In my time as Mental Health minister, I have written here several times about the unacceptable disparity between mental health and physical health in our health system. For far too long, physical health has been prioritised over mental health.
Perhaps the most stark difference is in terms of what happens when you suffer a mental health crisis. If you break your arm or suffer a stroke, you know that you will be taken to A&E, where you will get access to the expertise you need.
It’s very different in mental health. You may end up in a police cell or you may get sent a long way away from home to get a bed in a mental health unit. This would never be tolerated in physical health so why should it be acceptable in mental health?
Many of you last week will have seen or heard the story run by the BBC highlighting the shortage mental health beds. There were examples of people being sent tens or hundreds of miles out of their area because of a shortage of mental health beds locally. This is completely unacceptable.
The problem is that, despite protecting NHS funding throughout this Parliament, mental health has not had its fair share – I have said there is an institutional bias.
But why is mental health always disadvantaged by local commissioners when the money is tight? Exactly the same thing happened during the last government. During the financial squeeze in the NHS in 2005/6 the Health Select Committee concluded – with its Labour majority – that mental health had lost out.
As Lib Dem Shadow Health Secretary during the last government, I argued that the 18-week maximum waiting time for physical health conditions, combined with ‘payment by results’, sucked money into acute hospitals to the disadvantage of mental health. Now, in government, the Liberal Democrats have secured a commitment to introduce access and waiting time standards mental health from next year. This will finally force local commissioners to recognise that those with mental health problems have an equal right to access services on a timely basis and it will help to ensure that mental health gets its fair share of resources.
We have also introduced standards for mental health crisis care: every local area has been asked to sign up to the new Crisis Care Concordat before the end of this year. It sets out clear standards of crisis care in mental health – not just for health organisations, but also for other organisations like the Police who so often come into contact with people experiencing a mental health crisis. The Concordat demands a 50% reduction in the number of people with mental health problems who end up in a police cell as a so called ‘place of safety’. It also makes clear that mental health beds must be available locally for those who need them. This has been widely welcomed by those working in mental health. Crucially, the CQC will inspect mental health trusts against standards in the Crisis Care Concordat, and will expose areas where commissioning groups are not commissioning adequate crisis care.
But it is also important that we don’t simply focus on inpatient beds and crisis care in mental health. Often a patient only needs crisis care, or a stay in a hospital bed, because they haven’t received the care and support they need from community services.
I want to make sure that mental health services become much more focused on early intervention, supporting people in the community, and on recovery. We should not be waiting for them to arrive in hospital, or a police cell. So there is still a lot to do in terms of making sure that money within mental health services is spent in the most effective way. The Schizophrenia Commission highlighted the proportion of resources spent on ‘containment’, often with little or no ambition to pursue recovery – getting to a better place where the person is able to enjoy a good quality of life. Instead, they argued, there needs to be a shift of emphasis towards intervening earlier and aiding recovery.
Last week’s publicity from the BBC is a timely reminder of the scale of the task still to be achieved. It reiterates more than ever the need to fight for mental health to get the recognition it needs. And as Liberal Democrat health minister, that is what I will continue to do.
* 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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10 Comments
As someone with a teenage relative with serious mental health issues around trauma and depression, who might well have ended in a Unit 250 miles from his home, and another close relative who has ongoing issues with psychosis, I fully support the initiative shown by Norman Lamb in this area. We need to move mental health from its current (still) Cinderella status.
But, I am immensely critical of the Coalition in two central areas of its activity, which I think Norman should spend some time on. While w remain wedded to a cut-cut-cut austerity programme we will make little progress in specific areas, and even if mental health spending benefits, other vital and valuable public services will suffer. And while we continue to encourage the demonisation of those “on benefits”, many of whom have mental health issues, we will again not make progress. We need a civilised caring system of benefits, and we need to encourage a public discourse which also cares.
I think Norman is doing excellent work at health. Mental health crises and breakdowns are absolutely heartbreaking. I would add to really emphasise efficiency in health spending.
Norman is also doing great work helping people suffering from dementia and loneliness. Credit to him.
@ Tim,
You made a really important point. Just as prevention is important to prevent physical ill health, so prevention is important to prevent mental ill health. Also, when people are under stress, the last thing that is needed are policies that increase that stress, nor demonisation because they need ‘benefits’.
I hope that your cousin gets the support needed and makes a full recovery.
Excellent point about prevention, Jayne, and what a task that will be, to develop a society like that! But is it useful to confound mental health issues with benefits issues or demonization issues? Aren’t the causes of mental ill-health deeper than simply than today’s irritations, even if they are indeed severe?
Richard, speaking for myself, and clarifying a little, I was attempting to make the point that many accuse those of disabilities they can’t immediately detect as “skivers” “scroungers” etc, when actually they have recognisable and diagnosable disabilities. Unscrupulous journalists hook on to this, followed by politicians more concerned with pandering to tax-cutting demands. But since you mention it, there must be plenty of people depressed because they can’t find a job / adequate source of income. I think you need very quickly to look at the close linkages, in both directions.
Thankyou, Jayne, for your concern.
Correction – I should add to disabilities, more usually, recognisable conditions / illnesses.
Thanks for all your comments, which I really appreciate.
@Tim, @Jayne, and @Richard – I accept completely the important point you make. Mental health is closely linked to external factors like financial stress, employment, and housing. I am working to explore ways that the Jobcentre can work more closely with mental health organisations to ensure people are getting the support they need to support them with their mental health problems, and also ensure they get the wider support they need to work towards recovery and, where appropriate, employment.
It is essential that we have an assessment system for welfare which properly understands and reflects mental health issues. And once people’s needs have been assessed, we then need to work much more effectively to support them into work. Steve Webb and I have said previously on Lib Dem Voice that we should reform the Work Programme so that it makes good use of disability charities and other specialist organisations – including in the health and care sector – to provide support that is tailored to the needs of individuals. Steve has also been clear that as Liberal Democrats we will never indulge in the ‘strivers vs scroungers’ rhetoric used by the other two main parties.
@Norman Lamb
What you have written is that people on benefit are mentally ill. I thought that we didn’t go in for that kind of thinking?
I am appalled at the ignorance that politicians appear to have about what mental health and mental illness is. It certainly isn’t being depressed because you can’t find a job or can’t afford to eat – that’s one of a number of possible healthy reactions – happiness in that situation would possibly be a sign of mental ill-health.
I expect the Open University has a helpful course on this. Mental ill-health has traditionally (from Sigmund Freud onwards) been closely linked to childhood experiences and particularly to problematic parenting or child abuse. Modern practice also recognizes a number of possible physical and biochemical causes, such as damage to key centres in the brain, or inadequate production or over-production of key hormones.
Financial stress, employment, and housing are of course important issues which can have particularly severe consequences for persons who already have mental health issues, but tackling these issues is not at all the same as tackling mental health.
I suggest that the first thing that politicians need to do is to get a proper briefing on this. Mental illness is not the same as the healthy symptom of being exhausted after a few long nights in the House.
There are also technical issues that can often make diagnosis and treatment very different for mental health, so much so that the aim of “giving mental health the recognition it deserves” may need to include radical changes in the way medical people are trained and how an NHS is.
If you have a physical injury or a virus, medical people can see physical evidence that something is wrong, and of the cause of a problem. For instance an X-ray of my knee will show cartilage damage that is clearly one of the causes of my knee pain and limp. If I have a mental illness associated with an inability to resolve an emotional trauma from childhood, the diagnosis involves observing and interpreting behaviour, and there’s presently no way doctors can see physical evidence in my body either of that trauma or the causal link between it and my behaviour. Indeed, the term “illness” implies a judgment that something is not right, but for some mental conditions there may be no clear distinction between a person being “ill” and a person just being who that person “is”.
It’s certainly good to arrange that society does not impose mental ill-health on people, and so certainly it’s true that financial stress, etc are issues to be addressed. But the prevention, diagnosis and treatment of mental illness probably requires completely different types of vision, training, treatment, and organizational arrangements.
http://www.mentalhealth.org.uk/our-work/mentalhealthawarenessweek/get-involved/?view=Standard