Norman Lamb writes… Mental Health: our priorities for essential change

closing the gapSupport for those with mental health problems has come a long way since 2010. Rectifying the profound injustice in the priority given to physical health over mental health has been one of my highest priorities as Health Minister – as I know that it was too for Paul Burstow. When at least one in four people will experience a mental health problem at some point in their life, making sure they get the support they need to live independent and fulfilled lives is essential in delivering a stronger economy and a fairer society.

But there remains a very long way to go. People who rely on our mental health services – patients and carers – continue to experience unacceptable waits for services, and huge inconsistencies in the quality of provision. Some parts of our health and care system don’t do nearly enough to enable those with mental health conditions to live within their community, properly supported.

Today, I am therefore incredibly proud that Nick Clegg has joined me in launching an action plan for mental health – “Closing the Gap: Priorities for essential change in mental health”. The document sets out clearly 25 urgent priorities for changes that are needed in mental health, and the approach we will take to delivering on them.

One of our most urgent priorities is to introduce clear waiting time standards for mental health services. The last government introduced waiting times for physical health conditions, but not for mental health. As well as being fundamentally unjust, this has also governed spending decisions – as local commissioners prioritise areas of care where they have to meet targets. These new access and waiting time standards will be introduced in 2015 – and I will be working closely with NHS England and local health organisations to ensure that improvements are made in the meantime.

Another priority will be ending the use of high-risk restraint, including face-down restraint, and radically reducing the use of all restrictive practices. This will be linked with new support and research into better ways of managing challenging behaviour, such as positive behavioural support. This follows the recommendations of the review into the Winterbourne View scandal, which highlighted the shocking and unacceptable use of dangerous physical restraint at the hospital.

It is completely unacceptable that, all too often, those experiencing mental health crises – often placing their physical health, or even their life, in serious danger – can’t get help when they need it because services are full, or closed until Monday. We are shortly publishing a new Crisis Care Concordat, which aims to make sure that whichever part of our emergency services an individual comes into contact with, they will always receive prompt, appropriate and effective mental health support.

I think most adults will agree that one of the most difficult moments in anyone’s life is the official transition from childhood to adulthood at the age of 18, with the stresses and turmoil that comes with it. This period can be exceptionally difficult for those with mental health problems. And yet – perversely – this is the moment when our current system for the most part decides to withdraw Child and Adolescent Mental Health Services (CAMHS), and transfer to adult mental health services. The changes are all too often poorly planned, with support withdrawn and not replaced, and the disruption to people’s lives can be immense. This cliff-edge must end –proper transition plans should be put in place, and our ambition is for this to be standard practice across the NHS. There must also be effective co-ordination between CAMHS and adult services, and a commitment to ensuring that the support given is always age-appropriate.

We have known for a long time that mental health problems have an impact on a person’s physical health. Shockingly, men with a mental health condition currently have 20 years’ shorter life expectancy than men without (and for women it is 15). People with mental health problems deserve to live healthier lives and longer lives. We have made it clear that we expect NHS England to narrow this gap, and will be publishing a five-year plan for delivering this – for instance by providing more effective support to combat drug and alcohol misuse and provide joined-up care. We also need to tackle poverty and overall levels of inequality among those with mental health conditions – all of which contribute to lower levels of physical wellbeing and life expectancy.

One of the key contributing factors to mental health conditions is employment. Those with mental health problems who are able to access or retain employment, properly supported, are likely to have a better prognosis than those who can’t. Unemployment, meanwhile, can trigger or exacerbate mental health problems. We want to create closer working between psychological therapy services and Jobcentres, helping both provide more effective support to those with mental health problems. As well as improving support for individuals aimed at helping them to live active working lives, we also need to work with employees to make sure that people are supported in the workplace, and that employers understand the needs of employees with mental health conditions.

You can read the full details of our announcement here. I have only mentioned a few of the 25 priorities he has set out. This is one of the most significant steps forwards for decades in mental health. This renewed and strengthened commitment to mental health has the ability to really transform people’s lives – and is another example of Lib Dems delivering a stronger economy and a fairer society.

* 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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  • Melanie Harvey 20th Jan '14 - 1:23pm

    As many a mental health issue may well be due/linked to injustice or abuse, I would recommend in this instance and to cater for such that, the victim support helpline becomes a 24 hour service also. Currently it is not and during a very distressing time is a vital outlet particularly when the police are not proving helpful..

  • As someone expelled from the “LibDems” on a charge that being an economic liberal is “incompatible with party membership” I find it interesting to see what is compatible with it.

    In the normal way of “LD” bloggers I assume this comment will be censored.

  • Peter Balcombe 20th Jan '14 - 4:36pm

    As an active Lib Dem (and a Councillor) – and a retired senior NHS manager who previously worked in the mental health field I welcome these statements. However I am very concerned about the local mental health scene here in Norfolk on Norman’s doorstep. I find myself very much in support of the Defend Mental Health Services Campaign in Norfolk and Suffolk (and attended it’s inaugural meeting). I have subsequently observed the rather better presentation of the Campaign than the Trust and CCG management on Mental Health issues most notably at the Norfolk Health Overview and Scrutiny Committee last Thursday. I recognise that whilst claiming cross Party support the Campaign is getting considerable backing from the Labour Party but also know that it is widely supported both outwardly and clandestinely by many (probably the majority) of local health and social service professionals in the mental health field, by the staff of MIND and other similar organisations and most importantly by a justifiably vociferous and growing number of those with mental health needs. From my past and ongoing connections with the services I am acutely aware of both the extent of disillusionment of the very people we need to build the new better services and the consequent exodus of those people literally to all points around the globe. I am fearful that the very ineptitude in cost cutting which bought the QE2 in Kings Lynn into Special Measures is being replicated even more disastrously in Norfolk and Suffolk Mental Health Services.

  • If I were an optimist I would be looking forward to April when I could go to my GP chose a mental health provider that I haven’t been referred to before and design with them a programme of non-time limited depression counselling with non-time limited weekly support to get me to take up the community activities I once enjoyed and even support me to become active again in the Lib Dem local party. But I am a pessimist and so believe that when I raise this issue with my GP he will not be able to refer me to a mental health provider who can provide what we both know I need.

  • I have my doubts about employment being a significant factor in dealing with mental health issues.
    A boring and stressful job is far more likely to make depression worse.

  • All brilliant stuff – and a shame that it was rather lost in the news yesterday.

    Has any thought been put into how the classic problem of targets willl be avoided: that people change their behaviour in order to meet them?

  • Norman Lamb 21st Jan '14 - 7:12pm

    Thanks for all your comments. I think these proposals can make a real difference to mental health services in this country, and I am really pleased that they have been received so positively. Sorry for the delay in responding.

    Melanie – I certainly think it is essential that those with mental health problems can access support around the clock when they need it. One key part of the proposals is a commitment to improving access to crisis mental health care – no one should ever be turned away or told to come back on Monday (which currently happens far too often). We are also developing a “Crisis Care Concordat” to make sure that different emergency services work together to deliver effective support to those with mental health problems.

    Helen – I also have much sympathy for what you say. The new NHS Mandate requires NHS commissioners to work towards parity between mental and physical health, and I am determined that we will see this reflected in budget-setting and waiting times. This is something I will monitor very closely.

    Dave – I completely agree. The proposals specifically aim to tackle inequalities around service usage – whether among ethnic minorities, ex-servicemen, older people, or other groups who are at particular risk of suffering from mental health problems, or who are less likely to access support. Time to Change is running some important pilots in this area – and I will be following them closely to see what lessons can be learned.

    Peter – you are right to say that mental health services in Norfolk often are simply not good enough. You may be aware that I have campaigned on this over many years locally. NSFT has some very good services – such as its Youth Teams and Recovery College – but I also completely understand people’s concerns about the restructuring that is taking place. In my role as North Norfolk MP I have met with Monitor, clinicians, and local union representatives to discuss the changes, and will also be meeting with local commissioners in the near future. I am absolutely determined that Norfolk residents should receive good quality mental health services – and the same applies across the country.

    Amalric – we are expanding the IAPT programme for psychological therapy to increase the number of patients who can receive this support by 50% – so 300,000 more people will get the support they need. I don’t know the details of your case, but you could contact your local MP if you aren’t getting the help you think you need.

    Voter – you are certainly right that a stressful job can make things worse, but there is also clear evidence that being out of work can trigger mental health crisis or a deterioration on someone’s mental condition. One of the elements of the plan announced yesterday was supporting employers to help them provide a working environment which supports people with mental health problems – and an important part of that is managing stress, and understanding the impact this can have on vulnerable employees. Employers also already have a duty under the 2010 Equality Act to make “reasonable adjustments” where an employee has a disability, which could include a mental health condition.

    Ian – thanks for the very positive comment! Targets can lead to perverse behaviour, but they can also be an important way of positively influencing local commissioning decisions, and targetting inequalities between the standards of local services. It is clear that at the moment the emphasis placed by targets on the performance of physical health services leads to an unfair emphasis on the priority given to these services by our health and care system. Introducing waiting time standards for mental health is an important step forwards in achieving parity of esteem for mental health, but it is only part of the picture – the other parts of the plan we have announced are also important.

    Thanks again for everyone’s comments.
    Best wishes,

  • Neil Craig – wtf? The usual charge is that economic liberal entryists have stolen the party.

  • Firstly thank you Norman Lamb for responding to the comments made. Hopefully one day all our Parliamentary spokespeople will do the same. However your comments have not made me feel more optimistic. The IAPT programme means that therapy is not linked to other forms of support and is not part of a joined up service. To refer me to my MP clearly implies that what I need is not being provided easily and will only be provided after a fight that needs to involve my MP.

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