Queen's Speech

Lord Williamson of Horton Excerpts

Thursday 3rd June 2010 Lords Chamber

[Lord Williamson of Horton]

My Lords, I am still here and I intend to speak today on health and, in particular, on mental health. I welcome the noble Earl, Lord Howe, to the Government and recall that we had amiable and effective co-operation on mental health issues during the previous Parliament—we often agreed—so I am hopeful today.

Although there were no specific legislative proposals on mental health in the gracious Speech, the Government have indicated some forthcoming changes in the health field which may have repercussions for mental health. It is also evident that because the amount of financial resources for health expenditure is limited and is going to be under serious pressure, mental health is certainly not exempted from the pressures in the period ahead. Indeed, it may be under greater pressure than provision for physical health.

We do not have to legislate and re-legislate time and again to achieve the best results, but it is important that the Government should have a clear idea of their priorities, even if the implementation rests, as it does in many health areas, with the health authorities at local level. I am glad to see specific priority given in the coalition programme to research on dementia, and to see reference in paragraph 25 to “talking” therapies, both of which are important matters.

What, then, are the priorities for action on mental health in this period of strong pressure on the public finances? First, health authorities should try as far as possible to carry through the implementation of improvements to care decided on in the Mental Health Act in the previous Parliament. These include better provision of advocacy for those people, particularly young people, who are caught up in mental health problems which they do not always understand, and the provision of age-appropriate accommodation in mental health units for young persons and children. These changes resulted from amendments to the Bill in this House which I believe the noble Earl, Lord Howe, supported. I congratulate Lancashire Care on opening in April new facilities to provide age-appropriate accommodation for the young exactly as Parliament wished. I acknowledge at this point the efforts of the previous Labour Government, particularly the Ministers in this House, in carrying through the Mental Health Act. They perhaps needed a little prodding, but they did a good job none the less. Secondly, I share the view of Rethink, the largest voluntary provider of mental health services in the United Kingdom, which supports more than 48,000 people every year through its services and support groups. The areas which it considers crucial are: access and investment; criminal justice; and stigma and discrimination.

On access and investment, NICE produced as recently as 2009 updated guidelines on how schizophrenia should be treated, which individual NHS organisations should try to follow through. Currently, some of them are struggling, and it is clear from the very recent report of the all-party parliamentary group that this continues. Contrary to some misunderstandings, a first onset of schizophrenia in many cases never recurs. In other cases, its impact can be much reduced by various treatments and rehabilitation achieved. We know that cognitive behavioural therapy—CBT is a rather easier way of describing it—has a significant effect on treating schizophrenia. This issue now arises because of the extremely long waiting times for access to this treatment. The average in the whole kingdom is between five and seven months—in some cases, of course, it is much longer because that is the average figure. Waiting times are a significant factor affecting engagement with therapy. They affect the effectiveness and the uptake even when therapy is later received. Despite the economic climate, an improvement in waiting times should be the objective.

I make my plea for mental health services because we know that the pressure on them is likely to be disproportionately strong. In his letter of 1 April to foundation trusts, Stephen Hay of Monitor, the independent regulator, pointed out that mental health providers face a different set of risks from those in the acute sector. Historically, during periods of financial pressure in the healthcare system, expenditure on mental health activity has fallen more rapidly than expenditure in other areas. Mr Hay was quite right to draw attention to revised, downward financial assumptions, but we in Parliament can rightly stress the importance of some elements of mental health treatment, as do I.

I wish to say a word about the large number of people with severe mental illness caught up in the criminal justice system without much-needed treatment. In a powerful speech in the debate on the Address last week, the noble and learned Lord, Lord Woolf, pointed out the mess that we are in as a result of the overload on our prisons and the very high cost to the taxpayer. One of the most evident features of the problem is the very large number of prisoners who have some form of mental problem at any one time. At any one time, about 10 per cent of the prison population have serious mental problems and 30 per cent of female prisoners have had a psychiatric acute admission to hospital before they enter prison. I urge the Government to act on the recommendations in the excellent Bradley report, and make it a priority to reduce the large number of persons with mental illness in the prison system and divert more of them into healthcare.

Finally, we must keep up the effort to remove stigma and discrimination against those with mental illness. The Time to Change campaign, led by Mind, Rethink and Mental Health Media, is good, but mental health service users consistently identify stigma as an impediment to their overall health and well-being and access to other health services. I have spoken today to press on the Government why we must have priorities for improvements in mental health provision, and I look forward to a favourable reply.