Mental Health

Charles Walker Excerpts

Thursday 16th May 2013 Commons Chamber

[Mr Charles Walker (Broxbourne) (Con)]

It is a pleasure to follow the hon. Member for Bridgend (Mrs Moon), who made an important speech on the mental health of military veterans who serve this country so bravely in many theatres.

I am in the Chamber because this debate is extraordinarily important. I could spend this Thursday knocking on doors in my constituency and pressing the flesh. If I was lucky, I might meet 100 people, but by being here, I can represent the interests of many thousands of people. That is why the Chamber of the House of Commons is so important. I hope that, this afternoon, I speak up for the interests of many thousands of my constituents who suffer directly from mental health problems and illness, and many thousands in their families who support them.

We have come a long way in the past year. In June 2012, we had a great debate in the Chamber. Many familiar faces who took part in that debate are in the Chamber this afternoon. In a sense, the lid has been lifted. People now feel much more confident speaking not only of their own mental health experiences, but of mental health in general, and the hopes, aspirations, fears and expectations of their constituents.

Although I have been involved in mental health for about seven years as vice-chairman and now chairman of the all-party group on mental health, I have met an enormous number of organisations in the past year. I have written a few of their names down on a piece of paper. I will not read them all out—that would not look too good in Hansard tomorrow—but I will focus on two or three special people I have met.

Daniel Macnamee from Changing Our Lives has suffered from psychosis and has been very unwell for significant periods. He is well at the moment and recognises the signs when he is about to become ill, so the process and his drug therapies can be managed. Daniel is doing extraordinary things. He is an advocate for people with mental health problems and who are ill, including within hospitals—people who have been either detained or who are there of their own volition.

[Andy Sawford (Corby) (Lab/Co-op)]

The hon. Gentleman mentions a constituent who becomes aware before he has a psychotic episode. In that situation, he would want acute and crisis services. Is the hon. Gentleman aware of Mind’s work on that? It recently surveyed all primary care trusts, which are now clinical commissioning groups, and mental health trusts about their acute and crisis care services. Does he agree that we ought to ensure that such services are available to people such as his constituent and my constituents?

[Mr Walker]

I thank the hon. Gentleman for that information. I have campaigned alongside Mind for many years to ensure that people have such services. We talk about support within the community, but it is variable and people’s experience of it is variable. If we are to get things right when people go into crisis or feel a crisis coming on, they need to be confident that the support they require will be there for them. That is why having a crisis plan is so important: people’s wishes can be respected. We too often talk over the heads of people with mental health problems, unwellness or illness—however we define it. We need to be aware of their wishes, because have an absolute obligation to their welfare and to respect their wishes.

Daniel, from Changing Our Lives, is not a constituent; he is just one of the most inspirational people I have met in the 45 years I have tottered along this mortal coil. He is a wonderful man and I am full of admiration for what he is doing.

A couple of days ago, I met Liz Johnson from UK Changes, who works in Staffordshire to ensure that people with mental health issues can remain and keep a foothold in the workplace. For those who are out of the workplace due to illness, her organisation provides mechanisms to help them get back in. The organisation has some reach and I strongly recommend that the Minister meets its representatives. I know there is a drive to ensure that people who have suffered from mental health problems have the opportunity to re-engage with the labour market. One great sadness is that the chance of being in work for those with a diagnosis of psychosis or schizophrenia is approximately 8%. A 92% unemployment rate is unacceptable.

[Dame Anne Begg]

Generally, people with mental health issues have been in work—they are not young and may be in middle age—but have fallen out of it. Does the hon. Gentleman agree that there needs to be a lot more work done with employers to ensure that an episode of mental ill health does not lead to people being sacked and becoming unemployed? Employers need to be much more sympathetic, helpful and understanding to keep people in the job they already have.

[Mr Walker]

The hon. Lady makes a fabulous point. Many organisations are doing that at the moment. The Work Foundation launched a report in the House of Commons a couple of months ago, and I was delighted to be able to speak at that event. Some people who had been excluded from the labour market for many years but are now in work spoke at the launch downstairs in the Churchill room. It was moving and uplifting. Good news stories tend to be uplifting and we need to have more of them. There is still a lot of disappointment and sadness in this area, and that is why we have such an obligation in this place to work with all Governments to improve outcomes and ensure we get things right.

[Rehman Chishti]

Like every other hon. Member here, I pay tribute to my hon. Friend for the work he has done on this issue over many years. Does he agree that the current NHS approaches are too focused on fighting fires, and that more investment in community and preventive care would improve quality and potentially reduce costs, a view shared by an expert from Imperial college?

[Mr Walker]

I agree with my hon. Friend. We need to ensure that the systems are in place in local communities to provide people with the support they require. Care in the community is a great concept if that care exists. It exists more in some places than in others.

I will not read out all the names on my list, but they show that civil society is alive and well. They are not statutory organisations; they are founded and run by people who wanted to reach out and do something about a problem that was relevant and prevalent in their community. I am full of admiration for them.

[Ian Austin (Dudley North) (Lab)]

I am grateful to the hon. Gentleman for giving way; he is being very generous. Like other Members, I pay tribute to him for his work on this issue. Before he moves on, I want to touch on the important point about employment. A constituent has written to me to say that employers need to be far more open to the idea of encouraging their employees to talk about these issues and support them in times of need. The loss to companies could be greatly reduced if they were able to support employees through times of mental fatigue and mental illness. Does he agree?

[Mr Walker]

Absolutely. A lot of good points are being made this afternoon and that is another one. BT and Legal & General are doing a huge amount of work on this. BT does it because it is a decent employer, but also because it wants to hold on to some of its top performers who make a difference to the business. It therefore makes sense to support people and ensure they can stay in work.

We have a fabulous civil society doing wonderful things. The great thing about the area of mental health—it is not all doom gloom; far from it—is the diversity of provision. There are a lot of people out there thinking about different ways of doing things, ways that work for the particular communities they serve. That is to be applauded and promoted. We need to support organisations that provide services that meet the needs of specific groups and their community.

[Jason McCartney (Colne Valley) (Con)]

I thank my hon. Friend for lifting the lid off the whole issue of mental health. The more times we talk about it in this Chamber, the more we can break down the stigma. It does not surprise me that he has such a long list of wonderful people and local organisations that are doing great things. I met representatives of the State of Mind campaign, which is running in rugby league. It is not a particularly well paid sport, but the campaign is helping young men who suffer from mental health issues. Will he continue, with me and other Members, to support those organisations and the wonderful people who are breaking down these stigmas?

[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.

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[Mr Walker]

The hon. Gentleman makes an excellent point. Patients need a voice and an advocate, and often—not always, but often—a family member is best placed to do that. The patient’s wishes should be respected.

[Mrs Moon]

I wanted to follow up on the same issue as the Minister. In preparing for this debate, I received many e-mails from people who had to become experts in the condition in the hope of protecting a family member from exactly the sort of abuse that the hon. Gentleman is talking about. The fear that carers feel when a loved-one comes into contact with the health services, which should be there to protect them and aid them in their passage through their illness, should not exist. That fear should not add to the trauma of their treatment. That is something we have to address.

[Mr Walker]

It is not a crime to be ill. It is not a crime to have cancer, it is not a crime to have heart disease and it should not be a crime to have a mental health illness. What we need is compassion.

[Gloria De Piero (Ashfield) (Lab)]

rose—

[Mr Walker]

I give way to the hon. Lady, although I am going to get in terrible trouble in a minute for taking up too much time.

[Gloria De Piero]

I wanted to intervene because people were talking about family members. I have a close family member with a severe mental illness. It was a big part of my childhood and early adulthood, and remains a big part of my life to this day. It is so important that we have this conversation. It is not something that people share or talk about because of the stigma that surrounds it. Instead, people internalise it, deal with it and become their own expert, so I would like to thank the Backbench Business Committee for returning to this important issue. It is time to talk and time to change, and I thank the hon. Gentleman, along with Rethink and Mind, for their work in this area.

[Mr Walker]

I know that the hon. Lady is an expert on these matters. I was going to say in response to the hon. Member for Bridgend that there are experts in this place. I did not want to identify the hon. Member for Ashfield (Gloria De Piero), but, to her enormous credit, she has identified herself. She is a fantastic representative of her constituents, and it is a delight to have her here today.

We have to make progress on drug therapies. Lord Stevenson of Coddenham, who is known to me and the hon. Member for North Durham (Mr Jones) very well, is doing enormously good things in this area. He has established a charity with a significant budget to look into new treatments, pathways and the brain. The charity is called MQ, its chief executive is Cynthia Joyce and I commend its work to the Minister. I would also like to thank my hon. Friend the Member for Loughborough (Nicky Morgan), who cannot speak today because, according to some bizarre convention, Whips cannot speak in the Chamber, which is a great sadness, because I wish she could. I also thank my hon. Friend the Member for Halesowen and Rowley Regis (James Morris), who has done much in this area, and of course the hon. Member for North Durham, who has become a great friend over the past year and is a fellow musketeer in these areas.

I said that I would touch on suicide. We need to build mental health resilience in our schools. That should start at a very young age. It is a great tragedy that many young men and girls decide to end their lives in their teens and early 20s. It is a public health issue, and we need to address it.

[Jeremy Corbyn]

I compliment the hon. Gentleman on his speech and on his work on this subject. I am glad that he has raised the issue of suicide. Like me, he must be shocked by the number of suicides and attempted suicides within our prison service and by the number of prisoners clearly suffering mental health problems but not receiving the care and support they need. Does he agree that we need a much better regime of training and support on mental health issues for all prisoners?

[Mr Walker]

I absolutely agree with the hon. Gentleman. It is a great sadness that we shut down and cleared out the asylums only to put too many of those people in our prisons. They go in ill and they come out even more ill and more addicted. It is a disgrace and something we need to address.

I thank colleagues for being here today. I know that the call of their constituencies is hard to resist, but they will be congratulated by their constituents for taking part in this debate. I commend the work of the all-party group on mental health. We have done a lot of work on mental health, schizophrenia and ethnic minority mental health. I see that my hon. Friend for Taunton is here—no, it is not Taunton, but? [Hon. Members: “Totnes.”] Well, it begins with a T for crying out loud. What’s a T among friends? I thank my hon. Friend the Member for Totnes (Dr Wollaston) for her great work. I thank you, Madam Deputy Speaker, and the Backbench Business Committee for allowing the debate to take place, and I thank the Minister and his predecessor, the right hon. Member for Sutton and Cheam (Paul Burstow), who was also a fabulous Minister, for giving the matter such attention and focus. They are to be lauded and applauded.

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[John Pugh]

We are presumably talking about unintentional memory lapses—senior moments that may afflict any of us.

There is no absolute cut-off point between mildly obsessive behaviour and obsessive compulsive disorder, between mood swings and genuine bipolar conditions, or even between irrational fears of which everybody is sometimes a victim and some of the conditions we would call paranoia. There is a continuum; it is, to some extent, a matter of degree. It is even possible, apparently, to have hallucinations without having schizophrenia. Delusions are not unique to asylums; there are many victims in this place. There is nothing especially rational about clever, civilised people gathering here every Wednesday at 12 o’clock just to shout at one another.

There are two aspects to addressing the stigma of mental health. One of those is to persuade people that this can happen to anyone, including MPs. That is very important. The other job is to persuade the public that mental health is not an either/or, black/white distinction. I recognise that there are conditions such as serious neurological malfunctions, deterioration of the brain, and so on. Affective disorders can be evident in people classified as being well and also in people classified as being unwell with mental health issues. What determines the classification is not only the severity of the condition—the extent to which the person is down one continuum or another—but the capacity of society to deal with the condition and the ability of the person to cope within society with the condition. The cultural comparison made by the hon. Member for Bolton South East (Yasmin Qureshi) is useful in this context. The mental health of a society and the mental health of individuals are intertwined, and one is the index of the other. I wonder whether, when we talk in this place about producing a prosperous society or economic growth, or doing something about social mobility or social inequality, we ask ourselves sufficiently whether we are doing enough to make society a happy place for us all to live in.

Let me add one other point with which I think you, Madam Deputy Speaker, will be au fait. Community treatment orders were a bone of contention throughout the passage of the Mental Capacity Act 2005, when I served on the Bill Committee. We have to review that issue, and the Minister needs to make a response. I think that we made the right decision, but that depends on whether the Act is understood and implemented properly. There is a genuine case, particularly given some of the variations, for trying to see whether we have got it right.

[Mr Charles Walker]

On that point, it is very important to ensure that advocacy requirements are being met.

[John Pugh]

Absolutely, and I hope the Minister will take that into account when he responds.

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[Jane Ellison]

No; to the eternal shame of this country, in 25 years of this being an illegal act, there have been no prosecutions.

In recent times—I will return to the mental health aspects in a moment, Mr Deputy Speaker—we have had encouragement because Keir Starmer, the Director of Public Prosecutions, has been really good on this issue. He has a new action plan for the Crown Prosecution Service. It has reopened several old cases and is going through them with the police to see whether a prosecution is possible. It is also looking more imaginatively at prosecuting the aiders and the abetters, such as the people who set up the travel and those who supply the strong pain killers. If we wait for a seven-year-old girl to walk into a police station and report her parents, we will have a long wait. That is one reason why there have been no prosecutions. However, I am more optimistic now than ever that the police and the CPS are taking the matter seriously.

To return to the mental health aspects, a recent survey by the National Society for the Prevention of Cruelty to Children showed that 83% of teachers either do not know about FGM or have had no training on it. From memory, 16% of teachers thought that condemning FGM was culturally insensitive. That is extremely disturbing, given that it is an illegal act.

[Mr Charles Walker]

It is child abuse. There is no ambiguity. It is child abuse and it must be stopped.

[Jane Ellison]

I could not agree more.

My worry is about the 83% of teachers who just do not know about FGM or have not had the training. There are good guidelines, but they are not statutory. Not enough is filtering down. In my constituency, I have encountered people who say, “Don’t go there. It’s too difficult.” There is a role for Members of Parliament in pushing this matter at a constituency level. If teachers have no idea what FGM is or what the behavioural and psychological consequences might be, they will fail to understand why a young girl who has come back from being mutilated abroad is exhibiting naughty, disturbed or bad behaviour. It is therefore important to get more knowledge out there about the physical and psychological aspects of FGM so that we can understand and help children who present with signs of being disturbed.

In UK culture, women have an expectation that their sex life will be enjoyable and that they can have a normal expression of female sexuality. That is very much at odds with the mentality that leads to somebody being mutilated. Many of the women who are suffering the physical and mental complications of FGM do not speak English and live in socially isolated communities in which they are not encouraged to speak about it because it is entirely taboo. That is added to the taboo of speaking about mental health.

The lack of knowledge about FGM among teachers and medical professionals will increasingly be a problem as diaspora communities become scattered to places in the country where professionals do not see it as much. It is easier for a specialist in central London to know what they are looking for. Even if we stopped all FGM happening to young girls tomorrow—would that we could—we would still have to deal with the large number of women who are suffering the long-term consequences of it.

There is documentary evidence that some parents have second thoughts about having done this to their children. Some parents express regret. The Home Office had a good initiative last year, which we adopted from the Dutch, in which it provided girls and parents with a health passport to carry abroad with them to remind members of their extended family that the practice is illegal in the UK and that they must not do it, but must respect the rights of the child.

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[Ms Abbott]

I am afraid that there is increasing evidence that worry about the changes and about the threat of the changes is causing a lot of stress for people with mental health issues. Social services and health authorities must be mindful of that.

[Mr Charles Walker]

I apologise to the hon. Lady because I am about to leave the Chamber—I am chairing a debate in Westminster Hall in a moment. I agree entirely that Atos should not be a blunt instrument used to beat those who have mental illness. We need a system that empowers people with mental illness to re-enter the labour market, and not one that terrifies them.

I endorse the hon. Lady’s views on young men. Young men need to feel part of something and they need to feel wanted by their community. They need to have a job and a role. If they do not have those things, they join gangs. Her point about young men was beautifully and perfectly made.

[Ms Abbott]

I entirely agree with hon. Gentleman. Changes in society and economic changes such as the collapse of manufacturing and of de-industrialisation have left many young men unclear about their role, which puts tremendous pressure on their health and well-being.

Before concluding, I want to say a few words on black and minority ethnic persons and mental health. It has been known for at least 25 years that BME persons are disproportionately present in the mental health system. We are more likely to be diagnosed as schizophrenic, less likely to be offered talking therapy, and more likely to be offered drugs and electro-convulsive treatment—the hon. Member for Totnes touched on that important point. There is therefore a great deal of fear and anxiety about approaching the mental health system on the part of some of our BME communities. Very often, mothers will be trapped at home with sons who have serious mental challenges. I have dealt with cases in which they are assaulted in their own homes, but are so frightened of the system that they will stay trapped rather than take their sons for treatment. That is a real problem. We must monitor what is happening and use the voluntary sector. We need to ensure that minority groups do not hold back from presenting with mental health problems. The later people present, the more severe the problems.

Mental health is the biggest financial burden on the health service. It will affect the families of all hon. Members in the Chamber in our lifetimes. There is much to be concerned about in mental health trends. For instance, there is a rise in mental health issues among young people. Fully half of lesbian, gay, bisexual and transgender youngsters are self-harming.

As I have said, there is a relationship between an economic downturn and a rise in suicides of men under the age of 35. None the less, there is the possibility of progress. I believe that there is now less stigma about mental health than there was a generation ago, and the debate we had last year on the Floor of the House played its part in helping to lessen it. I think there is more understanding about some of the contributory issues than there was a generation ago, and I believe that public health going to local authorities opens up the possibility of innovation in mental health, working together with the voluntary sector.

I am grateful to the right hon. Member for Sutton and Cheam for securing the debate. I hope that it is part of a process of parity of esteem that will improve the outcomes for so many of our men, women, family members and communities.