It trains individuals to identify signs of distress within their own units and within themselves. It means that problems can be identified early on, and help provided quickly. Interestingly, the trauma and resilience handbook that is given to serving personnel and their families provides advice on looking after themselves, talking about their experiences, and how to deal with returning home—coping skills such as dealing with anger and alcohol, combating stress, and sleeping better. It provides tips for spouses, partners, families, friends and parents of returning serving personnel, as well as for the returning reservist. It is a prime example of how we help prepare people for what they are going to experience. We do too little in this country to prepare people for the risks of mental health problems. We do not tell people; we are not educating our young people in how they can identify within themselves, or within their families and friendship groups, some of the risks they will inevitably face in times of difficulty throughout their lives.
I am pleased that the work of TRiM has gained traction elsewhere and been adopted by many other organisations and employers. Even a cursory internet search demonstrated that a number of organisations are using TRiM to help their employers, in particular the blue-light brigades. The police force and Departments including the Foreign and Commonwealth Office frequently train their officers in TRiM.
US research into factors predicting psychological distress among rape victims has shown that initial distress was a better predictor of subsequent psychological functioning than other variables, as well as in the treatment of rape and other types of post-traumatic stress disorder. The use of TRiM and post-traumatic stress disorder management is extending into areas that we had not previously recognised would impact on the general mental health of people in the wider community.
Another area in which the military has taken time to expend its capabilities is the Big White Wall—an online 24/7 early intervention service for people suffering from mental distress. It is free for serving personnel veterans and their families, and as of December last year, 2,500 members of the armed forces community were registered. Seventy-five per cent. of members talked about an issue for the first time on the Big White Wall, 80% managed their psychological distress, and 95% reported an improvement in their well-being as a result of using that service.
There is consensus that reservists are more likely than other serving personnel to experience mental health problems as a result of their service, which is thought to be because when they return from tour they return to civilian life, away from the support network that a regiment offers. Academics at the King’s Centre for Military Health Research, in conjunction with others, conducted a five-year study of 500 reservists who worked in Iraq, which showed that they were twice as likely as regular soldiers to suffer from post-traumatic stress disorder.
Current drives to recruit 30,000 reservists as part of the Future Reserves 2020 programme mean that we will need further research in that area. A number of Members will have an interest in this issue, because reservists come from across the country and live and work in all our constituencies. The most recent figures Combat Stress could give me showed that it had received 1,558 approaches from veterans from Iraq, 123 of whom were reservists. From Afghanistan it had received 752 approaches, including 55 from reservists. With the discharge of large numbers of serving personnel as a result of cuts, I am concerned that high levels of alcohol misuse within the services may be transferred into their civilian life. Service personnel are not a group that readily seek help, and much remains to do in relation to mental health. Our wider society and its services must be ready for the discharge of large numbers of serving personnel into our communities.
Every hon. Member who speaks today will no doubt be aware of the difficulty of working with general practitioners and of making them aware of the mental health services that are available. One problem is that GPs see few veterans. There is a heavy reliance on individuals to make their GP aware of their military service. In 2011, the Royal College of General Practitioners issued guidance to GPs on how to meet the health care needs of veterans, but the onus is on the GP to be aware of it. According to the last figures I have, only 320 GPs had accessed an e-learning package on help to identify veterans with mental health problems. We need to work to increase that number.
Our police forces need to be helped and supported in understanding how often they will come across veterans. Figures show that they are coming across veterans who are dealing with alcohol problems and having episodes of self-harm, which in military terms means looking for fights in which they will receive physical injuries. Alarmingly, a recent independent commission on mental health and policing showed that the Met police have a particularly poor record of dealing with people in mental distress. A quarter of calls to the Met police each year—600,000 calls—were linked to mental health. We need to tidy up the link between mental health and the police.
Norman Lamb
The hon. Lady makes important points on people in the armed forces and veterans. Is she aware of Lord Adebowale’s valuable work and report on the link between police and mental health, which was published last week? It was commissioned by the police and dealt with how to improve the way in which they operate. It is good news that the police were prepared to commission Lord Adebowale’s report and are prepared to listen to his advice.
Mrs Moon
I am very aware of that research; the point I was about to make comes from it. The problem is that we often use the police as our first line in dealing with people with mental health problems, but they are not trained and equipped to carry out that role and function. We must do something about that. Otherwise, the person with the mental health problems is often dealt with as a disruptive element, and treated as if they are someone violent and aggressive, rather than someone who has a mental health problem. We must deal with that problem.
Words and anecdotes can be dangerous, particularly in the military. Research was published this week by the Defence Analytical Services and Advice agency on Falkland veterans. It found that 95 veterans had taken their own lives since the end of the conflict. That figure is lower than previously assumed, although each death is a tragedy for the individual and family involved. The research showed that, of the 26,000 mobilised, 255 died in conflict and 95 took their own lives, but 455 died of cancer. We sometimes forget that our armed forces community has problems we need to address that are not necessarily mental health problems.
Mr Walker
My hon. Friend makes a fine point. I want to touch, at the end of my speech, on resilience and the terrible tragedy of suicide among young men and women, so I will come back to that.
I remain terribly concerned about psychosis and schizophrenia. I mentioned a few minutes ago that anyone with a diagnosis of psychosis or schizophrenia is likely to be unemployed. If one is not unemployed at the time, one will end up unemployed. Life expectancy, which has already been mentioned today, can be up to 20 years shorter than for someone who does not have that diagnosis. That is not acceptable in a civilised society and should not be tolerated. I have spoken about this before in an Adjournment debate and I want to revisit it because it is so important.
My concern, having talked to people who care for loved ones with schizophrenia—sons, daughters, mothers or fathers—is that sometimes the NHS is more interested in managing the illness than with the overall health needs of the patient. Symptoms are managed down so that patients do not make a nuisance of themselves and take up time, but when one stands back and looks at them, one sees they are desperately unhappy. It does not matter if they are smoking 70 or 80 cigarettes a day, because they are not making a nuisance of themselves. It does not matter if they weigh 20 to 25 stone, because they are not making a nuisance of themselves. It does matter, however, because that patient is slowly killing himself or herself and we have to address that.
I know that the Minister and other colleagues share my concerns, but as a civilised society we just cannot allow this to continue. Yes, progress is being made in the advancement of drug therapies, but not fast enough in mental health. We still have treatments that were breakthroughs in the ’70s and ’80s, but we have not moved on to the 2010s and beyond. The hon. Member for Bridgend rightly said that we have to be very careful about the language we use today and not frighten people. I do not want to frighten people and I hope that she does not think I am, but I get terribly moved when a constituent, who is very ill and being cared for in hospital, writes to me and tells me that once every other week he is held down on the bed and has an eight inch needle injected into his backside. I just think that that must be terribly demeaning, distressing and awful—I am sorry, I am a bit upset about it. We need to get to a place where that does not happen anymore. It will take time, but we need to get there.
Norman Lamb
I pay tribute to the work my hon. Friend does on mental health, and the extent to which he argues the case for a fair share of resources and attention to be given to it. Does he agree that it is important for clinicians, who he was talking about earlier, to listen to loved ones and family members to hear their perspective? Of course there is the issue of confidentiality, but sometimes clinicians hide behind that and are not prepared to listen to those who know the patient best of all.
Mr Jones
The hon. Gentleman makes a very good point: schools are important in this regard, and it is important to get young people to talk about the issue. I have a fantastic charity in my constituency called If U Care Share, run by Shirley Smith. It was created following the tragic circumstances in which Shirley’s 19-year-old son hanged himself. Her organisation goes into schools, youth groups and football clubs—Shirley is working with the Football Association and others—to get people talking about their emotions. We need to get more of that kind of work going.
The workplace is important. Although he is not in the Chair at the moment, I want to pay tribute to Mr Speaker, as well as to the House of Commons Commission. Following our last debate on this issue, they earmarked some funding for our own mental health in this place. Dr Ira Madan, the head of the unit across the road that MPs and staff can access, has told me that that was valuable in that it allowed her to assist Members with mental illness, and that there had been an uptake of the services since the money was made available. I would recommend that anyone who wants to go and have a chat with her should do so, as she is a very good and open individual. We must give credit to Mr Speaker and the Commission for that funding, because that was not an easy decision to make, especially as he was getting criticism from certain newspapers for giving special treatment to MPs. It is not special treatment; it is a vital service. Unfortunately, it is still not open to many MPs because of the stigma that surrounds mental illness.
Norman Lamb
I pay tribute to the hon. Gentleman for the incredible contribution that he has made to this subject over the past year or so. It was encouraging to hear what he said about Mr Speaker’s actions, and I want to alert him to the fact that I am trying to get every Government Department to sign up to Time to Change, so that they can all make the commitment to be an exemplar. If we are talking about what employers in the private sector should do, it seems to me that we should be taking the lead here.
Mr Jones
I have spoken at a few events with the Minister, and I want to thank him for his interest in, and understanding of, this subject. Getting Government Departments signed up to Time to Change would be a very good move, and he should please ask if he requires any assistance from me.
I want to talk about an issue that affects many of our constituents—namely, the work capability test and the ongoing issue with the company Atos. Is work good for people’s mental health? Yes, it is. Should people be in work if they can work? Yes, they should, with the right support. The problem with the work capability test, however, is that it is still not looking at people with mental illness with any sympathy or understanding.
I believe that individuals with long-term mental illnesses should be taken out of the current work stream, and that there should be a dedicated system for dealing with such people. I am not saying that we should write them all off and leave them at home without making any assessment, but we cannot continue with the present ludicrous system in which they are assessed by the same people who assess claimants with bad backs and other injuries. There are assessors with no expertise at all in mental illness. The assessment process is leading to some people’s conditions being made worse, and, in some cases, to people taking their own lives. One of my constituents has taken an overdose because of the trauma of being asked to attend an interview.
The Parliamentary Under-Secretary of State for Health (Anna Soubry)
I would not normally intervene, but will my hon. Friend join me in paying tribute to the right hon. Member for Knowsley (Mr Howarth) for the great work he has done to raise with me and my Department this often unheard of, certainly unrecognised and very serious problem of type 1 diabetics with eating disorders? In considering how to tackle it, it is indeed important that we look at the mental conditions and problems my hon. Friend has identified.
Caroline Nokes
I certainly join the Minister in paying that tribute. I am delighted to hear her make the point that we must start addressing the underlying mental health conditions, when in too many cases the physical treatments are the sole emphasis.
I want to touch briefly on the significant impact eating disorders can have on future career opportunities and in the workplace. As I said earlier, eating disorders are often trivialised and generalised as being conditions affecting teenage girls. That is far from the truth, as the highest rate of increase is among male sufferers. In addition, many eating disorder sufferers are managing their conditions over many years or even decades. I am the first to emphasise that sufferers can be of any age and of either gender, although I acknowledge that the age at which an eating disorder is most likely to manifest itself is 17, and that it is most likely to do so in girls. It often occurs in academically high-achieving individuals who put themselves under immense pressure to be absolutely perfect in every way they can. That frequently manifests itself in a control of food intake. Those determined to put themselves under significant academic pressure also put themselves under massive physical pressure and wish to conform to a body ideal that is actually far from healthy.
I want to pay tribute to the work of April House in Southampton—a specialist unit that focuses on eating disorders in the city. I paid a very enlightening visit to the centre just over 12 months ago and met a number of sufferers, several of whom came from my constituency. Although April House serves the wider Southampton area, three of them were Romsey residents. They have kept in touch with me since my visit, and have emphasised that they have not only benefited from the work done at April House, but have undertaken other therapies.
I am very aware of the work of an organisation in Southampton called tastelife, which was set up by the families of people suffering from eating disorders. The aim was to move the focus away from the physical, and, through self-help groups, to encourage sufferers to talk about their issues, work through them with other people and concentrate on not just physical but mental wellness.
I pay tribute to the hon. Member for North Durham (Mr Jones), who drew attention to the stigma experienced not only by those who suffer from mental health problems, but by their families. Before the Westminster Hall debate, I was contacted by many parents, husbands and, indeed, wives of people with eating disorders, who told me that not just their relatives but they themselves suffered that stigma. A number of them believed that they must be in some way to blame for the fact that their relative, perhaps their child, suffered from an eating disorder. Many were suffering from massive levels of guilt and introspection because they felt they must have somehow caused it.
I have tried to emphasise during discussions of this topic that it is not possible to identify a single trigger, and that a parent cannot do anything to prevent the descent of a child into a form of mental illness, but what that parent can do is help. I was pleased to hear various Members stress the importance of having a parent or other relative as an advocate. In the case of eating disorders, it is almost inevitably the parent who will know the young sufferer best. I think it very important that we be prepared to talk openly about the subject and to move away from the stigma.
Many of those who attended the Westminster Hall debate will remember my hon. Friend the Member for Braintree (Mr Newmark) talking about a pea. He described how he had suffered at school from anorexia nervosa, and had decided to address his condition by seeking to tackle it one step at a time. The first step involved a single green pea on a plate, which he pushed around endlessly, trying to summon up the ability to eat it. His was a moving and interesting account, which gave those of us who had by then been debating the issue for some hours something on which we could really focus: that vision of a plain white plate with a single green pea on it.
Unfortunately the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), is no longer in the Chamber. I am sure the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), will do an admirable job in responding to the debate, but the point I am about to raise is one that I raised with the Minister of State after it was raised with me by an organisation called Anorexia and Bulimia Care.
Once a young person suffering from an eating disorder has turned 16, they can choose to accept or refuse treatment and their parents no longer have a say. In order for them to be force-fed, they must be sectioned. That brings me back to what I said earlier about teenagers who are in the middle of academic exams and approaching A-levels. Being sectioned could have a significant impact on their future career choices.
I am not necessarily suggesting that we should insist that the parents must be in charge until a child reaches the age of 18. The Children’s Minister explained to me carefully and clearly about previous rulings in this place and in the courts which have granted people Gillick competence at an earlier age. I am not saying we should insist that that right be taken away from eating disorder sufferers. I think it important for us to work with health care professionals, and with mental health experts in particular, to find a solution to what I regard as a very knotty problem.
Among the sufferers to whom I have spoken during various meetings at April House and elsewhere, one sticks especially keenly in my mind. She was a lady my own age, and, although she was not one of my constituents, she came from Hampshire. She had suffered from anorexia for decades, and was incredibly frail. When I mentioned April House she shuddered visibly, because she regarded it as a place where she had been effectively force-fed. She had not come through the treatment successfully; here she was, 20 years on, still suffering from anorexia nervosa.
I always find myself—with good reason, I believe—on the side of the sufferer or the patient, and I am therefore not suggesting to the Minister that when it comes to the debate about whether parents should have the right to insist on force-feeding young people until they reach the age of 18, we should enter the fray. I recognise it is a very difficult area. However, I want to leave that thought with the Minister. I have raised the issue with her colleague the Minister of State, and no doubt I will raise it again over the coming months and years.
Dr Sarah Wollaston (Totnes) (Con)
It is a pleasure to follow the hon. Member for Islington North (Jeremy Corbyn), who made some powerful points. Perhaps I might add to what he said about the appalling difference in respect of the use of compulsory detention under the Mental Health Act 1983 for those from black and ethnic minorities. We heard in evidence that the fear of this among some communities is acting as a deterrent to seeking early help. We must address that, making sure that people do have that access and that that fear is removed from communities in order to improve health for everybody.
I wish to begin by stating for the record that I am married to a consultant NHS psychiatrist who is also chair of the Westminster liaison committee for the Royal College of Psychiatrists, which provides impartial advice to all political parties on psychiatry. He is also now a clinical director of NHS England’s mental health and dementia network in the south-west.
The corresponding debate last year focused importantly on the issue of stigma in mental health, and I congratulate the ongoing work of Time to Change in reducing stigma. The other issue that was raised, which many Members have focused on today, was parity of esteem. It is wonderful that that important principle is established within the Health and Social Care Act 2012, but we now need to ensure that that translates into action and practice on the ground. As we have heard, 23% of the overall disease burden lies in mental health, but we all recognise from stories that we hear in our constituency surgeries, and from clear evidence, that that does not translate into either funding or our constituents’ experiences of services. How are we going to see that translated into action? We need to look at the evidence of what works and to focus on the outcomes.
We know that 30% to 65% of hospital in-patients have a mental health condition and that mental health and physical health are inextricably linked. Not only is someone more likely to suffer from a mental illness if they have a chronic long-term condition, but someone who has a mental illness will find that there is an impact on their physical health. We have heard again about the scandal that the life expectancy of people with a serious mental illness will be shortened by between 20 and 25 years.
Anna Soubry
My hon. Friend is picking up on the point made by the hon. Member for Islington North (Jeremy Corbyn) about there being a real link between public health issues such as smoking and alcohol, and mental health issues. Does my hon. Friend agree that we can do great work in this area at a local level, especially under the new arrangements whereby public health is devolved back down to local authorities, where it used to be and always should have been?
Dr Wollaston
I am grateful to the Minister for that intervention. There has been a consistent tendency to ignore physical health problems in those who have severe mental health illness. She is right to say that putting in primary prevention work locally is important, but the Government could perhaps do more on primary prevention, through having a relentless focus. I am grateful to her for the personal support she has given to addressing issues such as alcohol pricing and the availability of ultra-cheap alcohol. Such issues are very important, and the Government need to deal with them to support the work that is being done. Minimum pricing is, of course, not a magic bullet, but unless we address the issue of ultra-cheap alcohol all the other measures that public health directors wish to take within local communities risk being undermined.
Anna Soubry
Does my hon. Friend agree that we can do great work on the minimum pricing of alcohol at local level? I urge her to examine the work being done in Newcastle and, in particular, in Ipswich, where all the agencies are coming together. We have seen supermarkets and many off licences agreeing not to sell cheap beer and lager. Does she agree that such an approach has the potential to be a better way—I think it is one—of dealing with this issue than minimum unit pricing?
Dr Wollaston
Although I absolutely agree that those projects in Newcastle and Ipswich are impressive, there will, unfortunately, always be ways in which they can be undermined. In my area we can find an example of maximum alcohol pricing, whereby white cider is being sold at a maximum price of 23p a unit, and that is destroying areas. There will always be a way for people to get around a minimum pricing level and, although we can see real benefits from these projects, particularly for street drinkers in isolated pockets, I feel overall that minimum pricing would be a good way of addressing this issue on a wider level. But I will not focus on that today.
I want to draw attention to the evidence on providing integrated services. Mental health and physical health services should be much better integrated. Is the Minister aware of the recent report by the Centre for Mental Health and the London School of Economics, which evaluated the use in Birmingham city hospital of the RAID service—the rapid assessment interface and discharge psychiatric liaison service? Is the Minister aware of the role that liaison psychiatry plays? Such services are greatly appreciated by patients and provide an excellent way for them to receive services; moreover, they are incredibly cost-effective. By providing rapid access to a professional service, not only for in-patients but for people who attend accident and emergency services and those who are seen by the poisons unit, it reduces re-admission rates, provides better care and far better outcomes, and saves money. The pressure on A and E services has been much in the news in recent weeks. Liaison psychiatry reduces re-attendance at minor injury units and A and E departments, so such services are vital. It would be really helpful to know whether the Minister is aware of the evidence base and will be promoting liaison psychiatry services.
I want to talk about social exclusion and the role of mental health services in social exclusion. If a person is homeless, they are far more likely to suffer from mental health problems. Equally, if a person has mental health problems, they are very much more likely to end up homeless and on the streets. In my area of Totnes, we tragically have suffered some deaths among our homeless population. We know from those who provide help to the homeless in south Devon the level of dual diagnosis—the number of people who have both mental illness and, for example, addiction problems. I would very much like to hear from the Minister in her summing up what work will be done to improve access to dual diagnosis. I pay tribute to Mark Hatch and the work that he has been doing, alongside very many dedicated volunteers, with the Revival Life Ministries and with Shekinah, providing an outstanding service to our local community.
I want to raise a point about access to GP services for the socially excluded and homeless. In coming months, there will be much focus on how we reduce health tourism. If, in reducing health tourism, we require people to bring a passport to their GP in order to be registered, very many people who are socially excluded will not be registered because they simply do not have access to identification. I ask the Minister, in addressing an important problem of great concern, to be particularly careful to avoid making it even harder for the socially excluded to obtain help with their problems. That would be a real avoidable tragedy.
Prior to the debate, a constituent wrote to me most movingly about the Cinderella service around autism, and lack of access to mental health services for those who suffer from autism, which has a knock-on effect on their carers. Listening to accounts from parents, who have been struggling for so long to obtain the help that their children need, and their description of what happens as their children move into adult services, it becomes clear that that is an area where services genuinely need to be improved. I look forward to hearing from the Minister what more can be done.
Finally, I return to the Health Committee’s review of the Mental Health Act. Would the Minister look at the evidence on the variation in the use of community treatment orders around the country, and tackle that variation? It cannot be right that in some parts of the country they are not used at all, while in others they are heavily used. The evidence base on their effectiveness is very poor. Should the Government lead on that, or should the royal colleges take a lead, so that we have a system that is transparent and used equally around the country?
Mr Steve Reed (Croydon North) (Lab)
It is a pleasure to follow many moving and thought-provoking contributions. I want to raise the case of Olaseni Lewis, known to his family as Seni, who died after his family left him in the care of the mental health service. Seni was a 23-year-old young black man living in Croydon North, the constituency that I now represent. He had a degree in IT and plans for further postgraduate study.
Seni had no history of mental or physical illness when, on 31 August 2010, he started to behave in an uncharacteristically odd and agitated manner. His parents did what they thought was the right thing by taking him to hospital. He was admitted as a voluntary patient for a few days’ assessment and care. His family left him, when visiting hours ended at 8 pm, with reassurances that they would be contacted if anything happened.
Seni became agitated in his family’s absence, and even more so after he was told that he could not leave the hospital even though he understood he was there voluntarily. It appears he was sectioned in order to detain him against his will, and was then restrained and held face down on the floor by several members of staff and by police officers who had been called after he kicked a door, although there is no evidence that he was violent towards anyone.
Seni was held face down in a seclusion unit by up to 11 police officers for a total of 40 minutes in a way that appears to contravene international conventions on human rights and torture. During the course of that restraint, Seni slipped into a coma and was eventually put on a life support machine, which is how his family found him when they were eventually called four hours after they had left him. He was pronounced dead four days later.
The Independent Police Complaints Commission is responsible for investigating the events leading to Seni’s death. Its investigation began in September 2010. Instead of conducting its investigation under criminal proceedings and interviewing the police officers under caution, it chose instead to accept written accounts which were never challenged. It now accepts that that was a serious mistake.
In August 2011 the IPCC referred the matter and its report to the Crown Prosecution Service to decide whether to prosecute, with a recommendation against. In the meantime, the IPCC had received new information that led it to believe that a criminal prosecution should in fact be pursued. That new information, received in July 2012, was the pathologist’s report, which raised fresh concerns about the extent of restraint used against Seni Lewis. Frustratingly, the CPS refused to accept that new evidence because it was not included in the IPCC’s original report—even though it was the IPCC that wished to amend its own submission. The IPCC claims it has repeatedly raised that point with the CPS, but to no avail. The CPS refused to prosecute.
The IPCC, eager to put right its own admitted mistakes, tried to persuade the Metropolitan police to reopen its investigation in order to trigger a fresh investigation by the IPCC. Following legal advice, the IPPC believed that that would allow it to interview the police officers under caution and include the pathologist’s findings in a new report to the CPS. The Met, unfortunately, had contradictory legal advice telling it that the IPCC could not overturn its own original report and refused to open a fresh investigation. The IPCC is now accusing the Metropolitan police of blocking the investigation that the IPPC wants to reopen.
So we reach a highly unsatisfactory impasse. The police will not reopen the investigation, the CPS will not accept the fresh and potentially compelling evidence, and the IPCC is not allowed to overturn its own decision not to investigate under criminal proceedings even though it believes that the original decision was wrong. In the meantime, a bereaved family have been waiting, with astonishing patience and great dignity, for over two years and eight months for an answer to how and why their beloved son now lies dead after they placed him in the care of a hospital when he showed early signs of mental ill health.
The questions that this case raises are profound and frightening. The organisation Black Mental Health UK is concerned that black people are 44% more likely to be subject to detention under the Mental Health Act than their white counterparts, even though there is no higher prevalence of mental illness among the black community. Once in the system, black people are more likely to be labelled psychotic than their white counterparts for exhibiting exactly the same behaviour. They are also more likely to be given a diagnosis of schizophrenia and to be considered an immediate threat than non-black people. This group is 29% more likely to be subject to restraint and 49% more likely to be placed in seclusion. Black Mental Health UK believes this may be the result of prejudicial assumptions made about young black men in general, and in particular those labelled as suffering from mental ill health.
If black people are being treated differently from other people in a way that threatens their well-being, the community needs reassurance that the mental health service is not institutionally racist. We need a public inquest to establish exactly what happened to Seni Lewis in the four hours after he was first taken by his parents to A and E in Croydon. To date the Lewis family have been failed by the mental health service and the entire criminal justice system. Instead of the open inquiry this case deserves, we are treated to the unseemly spectacle of the IPCC, the CPS and the Metropolitan police fighting with each other and unable or unwilling to work together in the public interest to allow an effective investigation to take place.
I have raised the case of the Lewis family with Ministers over recent months but I am dissatisfied with their responses. When I asked when an investigation would be progressed, I was told this was an operational matter, but this case points to a wider systemic failing that requires Ministers to act and address it. When I asked the Home Secretary what advice was given to the police over how to operate in a mental health setting, I was told none. When I asked what discussions had taken place between the Home Secretary and the Health Secretary about the use of the police in mental health settings, I was told none. When I asked the Health Minister how many patients were restrained in a mental health setting and what their ethnicity was, I was told that the Department of Health does not collect these data. I do not wish to impugn the intentions of Ministers, but I have concluded that they are failing to give this matter the priority it deserves.
Norman Lamb
I apologise that I came in halfway through the hon. Gentleman’s contribution, but he is making extremely serious points. I would be happy to talk further to him about the case after the debate.
The Minister of State, Department of Health (Norman Lamb)
I thank the shadow Minister for her contribution. I feel that this subject brings out the best in this place—we have had a well-informed, civilised and rational debate. There has been no political point scoring, just thoughtful concentration on an important subject, and I am grateful to all hon. Members.
Before I come on to the contribution of my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), I will say that I completely agree with the hon. Member for Hackney North and Stoke Newington (Ms Abbott) that the arrival of public health in local authorities presents us with an opportunity. The establishment of Public Health England brings its expertise to bear on its relationships with local practitioners in public health, working alongside other services. The potential for public mental health, which has been largely disregarded or ignored in too many places in the past, is real. At the conference for the directors of children and adult services in Eastbourne last October, I attended a presentation by an academic from the London School of Economics on the economic case for interventions in public mental health. There is a powerful return on investment, which means that people are benefiting from it. We have a great opportunity, and I am grateful for the hon. Lady’s comments.
The hon. Lady made important comments about black and minority ethnic communities and the mental health system, and I will come back to that. I appreciated the comments made by the hon. Member for Croydon North (Mr Reed), and I will refer to them later.
The hon. Lady raised the issue of suicide and young people. There are too many cases in too many hospitals where people who have self-harmed turn up and do not get a psycho-social assessment. We know that having that assessment, with the therapy that can follow, massively reduces the risk of suicide, yet only about 50% of A and E departments ensure that that happens. That has to change, because lives are literally at stake. We have to take this issue very seriously.
I am tremendously grateful to the Backbench Business Committee for giving us another chance to talk about mental health. I again pay tribute to my right hon. Friend the Member for Sutton and Cheam for leading the debate and for the great work he did in office to lay the foundations for the progress we are now tangibly making. The previous Government invested heavily in mental health, as well as the rest of the health service, and it is right to acknowledge that progress was made in that period. The focus on parity of esteem, and making it a reality, is potentially exciting. I was struck by an interview with Angela McNab, the chief executive of the Kent and Medway mental health trust, which is one of the larger mental health trusts. She said that the Government were
“prioritising mental health like never before, making sure that it fits on a par with physical health”—
and that this had come as a welcome step change to mental health professionals. That is an encouraging view from the front line.
My right hon. Friend raised several important points, including about recovery colleges. I am very interested in the whole recovery model and the role of recovery colleges. He also talked about the importance of the inspiring Time to Change campaign, which is part- funded by the Government. I mentioned earlier that I am encouraging all Departments to sign up to that campaign, so that we can lead from the front. We cannot expect private sector and other public sector employers to act properly if the Government do not lead, so it is important to demonstrate parity of esteem in the way that the Government treat employees.
My right hon. Friend also referred to the adult psychiatric morbidity survey. I can confirm that discussions are taking place between the Department and the Health and Social Care Information Centre and that it should take place in 2014. He also referred to the intelligence network. NHS England and Public Health England are developing plans and using the cancer intelligence network as a model, not necessarily to replicate, but to learn from. I am grateful to him for raising those issues.
The impassioned words that we have heard today show that within these walls lies the ambition, across all parties, to make the necessary changes, and I thank all hon. Members who have spoken about their experiences, views and, yes, even their criticisms. This sort of open debate can help to challenge stigma, scrutinise services and scrutinise commissioning decisions, which are critical in terms of how much money is allocated to mental health as against physical health and to ensuring that mental health remains a core priority not just for the Government, the House and the NHS and care system, but for the whole of society.
We have heard many good contributions. I shall write to hon. Members to respond to the substantive challenges and questions they have raised, but let me touch now on several quick points made today. The hon. Member for Bridgend (Mrs Moon) mentioned the importance of recognising the link between alcohol abuse and mental health. She talked about people who have left the armed forces with problems of post-traumatic stress disorder, which has become prevalent with the conflicts in Iraq, Afghanistan and so forth. Simon Wessely and his colleagues are doing some fantastic work on that.
The hon. Lady also mentioned the role of the police, particularly the Metropolitan police, and made the valid point that they are not trained well enough or systematically enough. Lord Adebowale, whom I met this week to talk about his report, makes the point that the police will always have to deal with mental health. It is not a question of it being wrong that they are dealing with it; the critical point is that there should be close working between the police and mental health services so that there is an immediate referral, not an inappropriate placing of someone in a police cell. Just imagine suffering from a mental health crisis and ending up in a police cell. It is the worst possible thing that could happen. Even children sometimes end up in police stations. It is totally inappropriate and avoidable—that is the important point.
The hon. Members for Broxbourne (Mr Walker) and for North Durham (Mr Jones), who have done so much to challenge stigma, have performed a valuable service in speaking out about their own experiences of mental illness. They have demonstrated, very visibly, that someone can be successful and make an enormous contribution to society, yet also have mental health problems. That is an incredibly important point. The hon. Member for Broxbourne talked about the role of employers and mentioned some really good employers, such as BT. This is about enlightened self-interest, not just about being kind to people. It is in companies’ and employers’ interests, including the Government’s, to treat mental health issues seriously. The cost to employers when those suffering from mental health problems lose their jobs—the loss of all the training and experience or just the sickness absence—is enormous, but it can be significantly reduced with a smarter approach. The hon. Member for North Durham talked about a number of individuals who have had mental health issues, but also been very successful. He talked a lot about the importance of tackling stigma.
The hon. Member for Croydon North (Mr Reed) made an important contribution about the treatment of black people by mental health services—the shadow Minister talked about that as well. There is something wrong that has to be challenged. The hon. Gentleman raised the case of Seni Lewis, which I am happy to talk to him about—I have surgeries on Monday night and we can discuss this. I have agreed to attend the Black Mental Health conference on police and mental health in June, because I felt it was important that I should engage in this whole issue and take it as seriously as it deserves to be.
The hon. Member for Totnes (Dr Wollaston)—I apologise for missing her contribution and a number of others—raised a number of issues. I will ensure that she receives proper responses to them. She talked about liaison psychiatry. While we are talking about emergency services, one thing that has become more and more apparent to me is the complete disparity between what happens to people with mental health problems and what happens to those with physical health problems. I was utterly shocked—but sadly not surprised—by a letter that a Member of Parliament in the south-west wrote on behalf of a constituent. The constituent had rung the crisis number for mental health services in his area and had not got a reply. No one was answering the crisis helpline. On another occasion they rang and were asked to ring back in half an hour. In the meantime that person could have committed suicide.
Then we come to what happens in A and E and the fact that in too many hospitals there is no mental health specialism available. Last Saturday I met a constituent who had found her son at home with ligature marks round his neck. She took him to A and E, where there was a half-hour conversation with a junior doctor before he was discharged home. The next day she found him hanging in her home. She is determined to pursue the complete failure of the system when something so dreadful can happen.
Whether we are talking about what happens when someone is picked up in the middle of a mental health crisis by the police and taken to a police station inappropriately, what happens when someone tries to get in touch with crisis services or what happens at A and E, we have to have an effective emergency mental health response system in place. This is a matter of real urgency, so I have asked all the relevant organisations—the Home Office, the Association of Chief Police Officers, the Department of Health, the Royal College of Psychiatrists and so on—to come together and draw up an agreed plan to tackle the most stark differences between the treatment received by people with physical health needs and that received by those with mental health needs.
Paul Burstow
That is a welcome announcement from the Minister about achieving parity of esteem in emergency and crisis care. However, in the wake of the Francis inquiry, which rightly drew our attention to serious patient safety and dignity issues in our physical health care system, I suspect that we will need to ensure that we are not distracted or led into not addressing the same issues—which clearly exist—in our mental health systems.
Norman Lamb
My right hon. Friend makes a very good point and I completely agree.
The hon. Member for Romsey and Southampton North (Caroline Nokes) spoke again about eating disorders—I took part in a debate that she secured in Westminster Hall. She talked about the role of parents, the nightmare of a child—I will call them a child—over the age of 16 deciding to refuse treatment and the horror that parents sometimes go through when they are not listened to sufficiently by clinicians dealing with their loved one’s condition. She also mentioned type 1 diabetes sufferers, and I would be interested to hear more about that.
My hon. Friend the Member for Harrogate and Knaresborough (Andrew Jones) is no longer here. Oh, yes he is! He has moved to a different place, just to confuse me. He talked about the low diagnosis rate for Alzheimer’s and dementia in his area. He also stressed the importance of the recognition of mental health by the Government, which I think he welcomed.
The hon. Member for Bolton South East (Yasmin Qureshi) talked about the importance of accessing appropriate and culturally sensitive care and treatment. That is incredibly important, as is getting the approach right for each individual and giving them the power to determine their priorities. She made those points well. She also stressed that the picture round the country was very variable. That is more the case in mental health than in physical health. Some areas have great services, some of which I have witnessed, but in others they are simply not good enough.
Ms Abbott
On the question of culturally appropriate care, does the Minister agree that it can extend to quite mundane matters? There are mental health wards in this country with large numbers of BME people in them. Those people sometimes do not have the right hair care or the right music, or they might not have their culinary needs addressed. Those things can be really disturbing for someone who is already in a mentally fragile condition.
Norman Lamb
Yes, I completely agree. This is about treating people as individuals, and with dignity and respect. Those things are important to people and they should be treated as such.
Jeremy Corbyn
My hon. Friend the Member for North Durham (Mr Jones) and I raised the question of the work capability interviews being undertaken by the Department for Work and Pensions with people with mental health conditions. I do not think that the Minister was in the Chamber at the time, but we suggested that it would be better for the DWP to have access to those people’s medical reports rather than conducting rather bald interviews. Would the Minister be prepared to undertake discussions with the DWP about the treatment during those interviews of people who suffer from mental health conditions?
Norman Lamb
I am grateful to the hon. Gentleman for his intervention. I was going to mention his contribution, even though I was not present to hear it, for which I apologise. As a Member of Parliament, concerns have been raised with me about the suitability of those tests for people with mental health problems, and I was going to suggest that I should talk to the appropriate Minister at the DWP. I am of course happy to do that. Someone else made the point that this is not a question of not addressing the need to help people get back into work. Work is particularly important in relation to people suffering from mental ill health, and the idea that we should simply leave them undisturbed and out of work for the rest of their lives is totally wrong. The way in which we handle this is incredibly important, however, and if we have more to learn in that regard, we should be prepared to learn the lessons.
Mr Kevan Jones
I made the point in my speech that work was good for people with mental illness. The problem is that the present system is inefficient and costly, and that it is creating absolute agony for many people. I know that the Minister has a great understanding of, and a deep passion for, the subject of mental health, and I urge him to put pressure on the DWP to change the system. We are not asking that people should be excluded completely from work capability tests; we are just asking for the system to be changed.
Norman Lamb
I am grateful to the hon. Gentleman for reminding me that he, too, had made that point. I knew that someone else had talked about it, but I could not remember who it was. I take his point; I have heard it.
My hon. Friend the Member for Southport (John Pugh) made a thoughtful speech in which he talked about reminiscences. Oh! He has gone! Even though it pains me, as a Norwich City supporter, to talk about Everton, it appears that Everton and even Southport have done some very good work in these areas. My hon. Friend talked about a continuum of mental health. That was a good point, well made. He also mentioned community treatment orders and the need to look at how they are working. I will certainly reflect on that.
My hon. Friend the Member for Battersea (Jane Ellison) made a powerful contribution about the mental health aspects of female genital mutilation, a most horrific experience suffered by so many young girls. I really pay tribute to her for the work that she has done on that issue. The fact that there are 66,000 females in this country who have suffered this assault was an extremely striking point.
The hon. Member for Finchley and Golders Green (Mike Freer) talked about waiting times for access to treatment. He asked if he could gently challenge the Minister—I appreciated that approach. On the mandate for the NHS Commissioning Board, NHS England has been very clear that we expect it to assess the scale of the problem of access, including for IAPT. Other Members have raised the question of whether we are meeting the IAPT programme’s four-week target. We want the NHS Commissioning Board to assess the scale of the problem with a view to setting access standards.
One of the big problems relating to what I regard as the institutional bias against mental health is that on one side of the equation we have the 18-week maximum waiting time for physical health, which is a very powerful political driver of where the money goes, yet we have nothing equivalent for mental health on the other side. That, to me, is a lack of parity of esteem. For people with mental health problems, early access is particularly important to ensure that their condition can be halted, if possible, and the deterioration stopped. The hon. Member for Finchley and Golders Green made a good point there, and he also rightly talked about the importance of consistency and continuity of care.
I want to mention four of the most important things that this Government are doing to create the environment and incentives for improving mental health across the system as a whole. The first is the Health and Social Care Act 2012, which creates a “parity of esteem” so that mental and physical health share the same importance, as we have discussed this afternoon. Changing the law is just the start, but it sends a clear signal—that mental health is important, and that the health and care system can and must play a leading role in changing attitudes across society as a whole.
Secondly, there is the mandate the Secretary of State has issued to NHS England. It shows the importance we have ascribed to mental health and makes it clear where improvements are needed. The mandate makes clear our overarching goal—that mental health must have equal priority with physical health across all aspects of NHS work. In particular, we have highlighted the need to close the gap in outcomes between people with mental illness and the population as a whole, as well as the absolute imperative to ensure that people can access the services they need when they need them. Neither of these facets of good mental health treatment is entirely up to scratch at the moment. I think we all recognise that.
Mr Andrew Smith (Oxford East) (Lab)
The Minister is generous in giving way, and he is making some very important points. Would he include within this the importance of access to family therapy both to repair broken relationships and to aid recovery—an issue that Oxford Mind raised with me?
Norman Lamb
Yes, absolutely; I understand the importance of that. Incidentally, I visited children and adolescent services in Oxford and I was very impressed by the work under way there. I am getting a message that I am under some pressure from Mr Deputy Speaker to make some progress—
Mr Deputy Speaker (Mr Lindsay Hoyle)
I may be able to help the Minister there. It is not a question of pressure from me; it is a question of the Backbench Business Committee suggesting that Front-Bench contributions should be up to 15 minutes. If he looked at the clock, he would recognise that he has spoken for more than 20 minutes. He should not suggest that the Chair is interfering; it is the Backbench Business Committee.
Norman Lamb
I am sorry for putting the blame in the wrong place; I take full responsibility; I have tried to be responsive to Members as I have proceeded.
We are working with NHS England to decide how best to measure progress in these areas. Because, as we all know, words are not enough, we have to be certain that the objectives we have set out on paper actually translate into better, more accessible care for those who need it.
Thirdly, I mention the three outcome frameworks: for the NHS, adult social care, and public health. These frameworks will enable us to hold the health and care system to account for achieving what matters most—good outcomes for the people who use services and for the population as a whole. In the NHS outcomes framework, there are four measures that relate specifically to mental health and many others that include mental health just as much as physical health. The other outcomes frameworks contain other measures designed to ensure that we improve well-being and tackle the wider determinants of mental health, and that we provide the best possible care and support to those people with mental health problems who need it.
Finally, I want to mention our continuing commitment to the IAPT programme. Since the programme began, it has treated more than 1 million people with depression and anxiety, and as a result nearly 75,000 people have moved from benefits into work. Nevertheless, we need to do more. We are currently involved in a joint programme with the Department for Work and Pensions, which involves commissioning work to find a way of providing much speedier access to psychological therapies for people with mental health problems who are out of work. It seems crazy that we are spending money on benefits when giving those people access to therapy might help them to recover and return to work.
George Freeman
I am sorry that I was not able to be present earlier. I pay tribute to the Government for the work they are doing, and to the Backbench Business Committee for raising this issue. Does the Minister agree that, on the role of mental health in mainstream health, there is important evidence concerning outcomes and compliance with mainstream medicine? Important work carried out in America by the United States Veterans Association and the American dementia and mental health societies has shown the importance of positive psychology in helping people to recover and play an active role in society.
Norman Lamb
The hon. Gentleman has made some extremely good points.
The Government are implementing a diversion service to ensure that, as far as possible, people are diverted from the criminal justice system and from prison if that is not where they should be. If they are suffering from mental health problems, they should ideally be given treatment rather than being locked up inappropriately in prison.
Personal health budgets are a really good innovation, started by the last Government and continued by this one. Giving people—particularly those with mental health problems—power to determine their own priorities, and giving them some control over the resources available for their treatment, is an incredibly important development, for which I shall continue to proselytise at every opportunity.
In order to avoid any further trouble from the Backbench Business Committee—rather than from your good self, Mr Deputy Speaker—I shall draw my remarks to a close.
Today’s debate allows us to explore what more we can do to improve services for people with mental health problems, but as I said earlier it also allows us to encourage others to follow suit. We all have the same ultimate ambition—to provide excellent services and support for all who need it, when they need it—but if we are to achieve that ambition, all groups need to do their bit. We will not be able to do this alone. However, we can lay the groundwork to ensure that local leaders and local people can develop the excellent mental health care and treatment that can turn our common ambitions into reality.
I thank all Members who have spoken today. I also thank the Backbench Business Committee for allowing me to speak beyond my “guideline” time, and to explain what the Government are trying to do to improve access to, and the quality of, mental health treatment. Again, I congratulate my right hon. Friend the Member for Sutton and Cheam on securing the debate.
I am pleased to be able to count on my parliamentary colleagues to maintain the momentum of discussion of mental health in public forums, and I pay tribute to all who have spoken for their incredibly valuable contributions. I look forward to our third convention.