House of Commons - Opposition Day Debate - Mental Health Services

Norman Lamb leads a Liberal Democrat opposition day debate highlighting the need to place more focus on mental health services and calling on the government to ensure mental health services are better funded and more widely available.

Norman Lamb, Liberal Democrat Shadow Health Secretary

Introducing the debate, Mr Lamb said, "Another Opposition day and another debate on health - we have been getting rather used to them in recent months. I was particularly keen to use this opportunity to raise concerns about mental health services. It is something of a paradox that, although mental health problems touch one in three families, mental health still does not get nearly enough attention in this place or in the broader public debate. I hope that the debate will be constructive and that the Government will respond positively to the concerns that I and no doubt many others will raise. The subject is far too important for cheap political point scoring."

Outlining the background of the debate, Mr Lamb said, "Although real-terms spending has increased, the proportion of NHS spending given to mental health services has fallen from 14 per cent. of the total spend in 1997 to 11 per cent. today. I appreciate that the situation presents real challenges, but I am trying, in a mature way, to point out that at a time when concern about the need for mental health services is rising and there is an increased prevalence of mental health problems in our society, we should collectively be worried that the proportion of total health spending going to mental health is going down. For example, the mental health of children and teenagers in this country has declined over the past 30 years, although, interestingly, the prevalence has remained relatively stable in other areas. It is especially striking that the prevalence of mental health problems has increased at a time when economic conditions and physical health have improved. It appears that this is the emerging health problem of our age."

"The second and related point is that despite the increased investment, which we acknowledge, we have a long way to go if we are to ensure consistent access to high-quality services across the country in both rural and urban Britain, and for all sections of society, including ethnic minorities." Continuing, Mr Lamb said, "There is clear evidence of unequal access to services for ethnic minorities. The Sainsbury Centre for Mental Health concluded that investment in community-based services would free up millions of pounds that is currently spent on African and Caribbean people in psychiatric hospitals and secure units. Such people are six times more likely to be in medium-secure units than white people in our capital city. There are all sorts of reasons for that discrimination within health services, because those people are far more likely to suffer compulsion than white people are. We need to find the reasons for that and to address the issue. We have to ensure that the early intervention services, which ethnic minority communities often cannot access, are there for them.

The Government have rightly made a commitment to securing race equality in mental health services, but progress has been too slow. There is evidence that mental health facilities continue to be the poor relation to acute services, not just in relation to ethnic minorities, but generally. A Mind survey found dissatisfaction with the state of repair on wards, and the Healthcare Commission found that mental health facilities had markedly poorer standards of cleanliness than acute hospitals. There can be no justification for mental health patients being treated less favourably than patients in any other acute unit."

Moving to the issue of funding, Mr Lamb said, "My third concern relates to what the Select Committee on Health described last December as the "simply unacceptable" cuts that have resulted from the financial crisis that has afflicted many parts of the NHS. In many parts of the country, valuable support services have been lost, and that has affected some of the most vulnerable members of our society. Rethink has estimated that some £60 million of cuts have been made to mental health services, not as a result of financial crises within mental health trusts, but as a result of primary care trusts cutting block grant funding for mental health."

Continuing Mr Lamb said, "May I move on to the fourth issue that I wish to raise - the economic impact of mental health problems for both the individual and society, and the need for Government Departments to work together much more effectively to ensure that resources are used to optimum effect? May I respond to interventions from Government Members, by saying that to a large extent that is about using resources more effectively, rather than simply increasing them? Lord Layard focused on that in "The Depression Report" last June. He highlighted the waste of talent and the loss to the economy of the extraordinary numbers of people who are left stranded on incapacity benefits - people who could be successfully treated but who do not gain access to psychological therapies. One million people are on incapacity benefits as a result of mental health problems, and 30 per cent. of new applicants for incapacity benefits have a mental illness. Half the people on long-term incapacity benefit suffer from depression. Those are extraordinary figures: the human cost is massive, not just for the person suffering but for their families, too, and there is distress and deprivation. For children and teenagers, depression and anxiety often stop them learning, and condemn many of them to limited life chances as a result."

Concluding, Mr Lamb said, "The Government need to remedy the damage done by deficits over the past two years and to acknowledge that and to commit to ensuring that that damage is remedied. They also need to be honest enough to recognise that there is a long way to go before we achieve consistent access to services and choice for people in terms of the treatment that they receive. That must be a priority. The Government have to be much smarter at joined-up government. We can achieve the great prize of helping so many people to get better, helping them back to work, and benefiting the economy by ensuring that they have access to the therapy that NICE recommends. Surely we have a duty to those people who suffer in silence and in isolation."

Simon Hughes, Liberal Democrat MP for North Southwark and Bermondsey

Mr Hughes said, "Nobody knows what the exact figures are. The Library tells me that about one tenth of the world's population suffer from mental illness and about one in six of the population of Great Britain are assessed as having neurotic disorders. The best figure that anyone can come up with is that one in four of us will, during our lifetimes, have mental illness at one time or another. Like, I am sure, other hon. Members, I did not need to become an MP to realise how crucial mental health services are, because I know that from the experience of people among my extended family and friends, and of people whom I associated with at college or worked with. Indeed, we all know the stories of people suffering from mental illness, sometimes with tragic results."

Continuing, Mr Hughes said, "I join others in thanking my hon. Friend the Member for North Norfolk (Norman Lamb) for giving us the opportunity to put this subject on the agenda - and there is no argument but that this subject should appear more regularly on that agenda. I join others in thanking those who work in mental health services, whether in acute services, primary care services or intervention services."

"I am conscious that we are bidding for more funds, and I make a special plea again for universities and colleges to be given the services that they need, so that young people do not have to wait so long. They are often at their most vulnerable in their late teenage and early adult years - girls as well as boys, although it is apparently more common for boys. Their whole future careers may depend on securing the help that they need."

Moving to work force planning, Mr Hughes said, "I hope that we get work force planning right. I accept what the Minister said about there being more psychologists, psychiatrists, and psychiatric and mental health nurses, but we have not been great in nurse work force planning over the last 20 years. We have not been great at doctor work force planning in the NHS either. We need to ensure that we have the people - and we need to include alternative therapies, too. I very much hope that the answer to the question that the Minister ducked is that a bid has been put in for more money for mental health services in the comprehensive spending review."

Dr John Pugh, Liberal Democrat Shadow Health Minister

Concluding the debate Dr Pugh said, "Poor mental health is, in its severest form, the most terrible suffering known to man. No one can ever escape the torture in their own mind. All of us enjoy varying degrees of mental health in our life, including stress, anxiety, depression and unreasoning fear - some of us who are serving on the Mental Health Bill have gone through all those stages just today. Too many people enjoy socially disabling and serious mental conditions, and some live an endless nightmare and a living hell, and experience gnawing fear and enduring despair.

As has been made clear in the debate, addressing mental health problems means a huge win for society as a whole. Many benefit claimants, including increasing numbers of new claimants - that is quite important - are not at work owing to stress and anxiety. Professor Layard's work, which has been mentioned frequently this evening, has been very helpful both in underlining that key finding and in suggesting remedies, and there is evidence in my constituency that the Department for Work and Pensions is acting on his comments. More provocative and difficult, however, is his suggestion that social planners should be mindful of the mental casualty rate in modern society, and should plan accordingly."

Dr Pugh concluded, "If the Government increase funding, stop top-slicing, encourage people back into work, fight discrimination, increase public understanding, and fight stigma through programmes such as their laudable Salford's Health Investment For Tomorrow, or SHIFT, programme - under which £1 million a year is being spent on fighting stigma - they will have our support. They will also have our support if they concentrate on providing more good therapies, such as talking therapies, rather than the chemical cosh. However, even according to their own analysis, they should forget about payment by results."