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Mr Matthew Offord (Hendon) (Con): The Minister says that the Government wish to reduce the stigma surrounding mental illness, and I accept that. Does he agree that the decision of the Department of Health in 1994 to hold an independent inquiry into every death involving someone who has suffered mental illness or been part of the mental health system continues to perpetuate that stigma?
Paul Burstow: That is an important and challenging point, and I will want to go away and think about what we do. For patient safety, we still need to learn lessons when things go wrong in our system, acknowledge when things have not been done properly and put them right. In that sense, confidential inquiries are an important part of the learning mechanism. One point of frustration that I hear in debates in the House and see in correspondence from hon. Members is the sense that lessons are not learned. As part of our reforms, with the NHS Commissioning Board taking on responsibility for patient safety, we need to ensure that that is not the case in future.
I wish to make another point that touches on the contributions of my hon. Friend the Member for Broxbourne and the hon. Member for North Durham. One in five people still think that anyone who has a history of mental health problems should not be allowed to hold public office. How many former Presidents, Prime Ministers or Ministers would have been excluded if that view had been applied? [Hon. Members: “Churchill.”] Precisely. Such a law is as outdated as asylums and as outdated as many of the attitudes that sit behind it. It has to be consigned to the history books just like asylums have been, and under the coalition Government’s watch, it will be. I congratulate the hon. Member for Croydon Central (Gavin Barwell) on securing a slot for a private Member’s Bill on the subject.
Looking ahead, although we have made progress there are still big challenges to tackle. Reference has been made to the implementation framework that will be published to support the roll-out of the “No health without mental health” strategy. That framework has been produced in conjunction with five national mental health organisations—Rethink Mental Illness, the NHS Confederation, the Centre for Mental Health, Turning Point and Mind—and many others have been involved.
We have previously had a very good debate about “Listening to Experience”, Mind’s excellent report on acute and crisis care, and Mind’s policy team have been directly involved in ensuring that the framework delivers on those issues. It will provide a route map for every organisation with contributions to make to improve the nation’s mental health. It will spell out how progress will be made, measured and reported.
What does success look like? To me, it means more people having access to evidence-based psychological therapists; services intervening earlier, particularly for children and young people; services focusing on recovery and people’s needs and aspirations above all; and service users and carers being at the heart of all aspects of planning and service delivery.
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Today, economists tell us that mental ill health in this country costs £105 billion a year, and that is just in England. If we succeed and put in place the right combination of public health, anti-stigma policies, accessible psychological therapies and excellent community and acute services, we can dramatically reduce that figure. Put another way, if we can deliver the right evidence-based treatment to children and young people so that their conditions do not persist into adulthood, we can prevent as many as two in five of all adult mental health disorders. As a society, we have made huge progress in how we recognise people’s mental illness, but despite that we have not fully accepted that mental health is equal to physical health and that parity of esteem is needed between the problems of the body and the problems of the mind. That is the challenge—
Does the Minister accept, having made a convincing case for people being able to live with their illnesses by being at home, that part of the reassurance that they need to do that is to know that in periods of acute crisis, there will be a bed available for them should it be needed? That should be not only for detained patients but for voluntary patients.
Paul Burstow: One thing I did not say—I was trying to cut down my remarks—was that there is an essential need to give more people the ability to control their health care through crisis plans. Crisis plans are an opportunity for people to make a statement in advance on how they wish to be treated in the event of a mental health episode that requires an intervention from mental health services. We know that when the plans are in place, they make a huge difference to the need for admission, and that they can reduce the length of stay. We need to ensure that there is a sufficiency of beds so that people can get appropriate treatment, but we also need to ensure that there is much more focus on good, community-based intervention at an early stage. Getting that balance right is always difficult for health commissioners to achieve—I know my hon. Friend is struggling with that in his patch at the moment.
Those are the challenges the NHS faces. They are challenges not just for our health commissioners and providers but, as this debate has clearly demonstrated, for our whole society. We can transform mental health in this country only if we transform our attitudes. This debate plays an important part in that.
Andy Burnham (Leigh) (Lab): I begin by giving my apologies to the hon. Member for Loughborough (Nicky Morgan) for missing the beginning of her speech, and by congratulating the Minister on his excellent and thoughtful speech, to which I can hopefully add something.
I have high hopes for the debate. I hope it will help us to confront a major paradox: how can a subject that is so central to the big public policy challenges we face as a country—the challenges are not just of public health
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provision, but of worklessness, benefits, the criminal justice system and addiction—still exist on the fringes of our national debate, getting so little airtime and attention? As other hon. Members have acknowledged, the House, sadly, rarely applies itself to mental health. Perhaps that reflects our national stiff-upper-lip tendency not to talk openly about mental health, which in turn might help to explain why our public services are designed for the 20th century rather than the 21st.
Andy Burnham: I am proud of the improvements we made in the last Parliament, but I did not come here today to say that everything the previous Government did was right and wonderful. I will talk a little about those improvements, but given my failure to sing about Labour achievements, I am grateful to the hon. Gentleman for doing so.
We are reticent to talk about mental health as much as we should. There is a complacency in the public debate—that is not to make a political point, because it involves hon. Members on both sides of the House. The complacency goes throughout the civil service and the Government. To reflect on my time in government—not just in the Department of Health, but in the Treasury and the Home Office—it is remarkable how few submissions or meetings I had relating to mental health, given that it underlies the spending of hundreds of millions of pounds of public money. Indeed, £105 billion is the estimated cost of the full burden of mental health to this country.
That complacency is not shared by everybody and I congratulate the hon. Lady on introducing this debate. We have heard two unbelievably powerful speeches, from my hon. Friend the Member for North Durham (Mr Jones) and the hon. Member for Broxbourne (Mr Walker), to which I will turn at the end of my remarks. My hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott), who leads on these matters for the shadow health team, has rightly pointed out how mental health lies under the whole public health challenge. We will soon introduce Labour’s public health review.
We are beginning to wake up from our complacency. I am leading the debate for the Opposition to show that that comes from the top. We see the mental health challenge as central to health policy. Indeed, I made a point of making my first speech on returning as shadow Health Secretary on the subject of rethinking mental health in the 21st century at the Centre for Social Justice.
I must be honest: I shared the complacency about the mental health debate, or perhaps did not give it enough attention, but two things changed that when I was a Health Minister. First, I spent a day work-shadowing an assertive outreach team in Easington. I will never forget what one of the team told me about the early ’90s, when the mines closed and GP referrals for support were piling up on clinic desks, but there simply was no support to offer people. She said that that lay behind the social collapse in those mining communities. People facing difficult times were given no help.
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disabilities in the criminal justice system. I will never forget sitting in my office at Richmond house reading that about 70% of young people in the criminal justice system have an undiagnosed or untreated mental health problem. If that is not truly shocking to every Member and does not make us do something, frankly nothing will. That was the moment that changed how I thought, and I have tried to follow it through ever since.
I mentioned that we had a public service designed for the 20th century, rather than the 21st century, and I want to illustrate that point with reference to my own constituency. The world that gave birth to the NHS was a very different place. When the NHS was set up, Leigh, like Easington, was a physically dangerous place to live and work in. Working underground exposed people to coal dust, explosions and accidents, and people had no choice but to lock arms, look out for each other and face the dangers together—that is how it was—and that spirit of solidarity was carried over into the streets above.
Like many places in this country, then, Leigh in the ’50s was a physically dangerous place but emotionally secure, because people pulled together. In the 21st century, however, that has completely reversed. We now live in a physically safe society—our work does not generally expose us to dangers—but it is emotionally far less secure than it was for most of the last century. The 21st century has changed the modern condition. We are all living longer, more stressful and isolated lives, and have to learn to cope with huge and constant change. Twentieth-century living demands levels of emotional and mental resilience that our parents and grandparents never needed, yet the NHS does not reflect that new reality; essentially, it remains a post-war production-line model focused on episodic physical care—the stroke, the hip replacement, the cataract—rather than the whole person. That is the issue to confront.
The demands of this society and the ageing society require a change in how we provide health and social care. We need a whole-person approach that combines not only the physical but the mental and social, if we are to give people the quality of life that we desire for our own families. That one in four people will experience a serious mental health problem makes this an issue for all families and people in the country. It also means that mental health must move from the margins to the centre of the NHS.
I shall say a couple of things about that necessary culture change. How can it be that an issue that causes so much suffering and costs our society so much still accounts for only a fraction of the NHS budget? It cannot be right. We also have to consider the separateness of mental health within the NHS. This has deep social roots—the asylum, the separate place where people with mental health problems were treated, the accompanying stigma and suspicion about what went on behind those four walls. Essentially, we still have the same system in the NHS, with separate organisations—mental health trusts—providing services on separate premises. That maintains the sense of a divide between the two systems and raises a huge health inequalities issue.
The wonderful briefing that Mind, Rethink and others have prepared for this debate contains this startling statistic: on average, people with severe mental health problems die 20 years earlier than those without. What an unbelievable statistic! Why is that? It is partly—not
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completely—explained by the separateness within our system. If someone is labelled a mental health patient, they are treated in the mental health system, and consequently their physical health needs are neglected.
Andrea Leadsom (South Northamptonshire) (Con): Is the right hon. Gentleman aware that, right from the very start, the way in which a baby’s brain develops—whether development is healthy, through a loving bond, or not—can have profound implications for future physical health, and therefore life expectancy? It starts as early as that.
Andy Burnham: I completely agree, and obviously that was one of the major conclusions of the Field report, which the hon. Lady’s Government commissioned. The problem is not just the separateness of the system, although that is one of the factors; rather, it starts much earlier. We need to take that broad view.
More co-location of acute care and mental health care within the same hospital would be a good thing to encourage. We heard on the radio this morning about the RAID—rapid assessment interface and discharge—service in Birmingham, which is an excellent example of that and something we need to follow. That is part of the culture change we need in the NHS. The other part of that change is that practitioners dealing with mental health, particularly GPs, at the primary care level, should not just reach first for medical interventions, rather than social or psychological interventions. However, I am afraid that that is what we do. Let us look at these, more startling statistics. In 2009, the NHS issued 39.1 million prescriptions for antidepressants—there was a big jump during the financial crisis, towards the end of the last decade. That figure represented a 95% increase on the decade, from the 20.2 million prescriptions issued in 1998. Were all of those 40 million prescriptions necessary? Of course they were not.
Prompted by my north-west colleague, the hon. Member for Southport (John Pugh), let me pick up the point about Labour’s successes. We did address some of these issues. The improving access to psychological therapies programme is something I am very proud of taking forward as Secretary of State, because it began to give GPs an alternative to antidepressants and medication to refer people towards. That was an important development, and—credit where it is due—it was Lord Richard Layard who made such an incredible change, by pushing so determinedly for that programme.
Jeremy Corbyn: My right hon. Friend is making an important point. Too often GPs reach for medicine when they should be reaching for counselling. They should be offering a more supportive environment, but when we get high-speed GPs with little time to talk to patients, they tend to prescribe medicines when they ought to be doing something else. Does my right hon. Friend agree that we need to go a lot further than we already have?
I completely agree. I do a lot of work shadowing, and I recently shadowed a GP. What amazed me was how many of the people coming through his door were the people who also come through our doors on a Friday and Saturday. They are not necessarily looking for something to take to the chemists; they are
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actually just crying out for help, in one way or another, with a problem they are struggling with. That GP was very good and did not prescribe, but referred lots of people to the IAPT service, as I sat there with him. However, he said that across Coventry, where he was based, many others were not doing the same.
Chris Ruane (Vale of Clwyd) (Lab): The Minister mentioned the number of prescriptions that have been issued. I received a parliamentary answer a couple of days ago which said that in 1991 there were 9 million prescriptions. The Minister mentioned the figure of 42 million, but from 2010 to 2011 the number went up by 4 million. In the years before that the increase was usually 2 million a year, but in one year the figure increased by 10%, or 4 million. When I asked the Minister what his assessment was of the reason for those increases, there was no conclusive answer. We must get to the bottom of why these prescriptions are being issued and why they have gone up by 500% in a 20-year period.
Andy Burnham: We must. Perhaps I am about to make more of a political point, but as has been mentioned so eloquently today by my hon. Friend the Member for North Durham, as well as the hon. Member for Strangford (Jim Shannon), although the trend is upwards—that is happening come what may: I mentioned the financial crisis, during which the rate has jumped up, including in our time in government—the cumulative effect of some of the benefits changes on some of the most vulnerable members of society, coupled with the withdrawal of social care support by councils, means that, right now, some people out there are suffering very badly indeed. That is part of the explanation for the worrying figures that my hon. Friend has just given the House. The Government need to have a look at what is happening out there and whether or not some people are struggling with mental health problems because of the extra stress that other factors, particularly financial, are putting upon them.
I welcome the Minister’s commitment to the improving access to psychological therapies programme, but I hear that waiting times for it are increasing in parts of the country where GPs face much longer referral times. Indeed, a Mind survey of 2011 said that 30% of GPs were unaware of services to which they could refer patients, beyond medication. That tells us that we still have quite a long way to go. IAPT needs protecting and nurturing; it needs to come with a national direction in the operating framework. In the new and changing NHS world, we cannot allow it to be simply whittled away. More broadly, we need to look carefully at commissioning and find out whether GPs have the right skills to commission properly for mental health. We need to consider what the precise commissioning arrangements for mental health are, as there is still some confusion out there about them.
Paul Burstow: One of the key aspects of the NHS Commissioning Board’s work in authorising clinical commissioning groups will be to assess their capacity to commission in mental health. As I am sure the right hon. Gentleman knows, the Royal College of General Practitioners is currently exploring what the extra year of education and training will involve, as we move forward to ensuring that mental health is part of it. I think it is a very important innovation.
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Andy Burnham: I welcome what the Minister has said, but I say clearly to him that we are going to be vigilant about this. We do not want to see things slipping backwards, as we fear they may well do under this NHS reorganisation.
The hon. Member for Strangford made an important point about service personnel. I would like to pay tribute to the organisation Combat Stress, which has done a wonderful job—voluntarily, I think, for many years—giving some help and hope to people who come back here only to find that the statutory services are not providing anything for them. We have to absorb what it has done and the changes it has made into the mainstream to provide much better support. It is beginning to happen, but there is further to go.
On benefits appeals, I echo a point made by my hon. Friend the Member for North Durham. As he said, the number of employment and support allowance cases going to appeal is ridiculous. In 2009-10, the first full year of the ESA regime, 70,535 cases went to appeal at a cost of £19.8 million. In 2010-11, there were 176,567 cases at a cost of £42.2 million. If the Government want to cut waste from the benefit system, they have to get a grip on that. What we find is that 38% of cases—almost four in 10—are overturned on appeal; those cases should not have to go to appeal. My hon. Friend also mentioned the human cost. The financial cost is bad enough, but the stress that people with mental health problems are put through as they go through that process is, in many cases, unbearable. The Minister really needs to talk to his Department for Work and Pensions colleagues to encourage them to get a grip on this important problem. The Atos system is simply not working; it is actually making life a lot harder for some of the most vulnerable people in our society. Ministers need to look urgently at it.
Let me conclude with a point about stigma. I have picked up from today’s debate the fact that the hon. Member for Croydon Central (Gavin Barwell) is bringing forward a private Member’s Bill along the lines of the Bill introduced in the other place by Lord Stevenson, to whom this House should pay tribute. It is wonderful to hear that the hon. Gentleman will introduce that private Member’s Bill. Currently, a person who has had a serious breakdown and has been sectioned under the Mental Health Act 1983 is barred from being an MP, a juror, a school governor or a company director. What message does that send out? It says that recovery is not possible—a message that we might have put out about cancer in the ’50s or ’60s: “Once you have had it, it is a black mark; that’s it, you’re finished.” We urgently need to change that. Today’s debate has probably achieved some change. The Minister indicated his full support for the private Member’s Bill and I can pledge the full support of the Opposition for it. We wish the hon. Gentleman all good luck with it.
I think that today’s debate can begin to change social attitudes in the broader debate on mental health in this country. For the reasons I have set out, I think our debate has been historic, but we have a long way to go. When the Norwegian Prime Minister, Kjell Magne Bondevik had to take some time off, he publicly admitted that it was for depression. That was the reason he gave. Imagine a Prime Minister doing that! But he did so, and he changed the culture in Norway. Moreover, he went on to be re-elected and to become Norway’s longest-serving
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non-Labour Prime Minister since the second world war. That constituted incredible bravery and political leadership, and I think that we have seen two more examples of those qualities today in the speeches of my hon. Friend the Member for North Durham and the hon. Member for Broxbourne. That is the kind of leadership that changes social attitudes to mental health. Both Members deserve enormous credit for what they have said today, and I think that both have taken a major step towards changing the political debate.
“a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
Whatever differences we may have about precisely how we should construct the NHS, I think that today Members in all parts of the House can unite behind that definition, with the emphasis on prevention and well-being. I think that we can all commit ourselves to making major changes in the way in which mental health is seen in the House of Commons, the Government and the country, and begin to create a system of care for the 21st century that recognises the difficult, stressful lives that people are leading and gives them support when they need it so that they can fulfil their potential.
Mr Deputy Speaker (Mr Lindsay Hoyle): Order. Given that 19 Members wish to catch the eye of the Chair, it would be beneficial if each of them could aim to speak for about eight minutes. I hope that that will make it possible for everyone to contribute.
John Pugh (Southport) (LD): Let me begin by commending those who have spoken about their own problems today. I assure them that they have done their prospects no harm whatsoever. They have risen appreciably in the esteem of the House, although whether that is the key to promotion I do not know.
Mr Kevan Jones: I am grateful to the hon. Gentleman, but the use of language is very important when it comes to mental health. I do not consider it to be a problem. My own experience has made me stronger. I think we should be careful about how we use language: we should not describe mental health as a problem, because it is not.
I congratulate the hon. Member for Loughborough (Nicky Morgan) on introducing the debate, although she omitted to mention the Mental Health Act 2007, over which the House laboured long and hard to, I hope, some good effect.
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In the 18th century, it was possible to cross the river to Bedlam and gawp at people gesticulating, ranting, performing odd rituals, talking to no one in particular, exhibiting delusory beliefs in their own power, or expressing paranoid fears about their foes. The nearest 21st-century equivalent is probably Prime Minister’s Question Time. [Laughter.] That is not an entirely facetious point. The dividing line between robust mental health and mental illness is, in fact, a fine one. Statistics show that the bulk of people of working age who either report or are diagnosed with mental health problems are not, in general, those who suffer from the terrible scourge of schizophrenia. The hallucinations and delusions often associated with that disease currently affect less than 1% of the population, and are treated more benignly and more effectively than ever before. Moreover, numbers are not substantially on the increase.
Most mental health problems occur when the anxieties, the fears, the stresses and the dark moods to which we are all prone become insupportable, prolonged and disabling, and the individual is no longer able to cope in any ordinary sense but breaks down and loses control, social capacity and, sometimes, insight into his or her condition. That is on the increase: it is the major mental health challenge that we face.
Mental health is a genuine continuum. The mentally ill do not have viruses, germs, cellular patterns or physical impairments that the well do not have. They have the same gamut of emotions that we all have—often exaggerated, accentuated or uncontrollable, but in no way unique or uncommon. We all possess a shared vulnerability to mental health issues which could be described as a tendency to neurosis, managed with differing degrees of success at different times in our lives. That is why I took issue with some of the comments made by the hon. Member for Loughborough.
There is a nugget of truth in the American belief that we could all benefit from an element of psychiatry. As I have said, we share a common vulnerability, and for a variety of reasons—fairly complex in many cases—one in four, or one in six, citizens falls victim to that vulnerability. We have learned not to be too judgmental about those who do, and not to stigmatise them. We recognise that the vulnerability they display is often a product of circumstance, and that it is as frequently related to desirable traits—empathy and sensitivity, for instance—as to undesirable ones such as self-obsession or lack of self-control. However, although that recognition is now widespread, it does not eradicate stigma, nor does calling everybody “service users” as if they are some kind of consumer, and nor does saying mental illness is just the same as physical illness, because it is not.
The big problem for those with a record of mental health issues—particularly, perhaps, in respect of the workplace or getting off benefits and back into the workplace—is the bias of the wider world in favour of those who have not illustrated our common vulnerability. That bias is rather like having a—rational—preference for people with a stronger immune system. There are other vitiating factors at play, of course. People who suffer from mental illness often suffer from a lack of confidence, for example. There is also the fact, which has not so far been acknowledged, that a mental health diagnosis can sometimes be misused for employment and benefit reasons. The big problem is this bias and discrimination, however.
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There are only two real remedies for that. One is better public education about what mental health actually is and what mental illness and frailty actually are. I would put more faith in the second remedy, however: having a public mental health campaign that is geared in positive directions, as described by the hon. Member for Loughborough. Having said that, we must acknowledge that the active pursuit of mental well-being is a bigger and more significant task than we currently recognise. Corporate Britain, business Britain and every public service in Britain needs to be seriously engaged with the Layard agenda and to accept that we need to promote well-being at work—including here in Parliament. We must create a wholesome workplace, and therefore bother about the happiness of the workplace and the individuals in it.
We may need to tackle a huge fallacy, however: the idea that we either have mental health or we do not, so we are either employable or we are not. That ignores the fact that many people in employment—in senior jobs, even—have mental health issues, some of which might not always be diagnosed. Sometimes they work them out in the office and the workplace in a wholly unsatisfactory way, and sometimes to the detriment of their colleagues—although not always, in certain professions, to the detriment of customers and profits. Sometimes people mask their symptoms and problems through alcoholic self-medication.
There was a time when employers would have walked away from considering issues such as personal safety at work, and there was a time when they would have walked away from issues of employment legislation and the rights of people at work. Nowadays, however, most employers are keen to stick “Investors in People” logos on their notepaper to show that they are a good employer in that respect. The next, and most obvious, stage is the pursuit of the wholesome workplace, in a move beyond the “Investors in People” initiative. That must be encouraged by public health bodies and by large public and corporate organisations. Indeed, to some extent it already is encouraged: 41% of large companies now have a mental health policy. That represents appreciable progress.
For most of us, work is where we spend most of our time, and it is where our feelings of self-worth are either confirmed or demolished—that is certainly true of this place. It is where people find meaning to their lives—although we do not always succeed in doing that here. Indeed, we in Parliament cannot honestly say our working environment is wholly conducive to good mental health.
Let me conclude by reiterating my key point: we cannot help people with mental health issues without making it manifestly clear that in everyday work and everyday life mental health is everybody’s issue.
Jeremy Corbyn (Islington North) (Lab):
I welcome this debate, and I will do my best to stick to the eight minutes that you have suggested, Mr Deputy Speaker, to ensure that everybody gets to make a contribution. It is valuable to have this debate and to raise the whole issue of the stigma surrounding mental health. I pay a huge tribute to my hon. Friend the Member for North Durham (Mr Jones) and the hon. Member for Broxbourne (Mr Walker) for speaking out, because it is necessary to do so. The public need to understand that everyone knows somebody who has suffered from degrees of depression or many other conditions. I am sure that all of us, even if we do not believe that we have suffered
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from this ourselves in our own lives and in our own families, know people who have. Public attitudes have come a long way since the late Tom Eagleton was driven out of the US vice-presidential nomination in 1972 because he had had treatment for severe depression. He, to his credit, later went on to become a senator, elected with 60% of the vote, so the timidity of the political establishment in the US in 1972 was overturned by a much more generous political atmosphere some years later. We should remember people like him, who, in many respects, paved the way for it.
We have to understand that about 4,000 people a year in this country commit suicide. The figure varies a bit from year to year, but it is about 4,000. That is a very large figure indeed, which is why I intervened on the Minister on the question of deaths when people are in care or in custody, and I am looking forward to his response. As a society, we have to think a bit more carefully about the terror that some people live their lives in, which ends in a lonely suicide. These are people who were unable to seek help or support from anybody else, and were probably reading in the papers, hearing jokes on television and being the butt of comedians’ jokes about “sad nutters”, “desperate people” and so on. As a society and as a community, we need to reach out to people who are going through their own tensions and their own crises. If we cannot do that, the number of suicides will not fall and is likely to increase.
In my community, we have a good mental health service. We have a trust that operates in Camden and Islington, which is quite a small geographical area for it to operate across. It is certainly much smaller than many others in other parts of the country, and my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) and I fought very hard to ensure that it was operated on a relatively small basis because we felt that that would provide for a better service that was more in touch with the local community. I hope that it will be able to continue in that way, but I am saddened to have to report that this year the trust plans to deliver what it describes as
“£75.1m savings across the acute sector; £46.7m from acute productivity and £28.4m through changes in care setting and other demand management initiatives.”
“The work of the Islington Fairness Commission highlighted the wide-ranging impacts of challenges to mental health and wellbeing for people, communities and services in Islington, particularly during a period of economic uncertainty and financial hardship.”
“Levels of need are exceptionally high in Islington. There were 3,152 patients on serious mental illness primary care registers in Islington in 2010/11, representing 1 in every 65 patients. There are an estimated 31,000 adults and 3,000 children and young people…experiencing mental health problems…There are an estimated 3,500…drug users, and 10,000 problem alcohol users, with 46,000 adults in total drinking at hazardous or harmful levels. Underlying rates of mental health and substance misuse problems in prison reach in excess of 90%.”
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The other point I wanted to make was that the economic issues associated with stress are very serious indeed. Obviously, one such issue is unemployment, but others are housing and overcrowding and, often, the domestic violence that results. My hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) and I share the Finsbury Park Homeless Families Project unit, which is based in her constituency but does wonderful work to support families in both our constituencies. The unit’s staff point out that the severe problems of the people who come to see them are usually related to serious overcrowding, housing uncertainty and lack of secure tenancy. Various levels of stress and mental health issues pertain to that. In solving these issues, we must consider the economic factors.
We should also consider very seriously the levels of stress and depression among young people. Growing up as a young person in any community is not easy. They are faced with enormous pressures from a consumerist society to achieve and to have. Many cannot fulfil those ideals and will never be able to fulfil those ambitions. The levels of stress we are forcing on to young people result in some cases—although, thankfully, only a very small number—in serious illness or even suicide.
Yvonne Fovargue (Makerfield) (Lab): To return to the social pressures, does my hon. Friend agree that debt is a considerable social pressure? I ran a scheme where debt advice was provided on prescription and paid for by the PCT. Independent analysis reckoned that at least three suicides had been prevented by early access to debt advice. Does my hon. Friend share my concern that that access might well now be restricted?
Jeremy Corbyn: I completely endorse what my hon. Friend has said and the great work she has done in supporting advice agencies and dealing with such issues. My borough recently opened a new citizen’s advice bureau—I congratulate the council on being able to fund and reopen it—and it has been inundated with people with serious debt issues. It offers serious debt advice and a great deal of help. We have also given a lot of support to a credit union that is working very well with a large and fast-growing membership. People are accessing a limited amount of credit and support, and it is far better that it comes from that source than from the high street loan sharks who are appearing all over the country and bleeding people dry with the excessive rates of interest that they charge.
There are some things we can do, but my point is that if a young person worked hard in school, did well, studied hard and got good grades but is still unemployed and after a while becomes almost unemployable, it becomes a source of enormous stress about the future.
I want to bring up two more issues before I conclude. In my part of London and, I suspect, many other parts of urban Britain, many victims of domestic violence, usually women, seek support and therapy. The voluntary sector is often best placed to provide that support and therapy and that was why I intervened on the hon. Member for Loughborough (Nicky Morgan) when she introduced the debate to make the point that when commissioning is done by the primary care trusts or the wider trusts that deal exclusively with mental health issues, it tends to be skewed in favour of the very large and
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financially burgeoned organisations rather than local charities and voluntary sector groups with a specific base, which are often much more effective and provide a very good service. I would be grateful if the Minister could give us some good news on that, or if he could write to me about how those issues could be brought out.
In my community, we have a number of very effective charities that work with victims of domestic violence and racist abuse, which, fortunately, is not an enormous issue but nevertheless exists. We also have a large number of people who have experienced torture and violence and are either asylum seekers or have achieved refugee status. I thank those charities for the work they do. Nafsiyat, an intercultural therapy centre based in Finsbury Park, has done good and groundbreaking work on cultural values and dealing with stress and the victims of violence. The Maya centre deals with women who have suffered similar problems. We also have the Women’s Therapy Centre, ICAP—Immigrant Counselling and Psychotherapy—which gives enormous support to other people, and the local Refugee Therapy Centre. They all do very good work, all have difficulty coping with the demands placed on them and all have financial issues. When the Government talk about increased money for mental health, they should think very carefully about how the contracts are negotiated, as they often force very low rates of pay on the voluntary sector to undertake the kind of work that is done. The Minister needs to think quite carefully about that.
The housing issue has been referred to and the number of homeless people in this country is rising, as is the number who are suffering from stress. Locally, we have a group called the Pilion Trust which has recently been given a donation—I am grateful to the Amy Winehouse Foundation for that—to help in its work in providing a night shelter, but a night shelter is not a solution to homelessness problems. A solution to homelessness problems is having a requirement regarding re-housing and a much more aggressive housing programme in this country.
I conclude by saying that too many people commit suicide and suffer from mental health issues and stress in their lives. We cannot change all that but we can change the approach to mental health issues. We can look at the good work that is done and support people in that work. We can say to those who have gone through depression and crises, “That is not the end.” Such people are contributing to our society and will succeed later in life. We should recognise the value of everyone and not consign people to a mark that indicates they have become unemployable and have no future. That is as bad as what the asylum system did in the past. We can do better than that and learn from others and the good experience they have had.
Gavin Barwell (Croydon Central) (Con): First, I thank the Backbench Business Committee for securing this debate. In my limited experience in the House, the Committee’s debates often show the Chamber at its best. I also want to congratulate my hon. Friend the Member for Loughborough (Nicky Morgan), who is one of the stars of the 2010 intake on the Government side of the House. She is an example of the work that Lord Maples, who sadly passed away this week, had done to diversify the make-up of Members on our Benches. That is about a lot more than tokenism.
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As a number of Members have said, I came fourth in the private Member’s Bill ballot. I found that out because my inbox was suddenly swamped by a large number of e-mails congratulating me, and my mobile phone and desk phone started ringing at the same time. For a Back-Bench Member it is a fairly rare opportunity to change the law of this country. I have taken my time and thought long and hard about what I wanted to bring forward. On Wednesday, I will be presenting the Mental Health (Discrimination) Bill, which was introduced by Lord Stevenson of Coddenham in the last parliamentary Session, as the right hon. Member for Leigh (Andy Burnham) has said. I am doing that partly for personal reasons. Two of my closest personal friends suffer from mental health conditions, and two teachers who had a very formative role in my education, when I was a teenager, have also suffered from mental health conditions. My predecessor, the former Member for Croydon Central, Andy Pelling, who some Members in the House will have known, also suffered from a mental health condition.
In addition, since I have been a Member of the House, in my surgeries I have met a significant number of constituents who are suffering, including people whose children have been detained under the Mental Health Act 1983. There is one gentleman I will never forget who came to my surgery suicidal because he had lost his job and was at risk of losing his home and the ability to support his family. A couple of weeks ago I visited the South London YMCA and met a man who had witnessed someone commit suicide and had gone to his GP for help but had not received proper help and had suffered a breakdown. His marriage had broken up, he had lost his job and he had ended up sleeping in the park. So my decision has been prompted by a mix of personal reasons and what I have seen as a constituency MP.
The Bill is supported by the Royal College of Psychiatrists, Mind, Rethink Mental Illness and the Law Society. Its purpose is very simple: to remove the last significant form of discrimination in law in our society. This country has changed a huge amount since I was a young child. I remember the first Asian family moving into our road when I was growing up. Some of the people who lived in our road put pressure on the people selling their house not to sell to an Asian family. I also remember the arguments about section 28 and the language that was used in my school playground. We have made a huge amount of progress since then as a country, but we have not got there yet. To our shame, however, the law still discriminates against those with a mental health condition. An MP or a company director can be removed from their job as a result of a mental health condition even if they go on to make a full recovery. Many people who are perfectly capable of performing jury service are barred from doing so. If my private Member’s Bill is approved by the House, we will look back in a few years’ time and be amazed that the nonsense I have described was on the statute book in 2012.
As my hon. Friend the Member for Loughborough said, one in four of us will experience a mental health condition in our lifetime; three in four of us will see a member of our immediate family experience such a condition. As the right hon. Member for Leigh said, the numbers have increased because, while the physical conditions in which we live and work have improved, our lives are busier and much more stressful. The World Health Organisation estimates that by 2030 more people
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will be affected by depression than any other health condition. The law as it stands sends out the message that if someone has a mental health condition their contribution to public life is not welcome.
Lord Stevenson’s Bill had four aims: first, to repeal section 141 of the Mental Health Act 1983 under which a Member of Parliament, of the Scottish Parliament, of the Welsh Assembly or of the Northern Ireland Assembly automatically lost their seat if they were detained under the Act for more than six months. There is no equivalent provision to remove an MP if they suffer a physical illness that affects their ability to perform their role and, furthermore, someone who lacks mental capacity, as defined by the Mental Capacity Act 2005, can be detained for up to 12 months and not lose their seat.
Secondly, the Bill would amend the Juries Act 1974 significantly to reduce and better define who is ineligible for jury service. At the moment, the Act says that mentally disordered persons are ineligible. The definition of a mentally disordered person is extremely wide and includes people who manage their mental health condition through a prescription from their GP or counselling from a psychiatrist, thus eliminating all sorts of people who would make excellent jurors. Only 2% of people tick the box, but many more should probably do so. Not only is the law discriminatory but it is ineffective. If someone is on trial, they have a right to be confident that the jury is of sound mind. The Bill would better define who should be ineligible, thus making it much more likely that those people would identify themselves in the process.
Thirdly, the Bill would amend the Companies (Model Articles) Regulations 2008, so that someone no longer ceased to be a director of a public or private company purely because of their mental health. All companies are required by statute to have articles of association, and model articles operate where a company has failed to draw up its own. Many companies incorporate them into their own articles. They include a provision that someone ceases to be a director if a registered medical practitioner who is treating them gives a written opinion to the company stating that they have become physically or mentally incapable of acting as a director and they remain so for more than three months—in other words, the correct test of capacity. However, they go on to include a totally unnecessary additional provision relating solely to mental health.
Finally, the Bill would amend school governance regulations so that people detained under the Mental Health Acts would no longer be disqualified from holding office as school governors. Clearly, while someone is detained they are unable to attend governors’ meetings, but that may be for only a short time, and there is no reason why they should not resume their role.
I am delighted that the Government have dealt with one of those issues—the School Governance (England) (Amendment) Regulations 2012 came into force on 17 March, and rightly set the disqualification test as failure to attend six meetings in a period of six months without consent from the governing body. The Government made a public commitment, when they published their mental health strategy, to change the legislation in relation to Members of Parliament. I hope that they will support the rest of the Bill. In the other place, Lord Wallace of Saltaire said that the Government were considering the detail of what was proposed on jury
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service, and he hoped that the Bill would be reintroduced in this Session. I hope that it receives all-party support, and I was delighted to hear what the right hon. Member for Leigh had to say.
I want to end with two simple contentions. First, Parliament, schools, companies and the court system benefit from the involvement of people with experience of mental health conditions. Indeed, our debate has been illuminated in particular by the contributions of my hon. Friend the Member for Broxbourne (Mr Walker) and by the hon. Member for North Durham (Mr Jones). I do not know the hon. Gentleman very well, but I have always pictured him—and I think he would regard it as a compliment—as a bit of a political bruiser. For someone with that reputation to have the courage to say what he said will change people’s opinion of him, and very positively. The whole House has a high regard for what he has said, but I am sure that when we move on to other debates, normal hostilities will be resumed.
A school may have a pupil with a mental health condition; in a court case, the accused’s state of mind may be a key issue. How much better will that school be if a governor has experience? How much better will that court case be if there is a juror with the necessary experience? The Bill will directly help a relatively small number of people, but it also sends a clear message that discrimination is wrong: people have a right to be judged as individuals, not labelled or stereotyped.
In September, the excellent Time to Change campaign, run by Mind and Rethink Mental Illness, surveyed 2,700 people with mental health conditions. Of those, 80% said that they had experienced discrimination, two thirds were too scared to tell their employer, 62% were too scared to tell their friends and, worst of all, more than a third were too scared to seek professional help. Having a mental health condition is nothing to be ashamed of or to keep a secret. It is high time we dragged the law of this land into the 21st century.
Chris Ruane (Vale of Clwyd) (Lab): Most of the contributions we have heard so far today have concentrated on mental ill health, but I also wish to address mental health and well-being, and not just for those who have experienced mental health problems, but for the whole population in general.
Over £400 billion worth of illegal drugs are traded around the world ever year, which is the same amount that is spent on energy, or 8% of the world’s wealth. When that is combined with the amount spent on alcohol, cigarettes, legal drugs to help us over depression, over-eating and the amount spent trying to fix all those problems, we are probably talking about 20% of the world’s wealth being spent on, essentially, escaping from reality. That is a modern reality that has many causes. We need to look at the debate in the round and consider all the factors, including nutrition, advertising, the farming industry and work practices, because they all have an impact on what certain Members have so eloquently described today. We should look not just at the pinnacle of the problem, but what is behind it.
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or 59% of their children are mentally ill? The UK is not far behind. We follow the Anglo-American pattern, because 22% of our children experience mental health problems, and they are the lucky ones, because 74% of children in care homes experience mental health problems, as do 46% of those who are fostered. Some 90% of prisoners have mental health problems. Obesity is also a problem. At age five 10% of UK children are obese, but by age 10 the figure is 20%. What is happening in that five-year period to make those kids consume the sugars, fats and salts that will react with their bodies? Those fats will react with the fats in their brain and their myelin sheaths and neural pathways. It is an epidemic that is growing out of control, and we will be picking up the costs, including the financial costs and health costs for the individual and their families, for decades to come.
I recently received an answer to a parliamentary question. It showed that in 1991 almost 9 million prescriptions for antidepressant drugs were dispensed in the UK, but by 2011 the figure had increased to over 46.5 million, a 500% increase. When I asked the Minister for his assessment of why that was so, he replied:
“We are unable to provide a conclusive account for the increase in the number of prescription items dispensed.”—[Official Report, 30 April 2012; Vol. 543, c. 1286W.]
We do not know what is making the kids obese and we do not know what is turning our population into legal addicts. Those statistics are just for antidepressants and do not take into account the other drugs taken to help us sleep, keep us awake, keep us happy or manage our sex lives, although I never use them. There are other ways, because drugs are just one way of handling it. One-to-one counselling is another way, but it is very expensive. There is a third way: self-help. One of the best ways of self-help is mindfulness.
Mindfulness has been around for 2,500 years. To give a definition, mindfulness means paying attention in a particular way; on purpose, in the present moment and non-judgmentally. In other words, it means someone just focusing—not being chased by their past or worried by their future, but experiencing what they are experiencing there in the moment.
Mindfulness has been taught very effectively in America over a 30-year period and more recently in this country over a 10 to 12-year period. It involves an eight-week course, two-and-a-half hours’ taught lessons a week and 45 minutes’ meditation at home for six days a week, and it is taught in groups of eight to 20, so the costs are minimal and the benefits are unbelievable. It is out there, but it has not been taken up—even when NICE recommended it as a more effective means of treating repeat-episode depression. In 2004, it recommended the programme as being better than pills, but it has not been taken up. GPs and, dare I say it, Ministers do not know about it. I have quizzed Irish and British Ministers, and they do not know about it.
Mr Kevan Jones: I am listening carefully to my hon. Friend, but my experience is that, although group therapy might work for certain individuals, for many it does not. One thing that my right hon. Friend the Member for Leigh (Andy Burnham) did in the previous Government, and which has made a real difference, was to open up cognitive behaviour therapy treatments, as they have been a substitute for drugs. So no one treatment is a silver bullet for mental illness.
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Chris Ruane: Absolutely. Cognitive behaviour therapy is fantastic, and mindfulness has now been tacked on to it to make it even more effective. The group therapy lasts only for eight weeks; after that the individual can handle it themselves. I have practised it for five years now, and I have been on the formal course.
It was Descartes who said that the mind is separate from the body and the body separate from the mind, but in eastern philosophy and medicine that is not the case: body and mind are inter-related. Mindfulness can be used to combat pain, stress, eating disorders, addiction, anxiety and psoriasis, but it has been recommended in the UK only for the treatment of repeat depression—and it has not even been used for that.
In America they use it in the prison service, in the police, fire and emergency services, including on those with witness trauma, in the health service for a range of medical conditions, to improve heart and cancer treatment and, even, in Congress. Congressman Tim Ryan, its expert on the subject, has just written a book, “A Mindful Nation”, about how mindfulness can be used across the board.
So there are other ways that we have not explored, but they have been around for 2,500 years and proved to be effective. There are experts in mindfulness, such as Jon Kabat-Zinn who pioneered it in America, and experts in positive psychology, such as Martin Seligman. Freud believed that if a person was mentally ill the most they could achieve was wellness, not happiness, but Martin Seligman, who headed the American Psychological Association, turned that around 20 years ago and developed positive psychology in America.
We have our own experts: Professor Richard Layard, a Labour Lord in the other place; and Felicia Huppert, the mother of a famous Liberal MP based in Cambridge, who has a theory that if we shift the whole wellbeing curve, including on the right-hand side those who are mentally ill and on the left-hand side those who are positive, across and make the whole population happier, the greatest impact will be on the unhappiest—on those with mental health problems.
There are also impacts on the policies that we develop throughout society and on what makes people happy. On the Office for National Statistics’ list of what makes people in the UK happy, No. 1 is living next to a park or having access to a swimming pool; No. 2 is having access to cultural services such as libraries; No. 3 is being physically healthy; No. 4 is having time to relax and enjoy oneself; No. 5 is living in a fair society; No. 6, the only one involving money, is having enough money to do what one wants; No. 7 is freedom; No. 8 is being content with one’s situation; No. 9 is people looking after each other; and No. 10 is the smell of freshly ground coffee.
Only one pertains to money, yet our whole society is geared to making money. Those are the values that we and Governments of both parties have adopted, but now we need to develop policies that recognise the situation and the position of mental health in society. It is the No. 1 issue affecting our society, and we need to look at it in the round.
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debate of which the previous speakers and the Backbench Business Committee should be proud. I missed out on a lunch the other day and went with my hon. Friends the Members for Broxbourne (Mr Walker) and for Loughborough (Nicky Morgan) and others to appear in front of the Committee. They were tough and they were clear. We made our point that the subject needed a debate, and the issue then was whether it should be in Westminster Hall or in the Chamber. I think that if it had been in Westminster Hall, the impact would not have been so great.
When I was first elected to the House of Commons, if a Member of Parliament was thought to have gone mad, the Speaker would refer them to two people nominated by the Royal College of Surgeons. One of my early interventions was to suggest that psychiatrists might be rather more useful. If the Bill taken up by my hon. Friend the Member for Croydon Central (Gavin Barwell) gets through, perhaps that approach will be thrown away in turn.
Again when I was first elected, The Times and The Daily Telegraph would report debates and pick up a good point from everyone’s speech. If that happened after today’s debate, people’s understanding of the experiences of the lack of mental health, and of more extreme, occasionally disabling mental illness would become greater, deeper and wider. That would give comfort to the hundreds of thousands of people who care for people who are experiencing the lack of mental health.
Andy Burnham: I apologise for interrupting the hon. Gentleman so early on, but he is making such an important broader point about media coverage of mental health. Would he want to pay tribute to the Sunday Express, which has led a campaign that was mentioned by the hon. Member for Loughborough (Nicky Morgan)? One would not necessarily expect a newspaper to run a mental health campaign, yet it has. That is precisely the kind of media leadership that we need to see on this issue.
Sir Peter Bottomley: I join the right hon. Gentleman in saying that. I was trying to say things that had not been said already, and there has already been a tribute to the Sunday Express. I would add that several journalists have been prepared to speak about their own medical conditions that have challenged their ability to live or to work effectively. I am not saying that we should all have to spend our time saying what our physical or mental experiences have been, but it does help if it is regarded as being as normal to talk about having had an episode of depression as of having had a basal carcinoma removed or having recovered from a broken hip.
I pay tribute to the hundreds of thousands of people who care for those experiencing the lack of mental health. I also pay tribute to the professionals, particularly to Lisa Rodrigues, who is chief executive of the Sussex Partnership Trust. She has spoken of the services it provides across East Sussex, West Sussex, Brighton and Hove and Hampshire, and the 27,000 young people with whom she and her colleagues come into contact each year. They are not all experiencing real disability, but some will.
When I became roads Minister, one of my ambitions was to try to get the number of road deaths down below the suicide rate. Young people’s suicides number about 900 each year. The total number of road deaths among
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adults and young people is 1,800. The road deaths figure has come down from 5,600 a year to 1,850. Would it not be good if we could do the same thing for self-destruction and the penalties that that imposes—not only the shortened life but the damage to those around the person who has died?
My wife was a psychiatric social worker before she became a Member of Parliament, a Health Minister, and then Secretary of State for Health, when she took mental health issues very seriously. She worked with those at the Maudsley Institute of Psychiatry where, with one of her colleagues, Peter Wilson, she ran a support service for teachers. If we are to start being concerned with young people, we need to make sure that those who are in contact with them—parents, and teachers in primary and secondary schools—have an understanding of what is normally unhealthy, if I can put it that way.
One young person in four experiences some kind of mental health episode. We need to know how much of that involves a relatively normal experience from which they will recover. We also need to identify the one in 10 who will probably need help from someone with experience or specialist qualifications, and the 2% or 3% for whom the experience will be disabling.
YoungMinds is an association with which Peter Wilson was associated—I think he might have created it. It has a manifesto in which young people say that if they can get help when they are young, many more of them could be kept out of prison and psychiatric hospital, and kept in work and leading the kind of life that contributes to society.
I once met someone who had had experience of schizophrenia. There was a fine mental health project just outside my former constituency, and he told me that he was glad to have got to know about it. He became a client of the project. Six months later, he became a volunteer. A year later he wrote to tell me that it was the proudest moment of his life, as he was now a taxpayer with a paid job. He was given the opportunity to take those steps forward, in an environment in which everyone knew what was happening and could share in it and give support when appropriate. Those opportunities matter.
Had there been more time, I would have been tempted to talk about a range of issues, giving a sentence or two to each, but I do not think that that will be possible. I would say, however, to those who suffer at times, or constantly, from depression, anxiety, obsessive compulsive disorder, phobias, bipolar disorder, schizophrenia or personality disorders—I could go on—that information on most of those conditions is available on the websites of the organisations that provide help.
About 31 years ago, I was appointed to the council of Mind, formerly the National Association for Mental Health. The reason for that was that the then Conservative Government wanted to give the organisation their support, and its then general secretary was thought to be left-wing; I was there to provide balance. I am not sure how my Whips would regard that decision today.
The Mental Health Foundation does good work, and I also pay tribute to the Samaritans for the help that they give to people about whom they are concerned. Their website contains information on how we can help
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someone, even if we are untrained. It suggests avoiding the “Why?” question, as that can be regarded as challenging. Instead, it suggests asking:
“When—‘When did you realise?’ Where—‘Where did that happen?’ What—‘What else happened?’ How—‘How did that feel?’ In an ideal world what would you like to happen next? Would you like me to come with you?”
I want to give the House one or two examples from the weekly newsletter from Lisa Rodrigues of the Sussex Partnership Trust. I try to send it on to two or three other people each week, to whom some of the points might be relevant. One week she talked about cancer, describing how, in the 1950s, Sir Richard Doll and others had started to examine the causes of lung cancer, and to realise that asbestos could also have a serious effect on breathing. She wrote:
“So why am I talking about cancer? It is because today dementia is where cancer was all those years ago…Why Sussex? Because we have the highest percentage of old people in the country living here. And why me? Because specialist mental health services hold the key to unlocking the potential in primary care, acute hospitals, local authorities, the voluntary and nursing home sector to provide better treatment and care to people with dementia, and support for their families.”
Lisa Rodrigues also recently attended a conference on how to get the various groups to work together more effectively, which is vital for people and their families and carers. If only they could find a one-stop shop to refer them to a place where they could be embraced as a person, a household or a family unit. She said that if we could get our mental health services working more effectively, our physical health services would have far less to cope with. That point has also been developed by other hon. Members this afternoon. She also wrote in her newsletter:
“We have a dream. In our dream, our psychiatrists, nurses, social workers, psychologists, therapists, care staff, receptionists and anyone else who comes into contact with the 100,000 people we serve each year will have the best possible tools to do their jobs. This will include a small, lightweight…portable device via which they can access patient records”
Lisa Rodrigues talks every two or three weeks about employees who have done something special. In one example, she talks about the staff who have worked on a clinical reception and their helpfulness to patients and other visitors. She goes on to mention a person whom I have not met called Jackie Efford, a nurse in the health team at Lewes prison, who
“works flexibly so that, when prisoners arrive late into the night, she comes in to assess them and respond to any urgent physical or mental needs. Imagine being a prisoner and what a difference it would make to have a meeting when you first arrived with a compassionate and effective nurse.”
“no longer fit for purpose. The word adolescent has negative connotations. And young people don’t respond positively to the term mental health.”
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doing its job properly. We should not have to rely on the pleading and cajoling that we provided at the Backbench Business Committee. Debates on this matter ought to be built in, rather than bolted on.
Lyn Brown (West Ham) (Lab): It is a pleasure to follow the thoughtful contribution of the hon. Member for Worthing West (Sir Peter Bottomley). I am very glad to be in the Chamber to speak alongside those who have made exceptional speeches today, including my hon. Friend the Member for North Durham (Mr Jones) and the hon. Member for Broxbourne (Mr Walker) to name just two.
I will highlight three things. The first is the key factors that are linked to mental well-being and the characteristics of my local borough of Newham. The second is what resources are available to my local health authorities and mental health services. The third is the need for those resources to be improved in the light of what we know works in improving mental health.
The need for a robust strategy to promote well-being is illustrated by the correlation between the determinants of mental ill health and some of the characteristics of the population of my borough. As my hon. Friend the Member for Vale of Clwyd (Chris Ruane), who is no longer in his place, attested so powerfully, one such determinant is age. The rates of mental illness vary across age ranges, but it is a sad fact that younger people are more likely than the elderly to experience mental ill health. A high proportion of mental health problems develop between the ages of 14 and 20. One in 10 children between the ages of five and 16 have a mental health problem, and such problems may well continue into adulthood.
The borough of Newham has one of the youngest populations in the country. The number of young people with mental health problems is therefore greater than elsewhere. Some 40% of the borough’s population is made up of people under the age of 25. As nearly 10% of people aged between five and 16 experience mental health problems, statistically we can expect 4,262 of the children and young people in Newham to experience such problems. That clearly has an impact on the needs of the population of Newham and on the type of service that it requires. It should be funded to cater for those needs.
We all know that there are other important determinants of the mental health of a community. One of those is deprivation. Common mental disorders such as depression, anxiety and obsessive compulsive disorder are more prevalent in deprived households. Again, Newham suffers from high levels of deprivation. It is ranked the third most deprived local authority in the country and 51.5% of its children live in poverty. The index of deprivation ranks the borough fourth in the country for the proportion of children aged between nought and 15 living in an income-deprived household. That is just one measure of deprivation, but I am sure hon. Members will agree that it is a worrying one.
In addition, the decline of owner-occupation and the increase in the private rented sector changes the very nature of local communities. Support networks that people rely on—their friends and family, and wider communities such as their Church and faith—are disintegrating as housing pressures force families to move home, leave their communities or remain in overcrowded, sometimes
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unhygienic and often poorly managed private rented housing, which is sadly a fast-growing sector of tenure in the London borough of Newham.
In my constituency, there is a high level of need for services that will enable the people of Newham to be self-sufficient and lead independent, successful lives. My concern is that the process used to allocate the resources needed to support those services is fundamentally flawed. It is skewed in a way that significantly disadvantages my community.
Since 2006, if not earlier, the population estimate for Newham has clearly been an underestimate by the Office for National Statistics. The under-count was estimated at about 60,000 people until, in November 2011, the ONS went some way towards recognising the historic underestimate by provisionally estimating the population at 272,000, an increase of 32,000. That significant increase of 13% is, by the way, the largest change in any London borough. However, the new figure still falls some 30,000 short of the population estimate made by an independently commissioned study. That is a shortfall in excess of 10%.
The real population of the borough stands at roughly 300,000. That is the figure that should drive resource allocation, because it relates to the real world and real need. However, the ONS mid-year estimates are used to determine how the national funding pot is allocated to local areas, even though they do not accurately reflect the true population of my area. Given the level of need in my constituency, to say that resources are not allocated on a level playing field is an understatement.
The effect of an inadequate allocation system is compounded by a reliance on historical spend to determine current needs. That means that my local primary care trust has consistently struggled to find resources to deal with persistent need. Figures in the House Library tell me that expenditure per head on mental health in Newham in 2010-11 was £208.93. That compares with £447.21 in Westminster and £331.81 in Kensington and Chelsea. I wish to hammer home the point that the spend for Newham is based on the ONS population estimate, so the real spend per head is even lower.
The shadow health and wellbeing board for the London borough of Newham has discussed the matter at length and agreed a robust strategy, with a clear focus on maintaining resilience within the community. It wants to support people by ensuring that they possess the skills and resources that will enable them to negotiate successfully the challenges that they experience.
Let us face it: we know from evidence what works. The health and wellbeing board has indicated that it wants to focus its activity on parenting skills and pre-school education to set up an early family environment that supports children’s emotional and behavioural development. It wants to support lifelong learning, with health promotion in schools and continuing education, as schools are a really important resource, particularly for children facing difficulties at home.
The board also wants to find a way of improving working lives in the borough, as one in six people in the work force are affected by mental health problems, and a way of supporting a good and healthy lifestyle by encouraging exercise and good diet. It wants to encourage the learning of new skills and the taking-up of creative pursuits—social participation that promotes mental well-being across the piece. The board is also supporting
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communities through environmental improvements. Environmental predictors of poor mental health include neighbourhood noise, overcrowding, fear of crime, poor housing and so on. Finding out what to do is frustrating, but it is also frustrating that resources are being rather unfairly allocated. Newham is poorly served in that regard.
I thank the Backbench Business Committee for creating this opportunity to discuss an issue that is often invisible, and on which there is not enough focus and debate. Poor mental health has an extraordinarily detrimental impact on huge numbers of people in our communities. We could and should be dealing with the problem in a plethora of holistic ways in our local communities.
Newham is severely under-resourced in the face of significant pressures on mental health provision. I am glad to see the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), in the Chamber. I know he has listened to me and, given that he is a former Whip, that he is a very honourable man. I shall write to him to push the case for greater funding for Newham as we continue to fight for the resources that my communities desperately need to access better life chances, which includes better mental health.
Sir Paul Beresford (Mole Valley) (Con): It was beginning to look like a Whips’ cabal in the Chamber. I was quite worried. A number of hon. Members, particularly the hon. Member for Strangford (Jim Shannon), who is busy disappearing from the Chamber, mentioned care for, and the mental health of, veterans—[Interruption.] I am making a plea to keep my small audience. To my delight, the shadow Secretary of State mentioned a famous organisation in that field: Combat Stress—[Interruption.] He is also leaving the Chamber the moment I mention him. He can read my speech in Hansard as he has obviously been urgently called away.
Combat Stress was supported by the previous Government as it is by this one. Combat Stress clients—ex-servicemen, or veterans—suffer from the appalling conditions of post-traumatic stress disorder, depression or anxiety, or all three. Anyone who has seen such individuals with such conditions will recognise that they are exceptionally debilitating. They destroy the normal life of victims and those around them.
Combat Stress has three centres—the main one is in my constituency—an outreach service throughout the nation and a liaison team. It has been making a difference for some considerable time. Some 83.5% of Combat Stress clients are ex-Army. Three per cent. are female. Most of the veterans contact the Combat Stress service themselves or through family referral, but only 3.6% are referred by general practitioners, 6.9% by community health teams, and 0.3% by a hospital service. I hope the Minister thinks about that.
To make access to those services more available, Combat Stress set up a 24-hour helpline in March last year. It may interest the House and the Minister to consider statistics from the helpline from March 2011 to January 2012. Combat Stress received 6,279 calls, including voicemails. A few people hung up—a tragic few calls were silent, which I think says a lot.
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Of the callers who were contacted, 74% were male and 26% female. Army veterans made a total of 2,248 calls. The second largest group of callers were family, friends and carers of the victims, who themselves were therefore victims. Seventy-seven per cent. of callers called about themselves. Perhaps tragically—I hope the Minister makes a note of this—just 6% of callers were given the number and contact details by a health professional. The call centre seems to be catching on. In March, it received 286 calls, but that doubled to 604 the following January. The organisation is funded by the Government, and I plead with the Minister to keep the funding going. I am sure he will.
The average post-service delay is a staggering 13 years. The Minister should be aware that after such a delay an individual’s condition will have developed in complexity, meaning that their recovery treatment can last for years, whereas if treatment is early, it can last just weeks and months. Early diagnosis and referral can lead to faster and cheaper treatment, and greater success, and can mean that the potential side effects of alcoholism, drug problems, which have been mentioned—[Interruption.]
Mr Deputy Speaker (Mr Lindsay Hoyle): Order. Will the Minister wait while the hon. Gentleman is standing? The Minister was right in my line of vision, and it is not fair to the person speaking. This is the third time it has happened.
Sir Paul Beresford: As mentioned by several Members, the result can often be imprisonment, yet all these side effects could be avoided. On average, it takes veterans just over 13 years from service discharge to first approach Combat Stress. This is an ongoing issue for veterans.
Community outreach teams across the country now provide much support for veterans. They provide support and advice in veterans’ own homes and nearby community-based clinical care. Yesterday, we made much of the Falklands war, which ended 30 years ago today, on 14 June 1982. Of the 4,800 veterans Combat Stress is helping, 221 served in the Falklands war. The youngest is 46 and the oldest is 74, and on average the Falklands veterans have waited 15 years before going for help. Last year, 18 Falklands veterans contacted Combat Stress for the first time, and this year, to date, 10 have contacted it. But of course the case load is not just from the Falklands. Of the 4,800 ex-service men and women being treated, 589 served in Iraq and 228 served in Afghanistan. Between 1 April 2010 and 31 March 2011, Combat Stress received 1,443 new referrals.
Having set the scene, I shall touch on a few key points for the Minister to consider. First, all the UK Governments must acknowledge the ongoing need. Most of the Governments contribute considerably towards Combat Stress and its costs. Combat Stress estimates that in 2012, 960 service personnel will leave the armed forces with the likelihood of suffering from PTSD. I shall follow up a point made by the hon. Member for Strangford. We must persuade the MOD to look specifically at their decompressing veterans-to-be and, if there is any suspicion, to refer them to Combat Stress. It would make treatment by Combat Stress easier, because it would be given earlier, and all the pain and suffering of these men and women could be reduced to a tiny fraction of what it is for many of those in Combat Stress now.
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That brings me to the crux of the problem, which has been touched on. Because mental illness is not a physical but a mental wound, a stigma is attached to it. A lot of Members have mentioned that. Combat Stress tells me that 81% of veterans with a mental illness feel ashamed or embarrassed, which often prevents them from seeking help—it certainly delays them seeking help—and sadly one in three veterans are too ashamed of their condition ever to tell their families about it. As a result, many of those families break up. Among the other side effects are crime, disorder and alcoholism. This is a mental health problem, then, that could and should be alleviated early.
Much has been done to raise the profile of the condition and the availability of help, so that those individuals do not feel that they are unique or, perhaps, weak. Much needs to be done to encourage them and their families to seek assistance. We need to put these valuable individuals back on their feet—and they are valuable: they have already performed valuable service, and there is still valuable service available if we can do that. Amazingly, there appears to be a considerable lack of understanding among GPs. Research conducted in September 2011 showed that only 5% of the veterans receiving help from Combat Stress had been referred by their GP. Perhaps those GPs failed to recognise the condition or were unaware of the existence of Combat Stress—or, more likely, both. I urge the Minister to ensure that the word is spread among our GPs. Combat Stress has done a clinical audit, and it would appear that approximately 80% of the veterans who come to it for clinical treatment tried to get help from their GPs or other specialist services first, and did not get it. Appallingly, that support and treatment was not forthcoming. It should be.
I hope that the Minister will consider joining me in a visit to Combat Stress, to see the value of the work first hand, to understand its difficulties and to help to build on the opportunity to prevent some of the tragedies that we see. We need to remember that for those veterans the physical war is over, but the battle is still raging in their heads.
Heidi Alexander (Lewisham East) (Lab): I want to keep my remarks quite brief, because I know that many other hon. Members are keen to speak. Let me start by apologising to the hon. Member for Loughborough (Nicky Morgan) for not being in the Chamber for the start of the debate. I heard some of her thoughtful and comprehensive remarks on the television before I got in here, and I congratulate her on securing this debate. May I also say how powerful and honest the speeches that we heard from the hon. Member for Broxbourne (Mr Walker) and my hon. Friend the Member for North Durham (Mr Jones) were? I echo what the Minister said earlier, which is that this place is often at its best when people speak from their personal experience, rather than quoting statistics from briefings that we have been sent or things that we have read in the newspaper. It reassures everyone outside this place that we are also human beings, as well as Members of Parliament.
I have little expertise in this matter. Having said that, I have a close family member who has suffered obsessive compulsive disorder and psychosis in the past, and I have two very close friends who also suffer from OCD. I know how difficult it can be for them to overcome some of the challenges they face, so I think it is important
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that we have this debate today. I want to focus on the huge challenge of providing high-quality mental health services in what are difficult economic times. Given the tone of the debate, I do not want to turn this into a piece of political knockabout, but I do want to speak about the reality of the situation in my constituency, where a number of mental health facilities either are threatened with closure or have already been scaled back.
The shadow Secretary of State for Health spoke earlier about how the mental health system is somewhat separate from the rest of the NHS. However, the mental health system is also facing considerable budgetary pressures—just as the rest of the NHS is—which is having an impact on some of the people we represent. During the parliamentary recess I visited a continuing care home for elderly mental health patients which is wholly funded by the NHS. The patients there are elderly people, often in their 60s, 70s or 80s, who have been sectioned and who have significant mental health needs, in terms of both medical and care support. The centre, in Granville Park in Lewisham, is threatened with closure. The service is excellent and the care provided is exemplary, and the families of the people who live there are incredibly concerned by the proposal to shut the unit down. South London and Maudsley NHS Trust is consulting on the closure. It claims that it has too many beds of that kind and says that it wants to scale back provision in Lewisham.
My constituents know that many more elderly people have significant mental health needs so it is hard for them to understand why a mental health centre should be closed. I have to say that the way in which the consultation has been conducted is far from perfect. Parts of it just do not make sense. I have raised my concerns with the PCT and the South London and Maudsley NHS Foundation Trust.
Also threatened with closure are therapeutic care services for adults who have much lower mental health needs. A fantastic centre, known as the network arts centre in Lee, has been threatened with closure. I hope that the South London and Maudsley NHS Foundation Trust will find a way to maintain the provision by setting it up as some form of social enterprise. This is a place where adults with mental health needs—perhaps not as significant as others’, as I said—can come together and enjoy arts-based therapy in a setting that helps them to take the next step towards their recovery. I am hopeful of finding a way through that situation, but when services like this are threatened with closure, it is a matter of huge concern to the people who use them.
I said that I would focus my remarks on the challenge of providing high-quality mental health services in difficult economic times, and the budgetary pressures faced by public services is one of them. Another is the greater uncertainty that individuals themselves face, which some hon. Members have touched on. A few weeks ago, I visited Mencap in Lewisham and met a group of people who were primarily carers for people with mental health difficulties. The questions they wanted to ask me were about the work capability assessment for the employment and support allowance; they wanted to ask me about the process their loved ones would have to go through in transferring from disability living allowance to personal independence payments; they wanted to ask me about the changes to local council provision of day centres.
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What struck me was the great deal of uncertainty in the lives of people living with mental health problems and the people who are caring for them.
We heard from the shadow Secretary of State about the importance of getting advice and support to people in difficult times, and he mentioned the miners in Easington. That brings it home that we all—the Government and councils—need to recognise the importance of getting that local advice and support to people when they face this uncertainty, which only adds to people’s stress and problems.
The mental health charity Mind sent me some details about its information line. It told me that in the last 12 months, it had received 40,000 inquiries, but that unfortunately, because of the pressure it is currently under, two out of five of those calls went unanswered. Since the start of recession, Mind has seen a 100% increase in the number of calls relating to personal finances and employment. We need to understand the worries of people out there, and find a way to do more to recognise the importance of the local services that provide support and assistance.
I said that I would be brief as others wished to speak. I think we have had a thoroughly excellent debate and I congratulate those who made it happen. I look forward to hearing the remaining contributions.
Dr Sarah Wollaston (Totnes) (Con): I congratulate my hon. Friend the Member for Loughborough (Nicky Morgan) on securing this important debate, and I pay tribute to my hon. Friend the Member for Broxbourne (Mr Walker), whose speech has immediately entered the list of my top 10 favourite speeches. I thank and commend him for the work he has done over many years as chair of the all-party parliamentary group on mental health.
I state from the outset that I am married to an NHS consultant psychiatrist and that my husband is involved in providing briefings to all Members on behalf of the Royal College of Psychiatrists. For that reason, I think it best for me to confine myself mostly to some personal reflections and some concerns that have been raised in my constituency, and in particular to address the issue of stigma.
As we have been told today, one in four people will experience mental illness at some point in their lives. We have heard powerful speeches about that from a number of Members. Like the hon. Member for North Durham (Mr Jones), I have experienced severe depression: at the happiest time of my life I experienced an episode of post-natal depression, so I know what it is like. I am sure that many other Members and people who are following today’s debate will know exactly what it is like genuinely to feel that your family would be better off without you, and to experience the paralysis that can accompany severe depression.
It has been rightly said today that there is concern about the way in which some GPs handle depression, but I want to make it clear that in my own case, accepting that I had a problem and seeing my GP was very much part of the road to recovery. I think that we should be careful when we talk about how GPs manage depression, because I can tell the House—not only on the basis of my personal experience, but on the basis
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of what I have heard from others—that there are many GPs out there who provide an excellent service, which I think can only be assisted by a move towards longer appointment times and better training.
We have heard today about the various terms that people use for mental illness. Earlier, we heard it described as a mental health “experience”. I would say to anyone who is listening to the debate that an experience of depression makes many people stronger and more understanding. I am absolutely sure that my own experiences of depression and recovery—recovery is very important—caused me to become a much more sympathetic doctor, and I hope that it made me a more sympathetic and understanding MP, able to recognise the issues in others and respond to them appropriately.
I want to sound a note of caution about employment and depression. Many Members have rightly mentioned the issues surrounding Atos assessments, and I was glad to hear the Minister say that he would address himself to some of the concerns that had been expressed, but I think that we should be careful about making assumptions. We should not assume that people with depression are unable to work; we should individualise the position.
When I returned to work after having a baby, I was still suffering from severe panic attacks—especially when travelling on the underground—and in retrospect, I realise that I was still significantly depressed, but going back to work was part of my recovery. I know that it can be difficult to challenge the ideas of people who are depressed, but I think it important to present them with challenges and encouragement at some level, because depression is sometimes followed by a crisis of confidence, and getting back to work is part of the road to recovery from depression, however difficult it may feel. We should not make generalisations and assume that no one can return to work when they are depressed.
I pay tribute to all those who help people with mental illness, including the many volunteers in all our constituencies, and I pay particular tribute to a voluntary group in my constituency called Cool Recovery. It is an independent mental health charity which cares for a number of people—not only those who have experience of depression, or are currently living with depression or other forms of mental illness, but those who have recovered from mental illness, and those who care for people who suffer from it.
I feel that such voluntary sector groups are essential if we are to realise some of the benefits that can come from the Health and Social Care Act 2012. I was concerned to hear from the volunteers at Cool Recovery that they do not feel they have been sufficiently involved in the commissioning process, and that there are real anxieties about the extent to which the user voice and the voluntary sector voice are being heard in the new arrangements. Perhaps the Minister will give us an update on what is being done to ensure that there is adequate representation for the user voice and the voluntary sector at every stage on HealthWatch, on health and wellbeing boards, and right up to national level at the NHS Commissioning Board.
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I was pleased to hear that my hon. Friend the Member for Croydon Central (Gavin Barwell) will introduce a Bill to remove stigma. From talking to service users and those who have recovered from mental illness, it is clear to me that they are entirely capable of taking a full part in every aspect of life in their community and workplace, and in our national life. I was glad that the Minister and shadow Minister gave their full and unconditional backing to that Bill, as it will mark a very important step in removing the stigma of mental illness. I also join the Minister in paying tribute to the work of Time to Change, and I hope he will commit to continuing to give support to that organisation.
Some 22% of the disease burden in England comes from mental health issues, and it is time that we recognised that in our local and national commissioning. The mental health strategy is excellent, but we now need to ensure it is implemented. I know the Minister has set up a cross-ministerial group centrally, but who in this new system will be accountable for the successful implementation of the strategy locally and regionally—and what levers for change can they exert, and what sanctions will there be if it is not carried out?
Alison Seabeck (Plymouth, Moor View) (Lab): It is a privilege to follow the hon. Member for Totnes (Dr Wollaston). She has great personal and professional experience in this field. I congratulate the hon. Member for Loughborough (Nicky Morgan) on securing the debate, and I apologise to her for missing her opening speech as I mistimed my arrival in the Chamber. I will read it in Hansard, however.
This is a very important debate. Mental health problems stigmatise. We have heard harrowing stories from colleagues on both sides of the House about how mental health issues affect our constituents—and also Members of Parliament. I pay tribute to my hon. Friend the Member for North Durham (Mr Jones) for his brave speech; he will now only have greater respect. It was interesting to hear how his experience made him stronger. The hon. Member for Totnes made that point, too, from her own experience. The hon. Member for Broxbourne (Mr Walker) made a speech that managed to be entertaining despite the seriousness of the subject under discussion, and all I have to say in response is “rock ’n’ roll.”
Mental health problems are met with intolerance and discrimination, and sometimes fear. When I was growing up, the terms used to describe people with mental illness included lunatic, nutter, headcase and maniac, all of which have associations of dangerous or unpredictable behaviour. No real effort was made to understand or support. The usual solution chosen was to lock people away, or to stay away from them.
Many people, especially men, are reluctant to admit they have problems or that they are feeling depressed or are hearing voices. Some people do not understand that their lives are being affected by the state of their mental health. We find in our surgeries that people sometimes start talking about one problem, but when we dig we find layers of issues, including mental health issues. About 60% of the people I see have an underlying mental health issue, ranging from severe stress to serious psychotic conditions, and I do not think my constituency is unusual in that regard. Teasing out what support they have, or have not, sought can require great sensitivity,
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and very few MPs are trained counsellors or therapists. At times, however, we find ourselves taking on that role and doing our best.
Plymouth has a number of organisations that work with people across the full range of conditions; the Samaritans and Plymouth Mind are excellent. Mind has been in touch with me to express serious concerns that, at a time when more people are struggling, money is a huge problem, relationships are failing, young men and women are returning from war and housing pressures are intolerable for some, the main provider of mental health services, Plymouth Community Healthcare, is no longer structuring mental health as a specifically defined directorate of health care and appears to be shifting resources from mental health to generic health services. My right hon. Friend the Member for Leigh (Andy Burnham), on the Front Bench, talked about bringing mental health closer to acute care, and that is obviously a better approach. Mind is concerned that in Plymouth the limited funds are being shifted away from mental health support. The charitable sector, too, is struggling as a result of a reduction in resources. There are some truly excellent support groups in Plymouth, and I pay huge tribute to the staff and volunteers at those, many of whom have come through mental health illness themselves. There are far too many of them to name, but I just wanted to put that on the record.
I have mentioned housing pressures. How many of us have constituents who are living in desperately overcrowded situations? We encounter pressure on parents because their children have turned up, perhaps with their grandchildren. A woman who came to my surgery is sleeping on the sofa in her front room while the rest of the house is taken up by her children. These people are clearly struggling. Many of them are on antidepressants or more powerful medication, and some are suicidal. Our caseworkers also deserve enormous credit for the way in which they sometimes have to support people in those circumstances.
Equally, housing officers often cannot manage the tide of human misery that they face. People with mental health issues are much more difficult to deal with. A housing officer can understand someone who has a physical disability, as it is often obvious—it is there in front of them and it is not invisible—and they can offer adaptations or a possible move. Things do not work in the same way for people with mental health issues, and it is much more difficult to deal with those.
As we have heard repeatedly, mental health cuts across every area of our society. We have heard a great deal about the need and support for our armed forces and the excellent work done by organisations such as Combat Stress. We have heard about the iniquitous treatment of people at the hands of Atos and about problems faced by those in the criminal justice system, but there are other areas to address. The hon. Member for Totnes touched on the issue of young women, who clearly often need support both before and after childbirth. Midwives are potentially very important in that scenario, and I would be interested to hear from the Minister on what guidance and training they specifically receive on supporting women in those circumstances.
Work is also being done to address the needs of children. The Minister mentioned the work of YoungMinds, but we are still failing very many young people. Recent media reports on suicides highlighted just how difficult
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it can be for young people who are being bullied or are struggling through other personal issues. Tragically, schools and other responsible adults have failed to recognise what was going on in their lives. I pay tribute to the incredibly well-informed speech by the hon. Member for Worthing West (Sir Peter Bottomley), which specifically dealt with those issues. YoungMinds, which was praised by the Minister, is concerned by the service cuts and reductions in provision for child and adolescent mental health. We also have to address an issue about the transition from support in that area into adulthood. That area needs a lot more attention, and I hope that the Minister will address some of these specific issues in his correspondence with us.
Finally, I wish to offer my support to the hon. Member for Croydon Central (Gavin Barwell) in his attempt to make significant changes on the whole issue of stigma. Intolerance or discrimination in employment, and preventing people from holding public office because they have been sectioned, is wholly unacceptable. He is right to say that this archaic piece of legislation needs to be binned, and I welcome the support that he has received from the two Front-Bench teams. I also welcome the fact that we will have a further opportunity to debate some of these crucial issues and just get it out there.
Mr Deputy Speaker (Mr Nigel Evans): Order. As hon. Members can see, about nine Members are trying to catch my eye and we have just over an hour. We want to get everyone in, do we not? If everybody speaks for only six or seven minutes we can accommodate everybody, so I ask Members to be time-focused, please.
Dr Phillip Lee (Bracknell) (Con): I congratulate my hon. Friend the Member for Loughborough (Nicky Morgan) on securing this important debate. There have been some very impressive speeches, not least from the hon. Member for North Durham (Mr Jones). I have the pleasure of being, like him, a member of the Administration Committee because very early on in my time here at Westminster I realised that there were quite significant mental health problems among my colleagues. A few of them had approached me so I went to the usual channels, wanting to know what support was available for colleagues. As a consequence, I was put on the Administration Committee and I am now also on the medical panel. I am encouraged by the support available to colleagues if they choose to use it.
I congratulate the shadow Front-Bench team on what appears to be a decision to lead with mental health. It is an important decision that is politically astute and those on the Government Front Bench ought perhaps to reflect on their goals in that area. My advice would be not to be overambitious.
I want to reflect on my experience in this area, my family experience and my professional experience before saying a few brief words on GP commissioning. I have heard mention of the police and the concerns about their involvement in this area, so I shall comment on that. Finally, I want to mention the Human Rights Act.
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At a family level, at the last count there were three suicides in my extended family. I know a number of people who have had depression and, unfortunately, a family member has recently been diagnosed with early onset dementia. I myself have had moments of, shall we say, fluctuating mood, perhaps a bit more so since I have been in this place, so I feel that I have first-hand experience through my family and myself of how prevalent the problems are.
I know from my professional experience that the nature of this topic means that it is something one does not forget. I recall clerking in a patient who was a survivor of Auschwitz—I remember the tattoo quite clearly—and the following day, that person hanged himself. I remember the relative of a senior member of the Ministry of Defence at the time breaking down in front of us, which was a quite shocking incident for me as a medical student.
Finally, I remember a case—I only remembered this as I listened to the hon. Member for Strangford (Jim Shannon)—of somebody who had been a victim of the troubles in Northern Ireland and had been relocated to where I was working under the witness protection scheme. That gentleman had experienced guns being held at his temple, in his mouth and so on, and I was in a position to be able to help him.
The nature of this subject means that it tends to throw up cases that are quite memorable and emotive. I feel strongly about it. Locally, I have done my bit. I have met Rethink Mental Illness and the first hustings I attended during the 2010 general election campaign was run locally by a mental health charity. Broadmoor hospital is in my constituency, at Crowthorne. I have visited there and I would encourage everybody to visit Broadmoor hospital. It is a very interesting place to visit with recidivism rates that are, I imagine, the envy of the prison system.
I have done my bit to try to raise the profile of the discussion and debate around mental health services, because this is a significant area of concern. About 800,000 people have dementia in this country at the moment and that number will rise—it will double. That is because of ageing and lifestyle, depending on whether it is Alzheimer’s or vascular dementia. The estimated cost of mental health is £89 billion by 2026, although perhaps that figure is out of date as I heard the shadow Secretary of State give a larger figure. Half of that is due to loss of earnings in the work place. The significance of this topic cannot be overstated.
Unfortunately, more than half of people with anxiety disorders do not interact with the service and about a third of those with depression do not interact with it. The services we have cannot deal with the demands being placed on them, so God only knows what it will be like when everyone starts turning up to see me as a GP or, now I am here, as an MP. I fear that this will need some realism on the part of the current health team and any future health team that might come from the Opposition side in terms of rationing and prioritisation of resources. For example, I read that we are now giving fertility treatment to everybody. I am sorry, but if I were to prioritise where my funding was going, I know it would go to mental health before it went to fertility treatment. I know that is a difficult thing for people to accept if they have fertility problems but we have to make decisions and I know where my priorities lie.
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Let me address GP commissioning and some concerns that I want to raise with Front Benchers. There is some unease in my profession about the commissioning of psychiatric services—more so than for diabetes, hypertension or any cardiac service. In a recent poll that I saw, about 70% expressed significant concerns about this issue. I want to flag this up because most GPs do not get a lot of psychiatric experience when they are training. I happened to do a post in which I worked with depression and dementia as a junior but quite a few do not. That needs to be borne in mind. Perhaps we need to look at training in the way that my hon. Friend the Member for Totnes (Dr Wollaston) mentioned earlier. The commissioning of mental health services is complex and difficult, and we need to be cautious. I have been broadly supportive of the Government regarding commissioning but psychiatric services are different.
Another matter that I want to raise is about the police. I heard the earlier comments about the police force and I know that the police are not terribly enthusiastic about getting involved in acute psychiatric crises, but let me tell hon. Members an anecdote. A good friend of mine attended a psychiatric hospital at which someone had been brought in by the police. Six policemen had brought in that person, who was in a violent state of mind, and there was one female psychiatrist there. The six policemen had stab vests on and she was wearing a blouse. Somebody has to do that work and I am slightly concerned about who will do it if the police want to get out of it because the psychiatrists on the front line do not have the same protections that the police have.
On the Human Rights Act, let me highlight that whereas when people come on to the parliamentary estate they have their bags checked, psychiatrists cannot check the bags of a patient they are about to assess even if that patient has displayed violent intent. So someone could come in with a bag with knives and guns in it and the psychiatrist cannot investigate that bag or have it searched because of the patient’s human rights. I would very much like the Front Bench team to look at that and get back to me.
I want to take this opportunity to ask a few questions and re-emphasise that the knowledge base of GPs in this area needs to be improved, particularly for commissioning. I should like to know what the Government propose to do in this area. On the issue of choice, it is all very well wanting patients to be able to exercise choice but if they are not capable of doing so because they are profoundly depressed, demented or psychotic how on earth can they exercise that choice? Is the Minister confident that patients will get the care they need? I welcome the £400 million for talking therapies, but I should like to know where that money is being spent. What is the breakdown of the expenditure of that money? Is the Minister confident that it is being spent in appropriate areas? Anecdotally, I am hearing that it is not making much difference on the front line.
What can be done about the Human Rights Act and the example I have given? We should look at this. Perhaps it is an issue for colleagues in another Ministry, but I would appreciate a response about this.
Finally, let me raise a local issue. The Royal Military Academy at Sandhurst is in my constituency—or at least the parade ground and the buildings are. The residential accommodation is in the constituency of my right hon. Friend the Secretary of State for Education.
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The problem on the Surrey-Berkshire borders is that there is a difference in the mental health care provision from each trust. There is a perverse situation in which people registered at the Royal Military Academy, whether personnel or family members, receive different levels of care. I would appreciate a written response on this from the Minister or from the Ministry of Defence. We may be able to address that with commissioning groups, but it is important, particularly given the comments by some of my colleagues, with reference to our armed forces.
Finally, may I congratulate everyone in the mental health sphere and anyone who is delivering care. They do so in often challenging circumstances. Doctors, nurses and so on need all the support that they can get in a service that will be increasingly important to us in future.
Dr Julian Lewis (New Forest East) (Con): Unlike the doctors who have spoken from the Conservative Benches, my hon. Friends the Members for Bracknell (Dr Lee) and for Totnes (Dr Wollaston), who spoke with such expertise, I have absolutely no medical qualifications whatsoever, but that has not stopped me giving my opinions on this subject in the past, and I am afraid that it is not going to stop me today.
I see from the index on my website that this will be the ninth speech that I have made on the Floor of the House or in Westminster Hall on mental health. Many of those speeches were supported by my hon. Friend the Member for Broxbourne (Mr Walker), and I do not think we will ever hear a finer speech than the one that he made today. In passing, I pay due credit to the hon. Member for North Durham (Mr Jones), whose interest in these matters I have known about for a long time, although not his personal history.
The speeches that I have made in the past have tended to concentrate on three themes: the importance of separate therapeutic environments for people who have to be admitted when they are acutely mentally ill—it is obviously unwise to have psychotic patients cheek by jowl with people suffering from suicidal depression, for example; the importance of single-sex wards, particularly in mental health units, although that applies to the NHS hospital network as a whole; and the importance of making adequate bed numbers available for people who require periodic admission to a mental health unit.
We heard from the Minister about the new emphasis on recovery-based programmes, and I am all in favour of that. There is everything to be said for that, but even its most ardent advocates do not deny that there will always be a need for in-patient beds for some people some of the time. I am concerned that the cuts imposed on in-patient beds may mean that if we are not very careful indeed there will be enough beds available in future only for people who are sectioned. Those people who wish to receive the support and the underpinning—the fall-back position—of an in-patient bed when they are experiencing an acute episode may be unable to secure one.
It has rightly been said that a debate at national level brings out the best in people in the House of Commons. However, the debate at local level does anything but bring out the best, given some of the schemes, plans and measures that have been introduced. In that connection, I pay tribute to the hon. Member for Lewisham East (Heidi Alexander) who, in a measured and thoughtful
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way, made a speech that has become all too familiar to me. She talked about the way in which Granville Park in her constituency has been scheduled for closure on the basis of a consultation that she regarded as somewhat suspect.
I refer the hon. Lady to the Adjournment debate on the Floor of the House introduced by my hon. Friend the Member for Burton (Andrew Griffiths), who discussed similar techniques that were used in his constituency, and to my own experience with the Southern Health Foundation Trust, which used a similar method to make 35% cuts in in-patient beds for acutely ill adults, even though bed occupancy figures were consistently over 90%. The pattern seems to be something like this: they hold a consultation; they make assertions based on, at best, subjective surveys of what they say people want; they then rely on pseudo-independent “expert” research, which usually turns out not to be independent at all; and finally they bulldoze their pre-existing plans through.
Therefore, to take the message that Mr Speaker always used to give when teaching the art of rhetoric, which is that a speech should have at most two main points, the main point in my speech is the need for the objective monitoring of statistics so that when we are reconfiguring services we at least know whether there really are spare beds before we close services down.
I would like to be fairly positive in this debate, brief as my contribution necessarily is, so I would like to say that the health overview and scrutiny committee of Hampshire county council, despite the harsh words I have had to use about it in the past, appears to be taking on board some of my concerns by seeking to ensure, as it has stated in its minutes,
“that further bed reductions are being safely managed”
“made aware by the commissioner and provider should future acute inpatient bed demand regularly exceed bed availability in the service.”
I think that it is terribly important that in the process of reconfiguring we do not simply say that we are recreating a new system in the community while decimating the system that allows people the safety net of an acute bed during those episodes when they are really ill. As I said in my brief intervention on the Minister, if people are to have the confidence to get on with their lives and know that they can have useful and fulfilling careers even while living with and managing a mental illness, it is absolutely vital that they also know that, on the rare occasions when they really need the ultimate support of a few nights or even a week or two in an acute unit, a bed will always be available for them.
Mr Matthew Offord (Hendon) (Con): I will keep my remarks short, as time is certainly against me. I want to focus on the stigma of mental illness and the reasons why I think it continues to exist. We often recoil in horror when we think of the old asylum system in which people were locked up for various reasons. I believe that the care in the community system has been welcomed by most people, and I say that with evidence from the 1994 Ritchie inquiry into the care and treatment of Christopher Clunis, which broadly endorsed the community care policy.
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Even though the community care policy is widely accepted, the issue of mental health is not accepted by the majority of the British public. I say that with evidence from the 2010 public attitudes survey showing that, although people are broadly sympathetic towards those who suffer from mental illness, some of their attitudes are worse than when the Department of Health first commissioned the poll in 1994. I believe that it is fear that drives this county’s mental health system; not the fear of those who suffer from mental illness, but a fear that is perpetuated by the actions of vested interests and perpetuates the stigma. I believe that it occurs through three main areas: mental health lobby groups, politicians and the media.
First, fear of those who are mentally ill has been fuelled by lobby groups that use the rare cases of homicide to keep mentally ill people in the public’s consciousness. Although their motivations are honest, the reality is that their actions promote a fear that is not always conducive to their aims. I do not intend to criticise individuals who have suffered terrible personal tragedies, but highlighting mental health issues as aggravating causes in deaths will not reintroduce a policy of asylum hospitals for severely mentally ill people. That behaviour alienates other mental health charities, which consider it to be unproductive.
Secondly, we as politicians have to take responsibility for reducing stigma. As I have already said to the Minister, the political decision to hold an independent inquiry into every homicide involving a mentally ill person has exacerbated public fear. Following the Ritchie report in 1994, the Department of Health ordered that an inquiry should be held into every homicide involving mental health services, but mental health professionals describe the environment in which they now have to work as an inquiry culture, whereby staff are made aware that any variation from recommended perfect practice could lead to an unpleasant afternoon in front of a cynical committee and the humiliation of being named in one of their reports. Those inquiries are viewed by mental health professionals as a threat, rather than as a corrective mechanism to enforce a “safety first” culture that promotes a perception among the public that every death is preventable.
It is easy for politicians to fall into that trap of trying to face both ways; indeed, the previous Government did fall into it to some extent. They were described as “compassionate” when they embarked on what the Mental Health Commission called
“the quickest and most dynamic transformation of policy in the history of state intervention in mental health illness,”
The third influence on mental health policy is provided by the media. Comments have already been made about the front page of The Sun in 2003, when it faced a significant backlash for branding Frank Bruno “Bonkers” after he had been taken to a psychiatric hospital. But that was not an isolated story. There have been many others, such as “Doc freed psycho to kill” and “Psycho killer was a time bomb waiting to explode”. They all inflame public outrage and continue to promote among the public a perception that mental illness equates to dangerous murderers whom doctors allow out on to the street, free to roam and to kill at will, but that is simply not the case.
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Figures show that there has been no increase in killings by people with a mental illness in the past 40 years, during which time many mental hospitals have been closed in favour of care in the community. Less than one in 10 murders is committed by someone with a mental disorder, and over the past 40 years that number has decreased as a proportion of all homicides, as the overall murder rate has increased over the same time.
On the representation of mental illness on television, the Scottish Recovery Network found that 45% of characters with mental health problems in soap operas were portrayed as violent or as posing a threat to other people. In real life, it was very concerning when in 2007 Nikki Grahame, someone who clearly has mental health issues, and Pete Bennett, who suffers from Tourette’s, were allowed on “Big Brother” simply to increase its viewing figures.
Kerry Katona has admitted that when she sought to go on the same programme on Channel 4 in 2010, she failed the psychological test, as she had just come off her bipolar medication and a doctor advised her that it would not be sensible to appear. In 2011, however, when the show went over to Channel Five, that broadcaster did not produce any psychological tests and she was allowed to go on, the consequences of which could be seen each day.
The biggest change over the past decade has been the increase in protests from people with mental health problems who use the services on offer. Their dissatisfaction is with treatment, its greater emphasis on risk reduction and containment and its narrow focus on medication. Those who suffer from mental health problems dislike the heavy use of antipsychotic and sedative drugs, given their side effects, with some even rejecting completely the biomedical approach, which defines mental health problems as illnesses to be medicated, rather than as social or psychological difficulties to be resolved with other treatments, including talk therapies, for example.
There were some good measures in the Mental Health Act 2007, but there were also some negative ones, so I ask the Minister to address them and, in particular, to outline the benefits that he thinks the 2007 Act has introduced or, if he does not think that it has introduced any, the coalition Government’s policies to address the need for legislation that is fit for the 21st century.
The public and politicians want to be assured that the services people receive from mental health organisations are safe and will protect people from such rare but catastrophic attacks as those that have occurred in the past. People with mental health problems, and their families, however, want to be assured that the services are responsive and supportive, not coercive. They want to be included as active partners in, not passive recipients of, their care. However, a coercive service whose priority is public safety is vote-catching, while concern with civil liberties for a minority group, and one with a dangerous image at that, is not.
Patients continue to be treated with drugs rather than therapy, yet the constant cry is for more talking treatments, which NICE now accepts work for conditions such as schizophrenia. Carers are still neglected; their views are ignored and they lack support. There is huge variability, with some places having great services while others, as has been described today, have appalling services.
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severe, enduring mental illness die 15 to 20 years younger than on average. That is partly due to high levels of smoking and the use of other drugs—in effect, self-medication. There is also evidence that people with mental illness suffer discrimination in relation to their physical health. They do not get seen as quickly and they do not get treated as well as those in other parts of the NHS dealing with patients who do not suffer from their conditions.
The prescription for Ministers appears to be this: more talking treatments; better physical care; concerted action to reduce stigma; and more direct payments for those who can cope with them, allowing those on benefits to buy their own care rather than relying on social services.
Mr Robert Buckland (South Swindon) (Con): I speak as somebody with not only constituency experience of mental health issues but nearly 20 years of professional experience of dealing with a number of cases involving clients with mental health problems committing serious crimes such as murder, and crimes right through the criminal spectrum, many of whom have required the input of consultant psychiatrists and the assistance of the provisions of the Mental Health Act 1983. For many years, it struck me that the question of why those people ended up in that situation was never adequately answered. Years after my first experience with a such a client, I am still struggling to answer that question; perhaps it never will be adequately answered.
Mental health conditions are an integral part of what being a human is all about; they are with us every day of our lives. We are all, parliamentarians or otherwise, a little more brittle than we sometimes care to admit. Some of the testimony that we have heard today has shone a welcome light on the realities of what it is to be a human. Remembering that rule will guide us much more effectively as a society when we deal with mental health and the sad stigma that still pervades mental health issues far too strongly. However, I will not reiterate what other hon. Members have said about stigma.
I repeat my congratulations to my hon. Friend the Member for Loughborough (Nicky Morgan) on securing this debate. It is not an overstatement to call it historic, because many of the comments that we have heard will be remembered long after it is over, and not only by interested people in the mental health community. That is an excellent example of how this place can really help to make a difference in our wider society.
As a constituency MP, I take a huge interest in mental health issues in my area. Swindon, like many other towns of its size, has its fair share of mental health challenges. We have excellent local voluntary organisations that are increasingly working together to improve provision. In response to the hon. Member for Islington North (Jeremy Corbyn), the way to deal with the challenges of commissioning is for local voluntary groups increasingly to come together to co-ordinate their activities and to make bids for tenders. That is
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what is happening in my constituency. Only last Friday, I was at a meeting of Swindon Charities Working Together, where those from the carers centre, Swindon Mind and other organisations were all talking to each other and co-operating, because they recognise that if they do not, the scenario envisaged by hon. Members whereby the big players secure every commissioning tender will become even more prevalent. We must avoid that if we are to develop genuinely local and properly tailored mental health services.
Much has been said about the importance of involving service users themselves, and I cannot place enough emphasis on that. We have a wonderful organisation in Swindon called SUNS—the Service User Network Swindon—which runs a listening line that is operated by service users, for service users. So, on those lonely Friday and Saturday nights, if those people with mental health conditions have nowhere else to turn, they can ring their friends, talk to them and work through their problems. That saves thousands of pounds that would otherwise be spent on the use of crisis teams in the acute services. That is diversion. That is the kind of therapy and approach that we need to encourage more.
There is also much that can be done in the workplace. The Mindful Employer organisation is one of the largest networks of employers in the country. It brings together local businesses, shares best practice and emphasises the fact that it makes good business sense to manage the stresses and strains of the work force more sensibly. I am proud to be what I regard as a mindful employer. One of my employees here in Parliament, Christopher van Roon, has suffered from a mild bipolar disorder—I have his permission to say this to the House—and he manages it with the help of his employers, my hon. Friend the Member for North Swindon (Justin Tomlinson) and me. He has worked here for two years while dealing with his mental health condition. He enjoys his work and being part of a healthy workplace.
That is an example of how people with mental health conditions can be brought back into the workplace and shown that there is a way forward. The idea that mental health conditions somehow mean a dead end for people’s lives has to be ended. That is far from the truth. As other hon. Members have said, such experiences can often make people all the stronger.
My thanks go to all the organisations in Swindon that do so much for mental health provision in my constituency, and also to the army of family members and carers who, in an unsung way, do so much to support those with mental health conditions. I am delighted to have taken part in the debate, and I commend the motion to the House.
Andrew Griffiths (Burton) (Con): I too offer my thanks and praise to my hon. Friends the Members for Loughborough (Nicky Morgan) and for Broxbourne (Mr Walker) for securing the debate and for putting mental health at the centre of Parliament and the centre of our thoughts today. I also want to thank my hon. Friend the Member for New Forest East (Dr Lewis). Over recent months, he has played Starsky to my Hutch in relation to mental health debates. He also managed to make my speech today in a much more succinct and erudite manner than I could ever hope to do.
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I rise today to make a plea to the Minister. He graciously attended an Adjournment debate that I secured on the closure of the Margaret Stanhope centre, a mental health facility in my constituency. It was as a result of his intervention that the consultation was extended, and I was grateful for that. The end result, however, was that the local PCT—South Staffordshire PCT—took the decision to close the centre. As a newly elected Member of Parliament, I assumed that such decisions would be taken based on facts and evidence, and that there would be hard facts to enable the PCT’s claims to stack up. I assumed that its claims about the provision that was going to replace the Margaret Stanhope centre would be demonstrable. As my hon. Friend the Member for New Forest East said earlier, however, the reality was a mind-blowing situation, in which the inability of the PCT to make any of its claims stack up throughout the process became apparent. I was disappointed, but not surprised, that the PCT dismissed the petition organised by my local newspaper, the Burton Mail, to save this much-loved facility, which some 8,200 people signed. The PCT decided to dismiss it because, it said, the petition did not deal absolutely to the letter with all the options that were in the consultation.
Throughout the consultation, the PCT made a number of claims. To start with, it said that it had carried out a pilot scheme and could demonstrate that it could reduce the need for in-patient care by a third. Understandably, we asked for the evidence to back that up. After five weeks of asking, it eventually provided me with some occupancy rates. We then asked for further occupancy rates, because the initial ones did not stack up. We asked for daily occupancy rates. It took a further two months for the PCT to give us that information. When we analysed it, it showed that far from reducing the need for in-patient beds by a third, only stays of more than 90 days—a minute part of in-patient care—had been reduced by a third. The vast majority of the figures had stayed the same and one-day admissions had actually gone up.
We looked further into what the PCT was saying. It had claimed that an independent report by Staffordshire university had said that closing the facility would not have an impact. When we looked at the report, we found that the professor from Staffordshire university who had conducted it was also employed by the PCT. She was on the payroll of the PCT, and yet it was praying in aid her report.
We cited a benchmarking report by the Audit Commission, which demonstrated that the PCT had among the lowest provision of mental health beds in the country. It stated that of 46 mental health trusts, Staffordshire had the lowest provision. Surprise, surprise, the following quarter’s evidence showed that my PCT had the highest provision. It had shot up from the lowest to the highest. When we explored that a little more, we found that the PCT had included beds such as those for eating disorders and drug and alcohol problems. It had lumped them all together to fix the figures.
The most worrying thing for me was that when I attended the final hearing where the decision was made, lay members on the panel were asking basic questions such as how many beds were available and what the occupancy rates were, even after a four-month consultation. They clearly did not have any of the information that was necessary to make such an important decision.