Health: Parity of Esteem

Lord Alderdice Excerpts

Monday 28th November 2016 Lords Chamber

Asked by

[Lord Alderdice]

To ask Her Majesty’s Government what plans they have to ensure parity of esteem between mental and physical health.

[Lord Alderdice (LD)]

My Lords, first, I thank all noble Lords who have indicated their wish to speak in this debate. They are all Members of your Lordships’ House who have a considerable interest in this area. Perhaps I may mention in particular the noble Baroness, Lady Hollins, who, as a colleague in the Royal College of Psychiatrists, was probably more responsible than anyone for including the notion of parity of esteem in the Health and Social Care Act 2012. That is one reason that we are debating this Question this evening.

I also wish to mention the noble Lord, Lord Lansley, who was of course Health Secretary. He recently put his name to a letter, along with every other Health Secretary in this country over the last 20 years and a number of other senior concerned people, to talk about how the failure to provide appropriately and fully for mental health is a stain on our nation. I look forward to the debate because I think that it provides another opportunity for us to keep this important matter to the fore—not just mental health but the question of how we address these issues.

I should start by declaring two interests. First, I am a fellow of the Royal College of Psychiatrists and a clinical professor at the University of Maryland in the United States. Secondly, I was one of the people who negotiated the Belfast agreement. The first of those may seem fairly obvious and the second a little more opaque, but the reason for mentioning it is that the notion of parity of esteem was central to the Belfast agreement, long before it was discussed in terms of mental and physical health.

It is important because there were two approaches to the notion of parity of esteem there. The first was that parity of esteem really meant equality of treatment between Protestants and Catholics—between unionists and nationalists. The other, to which I adhere, was that parity of esteem was about an approach to all the people in the community. It was not about a dividing up into one side and the other and a balancing up, but about parity of esteem for all elements of the community—those who came originally from Ireland, those who came in later and those who have come more recently. Parity was not a question of one side and the other.

That is relevant to this debate because it seems to me that there is a danger that we see addressing these issues as a balancing-up of the funding, structures and championing of mental health against those of physical health. There is no doubt that there is certainly a case for that, and I have no doubt that other noble Lords will speak to the facts and figures and explain that mental health has always—certainly in living memory—been the Cinderella of health and social care, and how despite commitments in law and political policy, there is not much evidence that the situation is dramatically improving. That being the case, of course it is appropriate for us to press for things to improve, and to try to ensure that funding and structures do not disadvantage the care of the mentally ill. However, at the same time, we need to ask ourselves some questions. I would argue that instead of repeatedly returning to the issue of changing structures—and the Health and Social Care Act became much more famous for changing structures than it did for the inclusion of the notion of parity of esteem—engineering the cultural change emblemised by the notion of parity of esteem could fundamentally be much more important. That is what I wish to address, and other noble Lords will pick up on the other issues.

When Thomas Jefferson penned the American constitution, he described the inalienable rights as life, liberty and the pursuit of happiness. If any politician nowadays was to propose the pursuit of happiness or a ministry of happiness, they would probably be made fun of. That is partly because words change their significance and meaning, and the words of the 18th century do not necessarily fit with the language of today. Rather than “the pursuit of happiness”, the language that we might use is “the development of mental, physical and social well-being for our people”.

The notion that the pursuit of happiness, or of mental, physical and social well-being, might be a new ambition for health was picked up by the former Minister of State Paul Burstow, my friend and colleague, in a CentreForum panel and publication, which the noble Lord, Lord Adebowale, also participated in. It said that the future perhaps is not in creating structures in which mental health gets a fair crack of the whip or slice of the cake, even though that is extremely important, but rather that we try to look at addressing the well-being of individuals and communities in our country. In truth, no matter how much we deal with physical health problems, if people do not feel a sense of well-being, no amount of physical health will make life worth while.

I remember as a very young psychiatrist in Northern Ireland trying to get across on the radio and television issues about depression and bereavement and so on. I was joined by a very senior emeritus professor of surgery, Professor Rogers. I thought, “Oh my goodness, this is extremely intimidating; what is he going to say?”. I made my little presentation and he said, “I want people to listen to this because in a lifetime of working in surgery, with all the horrible diseases and disorders that people have, I have seen very few of them who actually wanted to take their own life. It is a measure of the deeper distress of many people when they are mentally ill that they sometimes feel a need to put an end to their life and their misery”. I have never forgotten that. We all try to promote our own causes, and yet here he was saying, “Yes, I did all sorts of work; but fundamentally, if people get to the point where life is not worth living and they take their own life, it is an incredible marker”.

In 2010, I did a report for the Royal College of Psychiatrists on self-harm and suicide. We marked out a number of things that needed to be done to address the increasing level of suicide. It is not getting better. Arguments might be made about facts and figures, percentages of money, numbers of people being seen, numbers of out-patient appointments and access to services. All of those are relevant and necessary for those who are trying to commission and provide services. But if we all know in our hearts that people who contemplate taking their lives have obviously reached a point that nobody should find themselves reaching—there has certainly been inadequate help and support—that marker tells us that something important has failed in addressing the well-being of our people.

This is also not really a party-political thing, because it has always been a matter of concern on all sides of the House. The noble Lord, Lord Prior, wrote me a note to apologise for not being able to be here for the debate, but he knew that he would be well represented. He said that this was a matter of great importance. Let us not treat it as a question of party politics. Let us try to understand what we need to do to make a real change. In the CentreForum document and the recent report by the King’s Fund and others, there has increasingly been an appreciation that we need not just to build on the pillars of individual kinds of illness and care but to find a way of bringing them together.

At home in Northern Ireland, we ended up with an integrated health and social care system. That was the one that I worked in all my life. The political problems meant that social care and health care—mental and physical—were all taken together and were able to be dealt with without arguing about budgets, where services were or any of those kinds of things. It helped. There is no doubt that it helped. However, it is not just about an integration of structures. It is also about a cultural change that helps us understand that mental health is not about one bit of us, physical health about another bit of us and social well-being and our relationships about yet another bit of us. We cannot be divided up in that way in any helpful fashion. It is about dealing with each other as human beings—all of us, the whole package of being a human being.

One of the tragic and disastrous consequences of what is happening in politics now globally is that people are not treating others as human beings. We can do all sorts of horrible things to people when we do not treat them as human beings. We need to think about things in terms of mental and physical health care. Of course we need to have specialists to focus on this particular aspect of the problem or that particular disorder, but there is no part of our physical care that does not have a mental and emotional component to it. There is no part of our mental life that is not related to our body. There is no part of our existence that is not about relationships with other people.

My question for the Minister is not just about what is being done to promote parity of esteem in terms of funding and making sure that it is fair funding. I am not arguing about the equality, but is it fair or is it not? Is it becoming less fair and if so can we do something about it? Yes, of course there are issues about structures and questions of commissioning, but are there things that we can do to change the culture and approach that ensures that we are dealing with the well-being of the people who live in our communities and of the communities themselves? That kind of cultural change is necessary if we are to achieve what we want to achieve in terms of parity of esteem for these different components of ourselves and our fellow human beings. I am keen to know what the Government feel able to do to promote that.