Mental Health

Luciana Berger Excerpts

Wednesday 9th December 2015 Commons Chamber

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I beg to move,

That this House believes that mental health should be treated with the same priority as physical health and recognises the importance of promoting good mental health from childhood through to adulthood; believes that not enough progress has been made in translating this House’s commitment to parity of esteem between mental and physical health into practice; notes with concern that the King’s Fund has reported widespread evidence of poor-quality care across mental health services, and the latest available figures show a rise in suicide rates and the number of detentions under the Mental Health Act 1983 increasing by 10 per cent in the past year alone; further notes the delay in the publication of NHS England’s Mental Health Taskforce report; notes the concerns that have been raised with the Scottish Government regarding the rate of inappropriate admissions of young people to non-specialist facilities for mental health treatment which have increased by 38 per cent since 2011; is concerned by the absence of data on NHS spending on mental health services since 2011-12; opposes the Government’s decision not to enshrine the right to psychological therapies in the NHS Constitution; and calls on the Government to urgently rectify this systemic inequity in entitlement to treatments, reinstate the annual survey of investment in mental health services and develop and implement in full a new strategy to improve the Government’s cross-departmental response to mental health.

It is a privilege to open this debate as the first shadow Minister for mental health. The fact that we are having this debate is testament to just how seriously the Opposition consider mental health. The issue affects one in four of us every year, yet it has been neglected for far too long. Mental health has come out of the shadows in recent years, and I know that many Members on both sides of the House feel very strongly about this issue. There have been many important steps forward, but talk to anyone with a mental health condition and they will tell you that they still face stigma, prejudice and discrimination. Sadly, there remain many areas in which there has not been the progress for which we had hoped.

Labour Members have deep concerns about our nation’s mental health and the services and support that are available. Three years ago, my Labour colleagues in the House of Lords won the fight to ensure that the Government wrote parity of esteem between mental health and physical health into law. However, the gap between the rhetoric we hear from this Government and the reality for patients on the ground is growing wider.

I am sure Members on both sides of the House have many constituency cases that echo such concerns. In my first few months in this position, I have been struck by the thousands of messages I have received from people up and down the country. They are desperate to see a change in how our society approaches mental health. This strength of feeling is not surprising. On this Government’s watch, there has been an increase in the number of patients who report a poor experience of community mental health care. More patients have to travel hundreds of miles just to get a bed. The number of children being treated on adult wards, which the Mental Health Act 1983 rightly says should not happen, has risen again this year. The number of people becoming so ill that they had to be detained under the Mental Health Acts leapt by 10% in the past year. The level of suicides, particularly among men under the age of 45, has been at its highest since 2001.

[Ms Karen Buck (Westminster North) (Lab)]

Does my hon. Friend share my concern about the scale of the stress—by common agreement, often inappropriate stress—on the police as a consequence of the pressure on emergency mental health services? My local police have advised me that they sometimes spend half a shift with severely mentally ill patients who are queuing for access to acute mental health hospitals. That is bad for the police and bad for the patients, and is a reflection of the terrible pressures on the acute mental health sector.

[Luciana Berger]

I thank my hon. Friend for making that very important intervention. There are too many stories of our blue light services—not just the police, but our ambulance and fire services—being under incredible pressure in contending with such issues. I believe that the Government must do more to address that issue.

[Norman Lamb (North Norfolk) (LD)]

I am pleased the hon. Lady has called this debate. Does she share my view that yesterday’s report on perinatal mental health makes incredibly disturbing reading? Many women have lost their lives because of the absence of services. We must commit to making sure that every part of the country has good services to ensure people get through such difficult times.

[Luciana Berger]

I will come on to the very serious issue of perinatal mental health that the right hon. Gentleman raises. Again, we should all be very concerned about that issue.

I am very concerned that there has been a psychiatry recruitment crisis, with a 94% increase in vacant and unfilled consultant posts. The NHS constitution treats mental health and physical health differently. The Government claim to be increasing mental health budgets, but patients and professionals tell a different story. Ever since Ministers discontinued the annual survey of investment in mental health three years ago, we do not have an accurate picture of spending on mental health in our country.

[Paul Blomfield (Sheffield Central) (Lab)]

My hon. Friend is making an important point about the transparency of spending. Last June, I asked the then Health Minister, the right hon. Member for North Norfolk (Norman Lamb), who is in his place, when figures would be published, and he told me that the Government were working with NHS England to provide meaningful data. Last month, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) tabled a question for written answer asking when the information would be available. It is still not available. Does my hon. Friend agree that the Government should come clean?

[Luciana Berger]

I thank my hon. Friend for his very important intervention. One of the key points of my speech is that there is so much we should do to shine a spotlight on what is happening to mental health funding right across the country.

[David Rutley (Macclesfield) (Con)]

The hon. Lady is of course right that this subject is vital. The Government are working hard on it. Will she join me in welcoming the Government’s promise and commitment to bringing in an extra £600 million for mental health services, as set out in the autumn statement?

[Luciana Berger]

My concern partly rests on the fact that, given the cuts we saw during the past five years, we are only returning to the levels of spending on mental health that we had back in 2010. I have asked a number of questions about how the £600 million might be presented, but I am waiting for the answers to see how the Government will allocate that money. I will come on to the pledges that the Government have made and what is actually happening in reality.

[Mr Robin Walker (Worcester) (Con)]

rose—

[Luciana Berger]

I will make a little progress, because I have my speech to get through and I am conscious that many Members on both sides of the House want to contribute to this debate.

We are calling for three things that we believe will make a difference. First and foremost—several interventions have referred to this—we are asking the Government to restore transparency to address the murky picture of mental health funding. Secondly, we are asking Ministers to address the fundamental inequality that currently exists in our NHS constitution. Finally, we are asking the Government to prioritise prevention and to implement a fully cross-departmental plan to prevent mental health problems from developing in the first place.

[Helen Whately (Faversham and Mid Kent) (Con)]

Does the hon. Lady agree that transparency is known to be a very effective lever for the Government to use to improve quality? Does she welcome the steps taken by the Government to increase transparency in the performance of mental health services?

[Luciana Berger]

I do not share the hon. Lady’s view. Just in the last week, I have written down a list of 10 things about which I have asked the Government for figures, but about which I have been told that they do not hold information centrally. Many of the statistics that were available previously are no longer available. The central request we are making today is to restore the transparency, particularly on how much is spent on mental health, which the Government took away in 2011-12. Many Members on both sides of the House would like to know those figures.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

My hon. Friend is making a very powerful speech. On prevention, is she as concerned as I am that a recent report by the University of Liverpool has estimated that an additional 590 suicides were associated with the work capability assessment process, a Government policy, between 2010 and 2013?

[Luciana Berger]

I am fully aware of the research that my hon. Friend mentions. It was carried out by a number of academics from the University of Liverpool, including one of my constituents. I have studied the research very carefully. It highlights many areas of concern, particularly the changes and reforms made by the Department for Work and Pensions that have had a negative impact. I will address the very point she raises later in my remarks.

Nowhere is this gap between Ministers’ rhetoric and the reality more evident than when we look at investment in our mental health services. Only last year, funding for mental health trusts was cut by 20% more than that for other hospitals. In 2011-12, total investment in mental health dropped for the first time in a decade. Perhaps unsurprisingly, in the same year the Government stopped publishing how much they invest in mental health.

Last year, I had to use freedom of information requests to get to the bottom of how much clinical commissioning groups were allocating to mental health: 67% of those who responded spent less than 10% of their budget on mental health, despite the fact that mental health accounts for 23% of the total burden of disease. This year, the Minister for Community and Social Care promised to do something about this. He said he would ensure that investment in mental health by clinical commissioning groups increased in this financial year in line with the increase in their overall budgets. However, as the Government do not publish a central record of these data, I had to use the Freedom of Information Act to find out for myself. Over the past summer, I found that more than one in three CCGs were not meeting the Government’s expectation. That is just one of many Government pledges on mental health that have not been translated into reality.

[Mr Andrew Mitchell (Sutton Coldfield) (Con)]

The hon. Lady is making an important speech, but may I encourage her to be as bipartisan or as all-party in her approach as possible on this vital issue? It is very good to see the Leader of the Opposition and the Heath Secretary in their places, both of whom have a long-standing interest in this issue. Will the hon. Lady at least accept that the all-party campaign led by the right hon. Member for North Norfolk (Norman Lamb)—very substantially assisted by Alastair Campbell, who has some considerable expertise in this area—was successful, beyond the scenes, in persuading the Chancellor to produce an extra £600 million for mental health? All of us will try to ensure that that money is spent well, but let us try to do so with an all-party or bipartisan approach.

[Luciana Berger]

I know that the right hon. Gentleman has worked hard on these issues, as have many Members across the House. My job is to hold the Government to account for the promises they have made, and that is what I am endeavouring to do. Where there are opportunities for us to work together we should be keen for that to happen, but the Government have not delivered on their previous pledges. I am keen to know the detail of how that £600 million will be allocated and over what period, and we look forward to that information coming forward.

The spend of clinical commissioning groups is just one pledge on mental health that has not translated into reality, and—unfortunately—another is the commitment to spending £250 million on child and adolescent mental health services this year. In response to a parliamentary question, the Government have admitted that there will be a £77 million shortfall on what they have pledged to spend this year. With those spending promises so far unfulfilled, Labour Members are concerned about the lack of transparency on mental health spending. That is why we are calling on the Government to reinstate the annual survey of investment in mental health services.

It is not only in funding that equality for mental health has yet to be achieved, because a huge disparity remains at the heart of our NHS. The NHS constitution sets out the rights to which patients, the public and staff are entitled, and the pledges that the NHS is committed to achieving. The constitution enshrines our rights to access drugs and other treatments, but it does not extend that right to talking therapies. Recently, the Government consulted on adding a right to psychological therapies to the NHS constitution, but they decided not to include it in its latest version. That decision reinforces the existing bias in the system against mental health, and if the Government are serious about fair access to cost-effective mental health treatment, they must address that fundamental disparity.

[Jonathan Edwards (Carmarthen East and Dinefwr) (PC)]

I am disappointed with the tribal attacks on the Scottish health service in the motion, and it does not say much for the new politics promised by the Leader of the Opposition. Has the hon. Lady reflected on the situation in Wales—the only part of the UK where the Labour party is in charge—because the Academy of Medical Royal Colleges in Wales, which represents 16 colleges and facilities, said last month that mental health services in my country face significant inequalities? How will the hon. Lady respond to those concerns?

[Luciana Berger]

I have heard from my colleagues in Scotland about the challenges that they face with mental health services, and it is right that we should raise that issue during this debate. I have also had the opportunity to meet my colleagues in Wales and see the fantastic work that they are doing. Their pioneering piece of mental health legislation, which came into force in 2012, is the first for any developed country in terms of how it treats mental health, and it ensures that patients have a proper dedicated plan that considers not only their health needs, but their support, personal care, wellbeing, education and training. I look forward to working with my colleagues in Wales and to supporting them in the fantastic work that they are doing.

[Mr Ivan Lewis (Bury South) (Lab)]

My hon. Friend made an important point about access to talking therapies. One of the biggest consequences of not having such access is the fact that the only option available to clinicians is medication—often in very inappropriate circumstances—which can lead to people becoming dependent, sometimes for a long period of time. This is not just a minor matter about whether this provision is in the constitution; that lack of access leads to inappropriate intervention that can have a lifelong effect on many people.

[Luciana Berger]

I thank my hon. Friend for his important intervention. I am sure that too many of us hear from our constituents about how that sort of experience has been replicated across the country. We know that the number of prescriptions issued for mental health issues has risen exponentially and is into the millions for people who have to access drugs. Sometimes that is because they cannot access talking therapies, which should be of serious concern to us all.

[Lucy Frazer (South East Cambridgeshire) (Con)]

Does the hon. Lady welcome the Government’s commitment to introducing waiting time standards so that patients do not have to wait a long time to get access to a talking therapy? This Government introduced that measure, but the Labour Government did not.

[Luciana Berger]

The Labour Government created the services in the first place. In order to introduce a waiting time standard those services have to exist, which was not the case previously. We had to address the chronic underfunding of mental health that existed pre-1997, and we introduced the improving access to psychological therapies programme, of which we are incredibly proud. As things develop, it is right that those waiting time standards come forward. The Labour party had waiting time standards in place for all consultant-led services, which included physical and mental health. I am proud of that fact but disappointed that in too many cases the same equality is not also applied to mental health. If the Government are serious about fair access to cost-effective mental health treatment, they must address that fundamental disparity. That is why we are calling on the Government to commit to ensuring that all patients, regardless of whether they need a drug, a physical health treatment or a psychological therapy, have the same rights.

[James Morris (Halesowen and Rowley Regis) (Con)]

rose—

[Luciana Berger]

I hope the hon. Gentleman will forgive me but I will make some progress as I am conscious of time.

Ensuring that people have access to help early on is critical to preventing people from becoming ill, but in recent years, short-sighted cuts to key prevention, early intervention, and community services have been having a devastating impact. When the number of children with a mental health problem who turn up at A and E has doubled in recent years, when one person in prison takes their own life every four days, when a young person who is self-harming is told that because they are not suicidal they do not meet the threshold for help, and when a woman with an eating disorder is turned away from specialist services because her body mass index is not low enough, it is clear that people are not getting the right help early enough.

Too often, mental health problems are ignored, and it is only when they reach crisis point that they receive attention. More and more I hear from mental health professionals across the country that their middle-tier community services, psychologists and counsellors are being stripped out. Apart from the obvious devastating human cost, which impacts on people’s ability to hold down a job, keep a tenancy, pay the mortgage and maintain relationships with partners, friends and family, those decisions will cost our NHS and local authorities more as they struggle to deal with the consequences of serious ill health that could have been prevented. That cost is not insignificant. Recent studies have put the cost of mental ill health to our society at a staggering £105 billion a year. How can the Secretary of State and this Tory Government justify that? Ensuring that people can access support when they need it is an urgent priority, but if we are to ensure that our services are sustainable into the future, we must do much more to prevent people from becoming ill in the first place.

The right hon. Member for North Norfolk (Norman Lamb) mentioned perinatal mental health problems, which affect up to 20% of women at some point during pregnancy and/or the year after the birth of their baby. Left untreated, perinatal mental health problems cost our economy £8 billion a year. Is it not appalling that even if those women seek help, they are not always guaranteed the specialist support they need? The number of mother and baby units has dropped since 2010. The Government’s pledge to spend £15 million on perinatal mental health this year was welcome, but as of this month— according to an answer I received to a parliamentary question—the Government have spent just one fifteenth of what they promised. That is a bitter disappointment because intervening early in perinatal mental health does not just help to improve the health and wellbeing of the mothers affected, but it also improves that of their children.

[James Morris]

May I take the hon. Lady back to her point about the IAPT programme that was introduced by the previous Labour Government and is an illustration of where both parties have delivered success? It may be good to enshrine psychological therapies in the NHS constitution, but we need to build more capacity in the system to deliver on access standards. This is not something that we can just write into the constitution; we need to increase choice and access to psychological therapies across the country.

[Luciana Berger]

I do not think it is an either/or situation; it is about how we do both, and I will come on to that in the rest of my remarks.

We know that 75% of people who have mental health problems in working life first experienced symptoms in childhood or adolescence, yet only about 6% of the mental health budget is spent on child and adolescent mental health services. We need to do more to focus attention on children, young people and, crucially, prevention, and here we must look to our places of learning, our workplaces and our communities. We need schools and colleges that promote good mental health. We need to ensure that all children have access to high-quality social and emotional learning so that they acquire the skills to express how they feel and develop an understanding and awareness of good mental health. We were concerned to read the 2013 Ofsted report on personal, social, health and economic education, which stated that mental health education was often omitted from the curriculum owing to a lack of teacher training. The Government have funded the PSHE Association to publish guidance and lesson plans to support teaching about mental health, but how are the Government ensuring that schools are actually using it?

We need communities that promote good health and wellbeing. Poor housing, fuel poverty and neighbourhood factors, such as overcrowding, feeling unsafe and a lack of access to community facilities, can have a harmful impact on mental health. These, along with abuse, bullying, trauma, deprivation and isolation, are just some of the levers of mental distress in our communities that we must address.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate my hon. Friend on setting out such a strong case. Does she agree that the pressure on local government over the last few years has had a negative impact on community cohesion in relation to mental health and led to a growth in loneliness and other such things that spawn mental health problems?

[Luciana Berger]

My hon. Friend’s intervention brings me neatly on to my next remarks. I am enormously concerned about the impact of the Government’s deep cuts to local authority budgets over the past five years, of the additional £200 million in-year cuts to public health and of the cuts coming further down the line. I am concerned about their impact on our communities and the services that serve them, such as our libraries, drop-in centres, leisure centres, befriending services—my hon. Friend talked about loneliness—children’s centres, which support parents and young children, and citizens advice bureaux, which support people early on. They are the glue that support and keep our communities together, and I am concerned about what might happen over the next few years.

We need a social care system that is integrated with our physical and mental health services, and we will continue to push the Government to address the fragmentation across these systems. Billions have been slashed from social care budgets and the number of people receiving social care support for mental health has fallen by a quarter since 2009-10. This is seriously impacting on mental health trusts’ ability to discharge their patients. I hear that time and again when I visit mental health trusts across the country. They have patients they cannot move out because the social care is not available for them to move into.

We need workplaces that promote a good work-life balance and where mental health is recognised, understood and supported. Some 70 million working days are lost every year owing to stress, depression and other mental health conditions. Mental health problems cost employers in the UK £30 billion a year through lost production, recruitment and absence. As the chief executive of NHS England has rightly pointed out, the NHS has to get its own House in order. Across the health service, staff tell me they are concerned about their wellbeing and that of their colleagues. Longer hours, fewer resources, greater demands and an incredible amount of goodwill are creating a perfect storm within the NHS. The figures from the NHS staff survey show that the proportion of staff reporting work-related stress has increased from 29% in 2010 to 38% in 2014.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

In the spirit of bipartisanship touched on by my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell), will the hon. Lady accept the clear evidence showing a link between good mental health and employment and comment on the number of jobs created over the past five years, which, I have no doubt, has helped to promote good mental health?

[Luciana Berger]

I am interested in the hon. Gentleman’s intervention as I am about to talk about employment and unemployment support. I am concerned by the number of constituents coming to see me about the increase in precarious employment and their ability to budget and sustain themselves from week to week.

For those who are unemployed or lose their job because of their condition, the hope of getting back into work under the Government is unjustifiably slim. The latest statistics reveal that fewer than 9% of people with mental health conditions receiving employment and support allowance have been helped back into work by the Work programme. In fact, 83% of people surveyed by the charity Mind reported that the Work programme had made their mental health condition worse. How can it be right that programmes that are supposed to help people into work are doing the opposite?

These issues alone cover the work of at least five Departments, and it does not stop there: the arts have long played an important role in helping people with mental illness; the Ministry of Justice must do much more on mental health in our prisons; and all front-line professionals, especially those in our police and emergency services, need training and support in how to respond to mental health issues.

I come now to our third and final call: we urge the Government to implement a truly cross-departmental plan to improve their response to mental health issues within our society. “No Health Without Mental Health”, published in 2011, promised to be a cross-Government outcomes strategy for people of all ages, but we are fast approaching its fifth anniversary and progress has been limited. We need a new strategy with teeth that will co-ordinate work across all Departments and set priorities, measure progress and evaluate success. We have been eagerly awaiting NHS England’s taskforce report, which was due to be released this autumn, yet we heard the other week in the Chancellor’s autumn statement that it has been delayed until next year, when the NHS England planning guidance will already have been issued. What influence or impact do the Government hope the report can have if the NHS guidance for the coming year will not take it into account?

In conclusion, mental health matters—in our schools, our workplaces and our communities. It matters to our fulfilment as individuals and to the economic success of our society. There have been important strides forward, which we welcome, but we are also concerned that too much is at risk. We hear too often that our mental health system is in crisis. We are concerned that the right help and support is not there for people when they need it; we are worried that not enough is being done to prevent people from having to turn to these services in the first place; and we are anxious that, in some areas, changes taking effect across Departments are making things worse for our nation’s mental health. Much needs to change, and we are asking for three things that will make a difference. I commend the motion to the House.

--- Later in debate ---

[Mr Hunt]

We, as a Government, make commitments and choices in terms of where we want resources to go, and we then have a duty to ensure that they are followed up locally. As we know from our experience of the health service, sometimes—under all Governments—that advice is followed, and sometimes it is not. The introduction of proper independent ratings, area by area, will enable us to expose the areas that are not making the commitment to mental health that they should be making. As has been pointed out many times by Members in all parts of the House, failing to invest what is needed in mental health is a false economy. It stores up problems for accident and emergency departments and for the providers of mental health services, because late intervention means more expensive intervention, and it is of course a very real human tragedy for the individuals concerned.

[Luciana Berger]

rose—

[Mr Hunt]

As the hon. Lady is the shadow Minister, I will give way, but for the last time.

[Luciana Berger]

I thank the Secretary of State. Will he clarify the commitment that he has just made? Does it extend to ensuring that we will be shown a clear picture of mental health spending in every area?

[Mr Hunt]

I believe that we will be able to do that, but I will write to the hon. Lady to clarify exactly what we think we are able to do. I am certainly committed to ensuring that the House is given information about the quality of provision throughout the service, and investment is a factor in determining whether the standard of that provision can be as high as we want it to be.

The hon. Lady rightly spoke of the importance of cross-Government work. We have established an innovative unit with the Department for Work and Pensions, and have set up a series of pilots to help people with mental health conditions to get back to work. We urgently need to do more to reduce the stigma perceived by employers. According to the findings of one survey, up to 40% of employers would avoid hiring someone with a mental health problem. We also want to help those who are at risk of leaving work because of mental health problems. We are working closely with the Department for Education as well. We have launched a pilot programme to create a single point of contact for schools that are concerned about pupils with mental health challenges. It now covers 22 areas and 27 CCGs.

If we are to tackle this issue, however, we need to achieve something that the Government alone—indeed, the House alone—cannot deliver. We need further progress throughout society in reducing that stigma. Bill Clinton once said:

“Mental illness is nothing to be ashamed of, but stigma and bias shame us all.”

Let me end by paying tribute to the Time to Change movement, founded by Mind and Rethink, and the Dementia Friends movement, led by the Alzheimer’s Society. I also pay tribute to Members in all parts of the House who have participated in mental health campaigns, and reassure them that they have the Government’s full support as we try to change attitudes on this vital mission. Someone once said that the greatest cruelty was our casual blindness to the despair of others. Let us resolve today that when it comes to mental health, no one can ever say that about the House of Commons.