Imagine you have the misfortune to be diagnosed with cancer. Perhaps you have already faced this devastating illness, experiencing first-hand the distress, fear and uncertainty that comes with it. A small comfort for many is that, under NHS waiting time standards, cancer patients have the right to fast access to the best possible evidence-based treatment – a right which is fiercely defended by politicians, the media and the public.
But now imagine you are told that you won’t be given the treatment you need. Services are under-funded and under-staffed to the point where the full package of care isn’t available. You are told that you will only receive a shortened chemotherapy cycle; that you can only have chemotherapy when what you need is a combined course of chemotherapy and radiotherapy; or even that you won’t receive the full package because you are over the age of 35.
In short, you won’t get the treatment that will dramatically improve your chances of recovery – the treatment that you should be guaranteed under standards of care enshrined in the NHS constitution.
This would never be tolerated in the NHS, and rightly so. Yet this is the reality for thousands of people with severe mental health problems, who are experiencing their first episode of psychosis but are being denied the standards of care they have the right to expect.
When the Liberal Democrats were in government, one of the most important steps we took towards achieving ‘parity of esteem’ in the NHS was the introduction of the first ever access and waiting time standards in mental health care. This included a guarantee that from April 2016, at least 50% of people with psychosis would receive a high-quality, NICE-approved approved package of care within two weeks of referral.
However, my investigation (reported today by the BBC) has found the new treatment standards are not being delivered in most parts of the country due to a chronic shortage of funding and staff. In response to my Freedom of Information requests, less than a third of mental health trusts said that they are able to offer their patients the full NICE package of care – known as ‘Early Intervention in Psychosis’ (EIP) – that meets the national standards.
Too many people are not receiving the different treatments and services that should be available – including specialist cognitive behavioural therapy, support for healthy living, interventions to support families and carers, and services to help people with psychosis to find employment. In some areas, we found that there were no trained staff capable of providing these services.
I also uncovered outrageous evidence of age discrimination, with a quarter of mental health trusts restricting their EIP service to patients below the age of 35 while older patients are denied their right to effective treatment. Whichever way you look at it, this is clearly impossible to justify. And on top of this, I have heard reports of patients being discharged just months into what should be a three-year programme of care.
These failings ultimately come down to the impossible pressure on mental health budgets. NHS England estimates that the cost of providing the full treatment package is approximately £8,250 for each patient – but my research found that mental health trusts spent an average of just £4,000 last year. The picture is little better this year, with trusts estimating that they will invest £4,900 per patient – still less than two-thirds of the recommended amount.
Be in no doubt: this is pure and simple discrimination against people with mental ill health at the heart of our NHS. Time and again we see people with severe mental health problems losing out as a result of tight budgets. It is both morally wrong and economically stupid. As well as the incalculable human misery and suffering, psychosis costs society an estimated £11.8 billion every year due to healthcare costs, unemployment and lost productivity. But we know that if those who experience psychosis get speedy access to the full treatment programme, it can stop the psychosis becoming entrenched and give that person the best chance of a good and fulfilling life.
On Time to Talk Day, it is important that we get the nation talking and encourage honest, open conversations about mental health. But we must also send a clear message to the Government that people with mental health problems should be entitled to the same standards of care in the NHS that we would expect for people with a physical condition like cancer. In her first speech as Prime Minister, Theresa May pledged to tackle the ‘burning injustice’ of inadequate access to mental health support. Delivering on the promise of better standards of care for people with psychosis would be a good place to start.
* Norman Lamb is MP for North Norfolk and was Liberal Democrat Minister of State at the Department of Health until May 2015. He now chairs the Science and Technology Select Committee
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19 Comments
Good article and I very much agree. There’s also a lack of understanding of the sometimes cyclical nature of some conditions and the effects of medications.
there was a `time to talk` tables at a library near here with mental health advisers – I thought it a great idea.
Dear Norman
I very much agree with your article.
We appreciate what you tried to achieve in coalition and what you are still committed to doing as an MP now for people who suffer with mental health.
You have been the most vocal champion in parliament for people who suffer with mental health and I am always confident in the fact that I know you will hold Theresa May and her government to account on these issues.
I know personally just how impossible it is to access treatment on the NHS.
In March last Year I was refereed back to mental health services because of deterioration, I was appointed a Lead Care Professional because of my history, but they could not get me treatment with a Psychologist. In September, I moved to a new town, My Lead Care Professional sent over my details to the new team who would be dealing with me.
It is now January and I still have not been appointed a lead care professional and come March this year it will be a Year waiting for treatment.
Parity of Esteem, I dont think Theresa May knows the meaning of the word
Norman has done a sterling job. I’d certainly like to see other parties on this issue put aside party loyalty and work with Norman. He is an absolute credit to Parliament.
The Problem with our current mental health system, is, not only is it near on impossible for most people to access treatment in the first instance. The NHS takes a once cap fits all approach to treatment. The problem with this approach is, people are individuals and have complex individual needs, just like physical disabilities, we all heal at different rates.
Like Norman says in this piece, imagining saying to a cancer patient that they can have no more treatment even though their condition has not been brought under control or cured, and yet, this is happening to people suffering from mental health conditions every single day.
If you are lucky enough to be given access to talking therapy, you are normally limited to 12 sessions.
Just think about that for a second. A vulnerable person who is suffering from untold trauma is expected to build a relationship with a complete stranger, to learn to trust that person and to trust themselves and their ability to cope with revealing that trauma, to divulge the most personal and sometimes tragic circumstances that any human being can go through in life.
Imagine the pressure put on an individual knowing that they are limited to between 600 and 720 Minutes to do all that.
In order for therapy to be effective, it needs to focus on 3 stages, all 3 stages are equally important and should not be skipped or rushed
Phase 1, Education, focuses on safety and creating a Safe place and a solid foundation in order for trauma work to begin, increase emotional control and social and psychological competencies and goals. (this education is vital before trauma works begin)
Phase 2, begin treatment for depression, Anxiety, traumatic memories and PTSD. This can take the form of CAT, EMDR, Narrative Exposure Therapy.
phase 3 consolidates treatment and focuses on relationships, work and community life.
How the NHS can expect to cram that all in to 12 sessions is beyond me.
Until the NHS stops treating people who suffer with mental health with a 1 cap fits all approach to treatment, it is going to continue to fail a lot of people
Norman reveals why he should be leader , the issues he deals with are those we the vast majority not going on about Brexit , are concerned about! I think it ironic that the party crowns a leader not any criticism of Sir Vince, because he is the only candidate because the other potential one many saw as the best, does not stand , despite priorities we need, like these herein.
The parity is though not the issue as much as the catastrophy that is the health service here and in the us. We think we are so wonderful, they so terrible, how blinkered.
Top down waiting like manna from above, is pitiful, Norman is wrong on his opening, on physical health the waits are long too often, targets met by patients in second level waiting lists having met the initial target.
We need this man as leader and his open minded but passionate attitude, and these issues ahead of Bre…
And we need more of Matt… good to read him.
Matt. There are undoubtedly shortages of provision of care, but there is not a ‘one cap fits all’ provision in the mental health services. Early Intervention in Psychosis is one part of the services, for new referrals, but needs are complex and often recurrent, and various forms of treatment will be tried. It sounds as if you have seen, and perhaps have partially experienced, aims for a twelve-week programme, but these are guidelines, as anyone can imagine considering only the ‘Phase 2’ you mention, where the different kinds of needs will need to be matched with different kinds of therapy.
For most people with mental health conditions not classified as severe psychosis, such as depression and anxiety, NICE suggests various forms of treatment, and there has been considerable expansion of the provision of Cognitive Behavioural Therapy in recent years. In ‘talking therapies’ like these, the relationship established between the therapist and the patient is significant in healing, and this can be rapidly achieved, long before substantive work is done. Voluntary agencies such as MIND supplement the NHS provision, while in the NHS itself mental health nurses going out to patients’ homes offer a vital service, which can prevent admission to clinics and hospital care. Appropriate medication is the ever-present accompaniment to the talking therapies.
Awake and alert to the intelligence of you, as usual, Katharine.
The thing is though we , as with the US, not as an alternative, are sleepwalking into defunding and starving the very services described at best.
At worst the reality is as Matt says.
I know this country and the US. Two disasters on health. One , there is no national system, the US, nor a real one in local areas.
Here there is one, paid lip service, reality starved of enough doctors, nurses, money.And instead , constant , we are the best , because at least we’re not America.
We are not France , or Germany or Holland or…
We are seeing the nhs increasingly a political football, that is why Norman was and is the best we have at the centre of the leadership, he gets it !
Housing, is another subject. I know someone living in a situation that was clearly effecting her depression. If it was a physical disability it’s seems easier for the local authority to understand.
I agree, on a recent disabled toilet the following was written. Some disabilities are invisible, that can be the case in many disabled people.
I agree, with the mobility badge for those with mental health, on a bad day this young person, finds contact with others very difficult.
@Lorenzo Cherin
Thank you for your comments. I was glad to see you back on the forum also 🙂
@Katharine Pindar
Without wanting to sound to personal, may I ask if you practice within the NHS or as an individual practitioner?
My comment was not in reference to Psychosis, although the crux of Norman Lambs piece was, I expanded on this to include Depression, Trauma and PTSD
“but needs are complex and often recurrent, and various forms of treatment will be tried.”
Which was kind of my point, but if you have experience with the way the NHS works, as I have, you will know that more often that not, the person is given a set amount of sessions (usually 12) and if this does not work then the sessions come to an end. You can then maybe get referred for more therapy and a different approach at a later date (If refereed by your GP) say in 12-18 Months. Which again was my point. You would not say to a cancer patient who is not yet got their condition under control or cured, sorry sessions are up, please come back in 12-18 months if needed (Or if still alive) and we will see about giving you more treatment.
“In ‘talking therapies’ like these, the relationship established between the therapist and the patient is significant in healing, and this can be rapidly achieved, long before substantive work is done” Well My experience as someone who suffers from severe forms of depression and PTSD, who has difficulties with trust issues with others as well as myself, relationships based on trust cannot be rapidly achieved and I am sure I am not unique in that matter.
This has been MY experience with the NHS mental health services which I have shared during my time to talk. Fortunately I have not been solely reliant on NHS treatment and have had Private treatment as well, so I have experienced both and the different approaches taken.
I found failings where threats of suicide becomes a problem. On a weekend there is often problems with coverage.
I know there are two excellent GPs in the Bath area, very keen to improve on mental health, as this in turn can cause physical health issues.
The young person I know, has suffered for several years until reaching this point in time.
If Norman wishes to know the names of these two excellent GPs, I can email. One of them is a very much respected representative. There also, has been another lady GP who is also becoming a much interested sympathetic addition to the subject.
Depression is different to psychosis, I fully understand the difference.
@ Helen Dudden
Completely agree with your posts and about the Blue Badge Scheme.
There are a lot of uneducated prejudices about the Blue Badge Scheme, to many people think this is all about a disabled parking spots at supermarkets when it is nothing of the sort. It is about so much more than that.
So many illnesses are invisible.
Someone suffering from a severe anxiety related disorder, they might love the opportunity to go for a walk along a secluded beach, however, the nearest parking to the beach might be 100’s meters away if not further through a busy seaside town with shops, people and arcades and making the journey impossible for them so they miss out on a fabulous opportunity and the simple things in life that so many people take for granted. A blue bade would permit them to park on a yellow line, closer to the beach and avoid the anxiety of busy centre and people
There are so many examples that I could give you, where people with mental health and anxiety related disorders who would benefit from being able to park closer to their destination, opening up a whole new world of opportunities where at present they are cut off.
This is not about a supermarket disabled bay. Walking a couple of extra meters is of no consequence to a person with mental health disorders in a supermarket car park (if they are even able to do this) , this is about expanding the opportunities and to lead a more inclusive and fuller life.
Lorenzo, thank you, and I hope your being awake at 3 a.m. was voluntary! Matt, I am glad you have now written that you were not writing about psychosis, because I posted my comment in some alarm that people with neurological conditions might think the gloomy picture you painted must inevitably apply to them and even cast them into deeper depression. As I said, there are many different types of treatment, and I have more knowledge of short-term therapy which tends to allow six sessions of CBT rather than twelve in the first instance. Besides, I understand that the first step may be telephone counselling. In my area there is some wonderful supplementary provision by MIND.
I mentioned the relationship because it has been observed that an important step to successful therapy is that when client and counsellor meet they have an instinctive rapport, which carries them over the gulf of not knowing each other in any real sense for some time.
I have a personal practice, not in the NHS, which is why I considered long what I would write to you with all your NHS experience. However, I have observed long-lasting treatment of a close friend by NHS practitioners, and have also myself treated more than one NHS nurse, besides of course having continual professional updating from the Therapy journals and learning from my own supervision. I hope that you will find better help than you seem to have had when most needful. Much more is indeed needed generally.
(Have I not heard that the mobility allowance of PIP has now been agreed by the Government? I remember your campaigning for it.)
Katherine Pindar. Yes totally agree. Many more young people are finding life not easy. I’m surprised by my young relative and the others they may know suffering depression, not unhappiness depression.
I also have another very young family member who was caught up in a legal dispute, after being illegally removed from this country, they are anorexic. This has been for years, a form of control. Life seemed to much to cope with.
Depression can be caused by broken relationships, just too much.
More understanding is needed in certain situations.
@Katharine Pindar
I am glad that we cleared our crossed wires up 🙂
(Have I not heard that the mobility allowance of PIP has now been agreed by the Government? I remember your campaigning for it.)
Well, there is some confusion still over what is going on and the DWP Ministers are not being entirely forthcoming with answers.
They have agreed that they are not going to appeal the high court case which said the legislation changes where discriminatory against those suffering with mental health.
The legislation changes which inserted the words (Apart from Psychological Distress) have to be removed and the application forms need to be updated : The Minister has not given an answer when this will happen.
The decision guides given to decision makers needs to be updated: Again they have not said when this will happen.
People who were in receipt of DLA and used to have mobility cars and lost them because of PIP: The Minister has not given a promise that these people would be given a priority
1.6 Million cases are going to be automatically reviewed by the DWP, where it is expected that 220,000 will either see an award when they previously scored zero points and some people who were given the lower rate would see their award increased to the higher rate: Again, the Minister has given no indication as to how long this process will take, but it sounds like years.
There are so many unanswered questions and weasel words still coming from the Ministers.
Those that lost their awards when they transferred from DLA to PIP and lost their mobility cars as a result, should be given the utmost priority.
(This is not something that affects me for clarity)
@Katharine Pindar
I am glad that we cleared our crossed wires up 🙂
(Have I not heard that the mobility allowance of PIP has now been agreed by the Government? I remember your campaigning for it.)
Well, there is some confusion still over what is going on and the DWP Ministers are not being entirely forthcoming with answers.
They have agreed that they are not going to appeal the high court case which said the legislation changes where discriminatory against those suffering with mental health.
The legislation changes which inserted the words (Apart from Psychological Distress) have to be removed and the application forms need to be updated : The Minister has not given an answer when this will happen.
The decision guides given to decision makers needs to be updated: Again they have not said when this will happen.
People who were in receipt of DLA and used to have mobility cars and lost them because of PIP: The Minister has not given a promise that these people would be given a priority
1.6 Million cases are going to be automatically reviewed by the DWP, where it is expected that 220,000 will either see an award when they previously scored zero points and some people who were given the lower rate would see their award increased to the higher rate: Again, the Minister has given no indication as to how long this process will take, but it sounds like years.
There are so many unanswered questions still coming from the Ministers.
Those that lost their awards when they transferred from DLA to PIP and lost their mobility cars as a result, they should be given the utmost priority.
(This is not something that affects me for clarity)
The Work and Pensions Secretary and the DWP need to pull their finger out, because until they update the legislation and the wording on forms and decision makers guides, All Applications currently being assessed or new applications being submitted, technically, have to be assessed under the current guides. Unless they are going to put these cases on hold, which means more people waiting even longer for decisions and access to benefit that they are entitled.
As Katharine Pindar points out “there has been considerable expansion of the provision of Cognitive Behavioural Therapy in recent years”. I think it is being provided separately from local mental health trusts and is seen as a silver bullet which will help nearly everyone with a mental health issue. This is of course not true. I do wonder if cuts to the availability of other talking therapies were made to bring in the huge expansion of the provision of Cognitive Behavioural Therapy since 2008. This might even be the position of the UK Council for Psychotherapy.
It is often claimed that research shows that CBT can be an effective therapy for large numbers of people suffering from a large number of mental health issues, but no one claims it is 100% effective (Wikipedia questions the validity of the studies sighting many different researchers https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy#Relative_effectiveness). As the NHS site states “it (CBT) may not be suitable for people with more complex mental health needs”. Also because it focuses on the individual changing themselves it can seem like a person with mental health problems are being told that their problem is themselves and if only they were different and changed the way they think they would be better and not have their mental health issue. This seems very strange with regard to depression because anti-depressants are used to treat chemical imbalances in the brain which it is believed cause depression.
Am I wrong in the understanding of proof that depression is part of chemical imbalance and some type of inflammation of the brain itself?
Having a family with depression that is at last easing, I would state it is difficult to find appropriate treatment. I also understand that depression is more common in the younger generation that we thought.
It may be useful to have a study on the subject.
Helen, I have never heard of depression being regarded as ‘inflammation of the brain’. but I am not competent to comment on the medical effects of the use of anti-depressants. Michael, thank you for that reference to the long posting on CBT from Wikipedia. Practitioners use various treatments on the basis of advice from NICE, and CBT was one of those recommended for treatment of depression and anxiety. One of the reasons why it was more firmly recommended than general counselling was, I believe, because its effects could be more easily researched as it is more prescriptive.
However, I don’t believe that you are correct, Michael, in stating that ‘because it focuses on the individual changing themselves it can seem like a person with mental health problems are (sic) being told that their problem is themselves and if only they were different and changed the way they think they would be better.’ With respect, no trained therapist would treat a patient so insensitively as to suggest that s/he must change, that the problem is yours and it’s up to you to change the way you think. Moreover the programme has allowed hundreds more people to try a ‘talking therapy’ for their problems over the past few years than would have been possible for them before.