Charles Walker leads debate on schizophrenia care

Charles Walker MP speaking in the House of Commons

Charles Walker leads a debate on schizophrenia care, praises the work of the NHS in mental health and highlights areas where provision and support could be improved.

Mr Charles Walker (Broxbourne) (Con): Let me start by saying that I am a great enthusiast and a great optimist. I enthusiastically believe that in the area of schizophrenia we need to do more of what we do well and less of what we do badly—more of the good stuff and less of the bad stuff. I pay tribute to the fantastic men and women who work in the NHS in mental health; they are the unsung heroes. It is not the glamorous end of the NHS but it is, perhaps, the most important.

I want this to be an upbeat speech—I really do—but I think that at the beginning we must focus on what we do badly. First, I am very concerned at the fact that the life expectancy of someone who has a diagnosis of schizophrenia or psychosis is up to 20 years less than that of someone who does not have that illness or disease. I do not believe that that is acceptable in a first-world civilised society; we cannot tolerate it any longer. I am concerned that young and middle-aged men and women around the country who have a diagnosis of psychosis and who live with schizophrenia might well end up smoking 60 or 70 cigarettes a day, gaining huge amounts of weight and living pretty desperate lives. Their drug therapies cause them to feel pretty miserable and disconnected, and that is why we end up in this terrible and desperate situation of such a lowered life expectancy.

Secondly, we need a system in which people are not frightened. Being ill is not a pleasant experience. People are naturally fearful, but too many people suffering from psychosis or schizophrenia are very scared and very frightened far too much of the time. That is very upsetting for many people. It is upsetting for them and for their friends and families, and I am afraid it is upsetting for those of us who observe this going on and want to change things. Again I say, we are a first-world society and we cannot have people feeling frightened and separate.

Thirdly, we lock up far too many people who are ill. There are 7,000 people in secure units, many of whom should not be there, but we do not know how to get them out. We do not know how to take them out of a secure unit and reintegrate them into society. Those processes are not in place, so we remove people’s liberty, sometimes for their own good to stop them harming themselves, and in the most extreme cases to stop them harming others. But we must ensure that when they are in these places they feel safe and secure and that the systems are in place to enable them to return, as far as possible, to mainstream society.

Finally on the bad things that we must stop doing, only one in 10 people who are diagnosed with psychosis or schizophrenia are in work. We have an unemployment rate of 92% and we all know in this place that employment is the route to fulfilment: being in a career with friends and colleagues, having a sense of purpose, being able to get up in the morning to go to a place that is welcoming and to which we want to go.

Let us now be upbeat. What we need is a manifesto of good things. We need more and earlier interventions, because the quicker we can deal with a problem the more chance there is that it will remain manageable and the less likely it is to escalate to something far more serious. That is why we need early interventions.

Mr Brooks Newmark (Braintree) (Con): I appreciate that I did not speak to my hon. Friend about his debate, but I have been listening to him and I congratulate him on holding the debate. Does he agree that another bad thing that happens with schizophrenia is that people are left to roam the streets and end up homeless, and that a huge number of people are afflicted by schizophrenia and other mental illnesses with whom we need to deal?

Mr Walker: My hon. Friend makes a very good point. I have had an extremely good paper from St Mungo’s dealing with that very issue.

We also need to do more listening. We must stop talking over people who suffer with psychosis or schizophrenia. They are warm, live human beings. They exist. We tend too often to talk over them and about them, not to them. Certainly there will be times when they are in crisis, but when they are, we need a crisis plan so that they can tell us how they want to be treated, looked after and cared for—how we can help to secure their dignity. Then we need to ensure that they have advocates who can sit alongside them and be their voice—someone they trust at a time of crisis, illness and distress.

We need more support for carers—the people who love them, the people who stand by them day in and day out, trying to do the right thing, trying to get them the care that they deserve and require—their champions. Let us not forget in this place the important role that carers play in being the champions. We need much more talking and listening to carers, involving them in the process. They will know so much more about the individual being cared for than probably anyone else.

Then we need to provide more training for people working in the mental health arena. It is a demanding environment. In the acute settings people tend to be admitted who are very ill. The threshold for admittance is so much higher now. The staff need to be trained to deal with and to care for these people. It is no reflection on the staff that I am asking for this. I want to stand shoulder to shoulder with the staff. We want to stand alongside them and help them to deliver the care that they want to deliver, and that their professional pride demands that they deliver.

Robert Halfon (Harlow) (Con): I congratulate my hon. Friend on securing the debate and on his knowledge of the subject. He talks about early intervention. I recently visited the North Essex Partnership NHS Trust, which works on mental health. It puts people into schools to identify children and young people who are developing such problems, which has a huge impact and manages to stop more serious problems developing later.

Mr Walker: My hon. Friend makes an excellent point on early intervention. It is about getting there before the crisis occurs and making sure that people who are at risk have the support they need to manage their illness so that they end up in a good place, not a frightening place.

We need more peer support. When someone goes through a mental health crisis, many people tell them that it will get better, but they might not be believed, as things can look pretty dark and desperate at the time.

There are many professionals around, but perhaps that person wants to talk with someone who has been there, travelled through the fire they are going through and come out the other side, someone who can sit with them and say, “We’re going to work through this together. I’m not just saying this; I’ve actually done it. I’ve been where you are and I’ve come out the other side. I’m going to take you by the hand and we’re going to walk through this together.” That is peer support, and we need to encourage it and see more of it.

We need more intermediate services, because many people are terrified of going into acute care and too often the experience is not a good one. Being hospitalised is frightening. They do not want to go into acute care because they are terrified by that prospect. Let us think more about intermediate care. When things are getting on top of someone and they are feeling stressed out, that perhaps the ground is going from underneath them and that things are getting out of control, there should be a place they can go in the community, a crisis house, where they can say, “I need help, because I feel that I’m going to have some troubled times ahead.” There they can be told, “Come on in. We’re going to work together for the next couple of weeks. We’re not going to be a crutch and you aren’t going to be here indefinitely, but we will work together for the next five or 10 days or two weeks to get you back on your feet and out there again.”

We also need uniform reporting. I want diversity of provision, because out of diversity comes innovation, but I also want to know what is going on. I want to know when we are successfully meeting the needs of those with psychosis and schizophrenia, but I also want to know when we are not, because that is when we can start doing something about it. With heart disease, cancer or stroke, we can check the league tables and know exactly what is going on, but it is much more difficult with mental health problems, particularly psychosis and schizophrenia, so we need uniform reporting. I am concerned that the Care Quality Commission is stopping its in-patient surveys in mental health wards, which I think is a mistake. I think that it is regressive and that it needs to be revisited. I hope that I can bring the focus of the House to bear on that issue.

Patients need a voice. They need to be able to tell us what is and is not working. Most of all, we need to ensure that people have a chance of living fulfilled and complete lives and that a diagnosis of psychosis or schizophrenia is not the end of the road. They should not hear, “That’s it. Society will now turn its back on you. You’re in real trouble and you’re going to be removed.” We must have absolutely no more of that. We have an obligation to work together on mental health problems in this place and with the NHS and to say to people, “We’re going to work together to get you through this. You have a right to have a chance for a fulfilled, happy and productive life. What has gone before is not good enough, but what will come will be better.”

I have said that I am an enthusiast and an optimist, and I am optimistic. We have the bit between our teeth, we are moving ahead and mental health is being talked about, but schizophrenia and psychosis is a difficult area for politicians and for the public, because so much misinformation and nonsense has been talked about it for so many years. It is going to be the hardest mountain to climb, but climb it we must, because we have an obligation and a duty in this country to take everyone with us. We must not leave people behind because they are ill but take them with us on a journey together—a journey towards wellness.

I have spoken for far too long and I am now much more interested to hear what the Minister has to say. I conclude by saying this: I speak a lot about mental health, but I am fully aware that an army of people out there, professionals and charities, do mental health and do it extremely well. Mind and Rethink are fantastic organisations that campaign daily, hourly, by the minute to ensure that people with mental illness get a voice. As a result of their hard work, those people are getting a voice in here, and that is a good and positive thing.

10.15 pm

The Minister of State, Department of Health (Norman Lamb): I sincerely congratulate my hon. Friend the Member for Broxbourne (Mr Walker) on securing this debate on an incredibly important subject. It is good that in this House today we have debated people with learning disabilities and how they get treated by the system, and now we are debating people with schizophrenia. In the past, those two very important groups of people have often been rather neglected, and it is good that Parliament is focusing on them and how the system treats them. I pay tribute to my hon. Friend’s work as an advocate in mental health. It is very important that people speak up for those with mental health problems, and he and one or two other MPs have done us a good service by being prepared to talk about it openly. I pay great tribute to his work in this field.

This is a timely debate. The premature mortality that my hon. Friend mentioned, the stigma, the human cost and the statistics are as well known as they are shocking. Together they add up to a compelling call for action, and that makes the recent report, “The Abandoned Illness”, very important. It sets out how things must change, how services have to be more accessible, how staff have to be fully supported, how integration of services can change lives, and, of course, how people’s mental and physical health must be treated equally. Too often in the past, mental health has been seen as the poor relation. The Government have established the principle of parity of esteem, and we now have to make it a reality. This debate is an important moment at which to consider that.

The Government have published a mandate for the NHS Commissioning Board which sets out our key priorities for the service. The mandate goes further than ever before in setting out the priority that the Government give to mental health, and it makes it very clear that mental and physical health problems should be treated in a co-ordinated way with equal priority. We expect the NHS to demonstrate real progress on this by March 2015. We have also tasked the NHS with making progress in specific areas. Accessing care and treatment should be as easy for people with mental health conditions as for those with physical conditions, so we have asked the NHS Commissioning Board to consider new access standards, including waiting times, for mental health services. It is remarkable that in the past decade we have introduced waiting time standards for physical health—the 18-week wait—and yet in mental health there is no comparable standard. That has to change.

The NHS outcomes framework includes four measures that relate specifically to mental health. Three of those focus particularly on patients with severe mental illness: premature mortality in people with serious mental illness; the employment of people with mental illness, which my hon. Friend spoke about very movingly; and patient experience of community mental health services. Many other outcomes that we are measuring will be as relevant to people with mental health problems as to people with physical health problems. There is no magic bullet, but I think that this will help to kick off the drive towards real parity of esteem, just as it says in “The Abandoned Illness”.

On top of that, a lot more needs to be done to improve access to psychological therapies for people with severe mental illness. Much of the consideration of the improving access to psychological therapies project has focused on anxiety and depression, but we know that psychological therapies can also be very effective for those with a severe mental illness.

Six local projects, backed by £1.2 million of Government funding, are working on demonstrating the benefits of IAPT in treating people with a severe mental illness or personality disorder. Over the next five months, these organisations will share what they have learned about how best to deliver evidence-based treatments. The work will include demonstrating how this group can get better access to psychological therapies, spreading good practice to other services, and providing good quality data—this has so often been missing in the past on mental health—on how services can be improved for patients.

One of the report’s main findings was that there are far too many people with a mental illness in in-patient wards—my hon. Friend made this exact point—who do not need to be there. Furthermore, many wards are not the calm therapeutic environments that are conducive to improving patients’ well-being. Everyone in the House knows how much of a problem this is. It is not good for patients, families or the staff who work there.

The mandate of the NHS Commissioning Board sets out plans to introduce the friends and family test for all NHS services, including those for mental health in-patients. This will allow people to feed back their experience by saying whether they would recommend a particular service to their loved ones. I should also say that I am looking into the issue of the Care Quality Commission survey. I understand that it was terminated because of concerns about its accuracy and value, but the fact is that it applies in other parts of the health service and I am concerned that mental health services lack such a survey.

Our cross-Government mental health strategy, “No health without mental health”, also recognises the problem. Among its core objectives it lays out, first, that people who are acutely ill need to get safe, high-quality care in an appropriate environment when they need it and, secondly, that following acute illness people should be helped and supported to recover. This will mean different things to different people, but for many it will mean services working together to help people live independently, to find work and to play an active role in society. That means people moving from in-patient wards into the community, with support. This same service is integrated with early intervention, which my hon. Friend has also mentioned, and crisis teams can also support people early in their illness or during an episode of illness, so that they do not progress to needing in-patient care.

Our implementation framework sets out specific actions that local organisations can take to make that a reality. The framework was co-produced by five leading mental health organisations, including Mind and Rethink. In addition, we are already measuring employment for this group as part of the NHS outcomes frameworks for public health and for adult social care.

Mr Newmark: On the subject of Rethink, which does a tremendous job, will my hon. Friend join me in congratulating my constituent, Trina Whittaker, and Braintree Rethink on doing a tremendous job for those with schizophrenia and other mental illnesses?

Norman Lamb: I absolutely join my hon. Friend in applauding Trina Whittaker and the work of the local Rethink group. I met the national group last week to discuss this very subject. It does tremendous work around the country and I applaud it.

On personal budgets, we know that people want more control over their own care. For instance, patients often do not like the drugs that they are being prescribed—they might make them overweight or have other detrimental effects. It would be far better to move away, if possible, from that paternalistic, disempowering model towards a system in which patients have much more say.

We are already taking steps to help make that happen. The draft Care and Support Bill, published in July, places personal budgets on a legislative footing for the first time. It specifies that everyone eligible for ongoing social care, including those who are mentally ill, will get a personal budget as part of their personalised care and support plan by April 2013. On NHS services, the mandate sets out that patients with mental health conditions will be able to have an agreed personalised care plan, which they must be involved in preparing; it will not be imposed on them. Those plans will lead directly to people with mental illnesses getting the help that they want, and not being directed to a one-size-fits-all service.

Listening to people with mental illnesses is particularly important because of the huge stigma—my hon. Friend the Member for Broxbourne talked about this—that they endure throughout almost every sphere of their lives. Stigma features heavily in the report and I welcome the clear message that it gives us: we will not tackle stigma by burying our heads in the sand. It goes without saying that schizophrenia is an immensely complex condition, and it is made even more difficult when people characterise it as simply a split personality.

We are listening to service users who tell us of the appalling discrimination that they suffer. Many people tell us that the discrimination they face is often worse than the condition itself. That is why the Government are joining forces with Comic Relief to tackle mental health stigma. We are giving up to £16 million, alongside the £4 million that Comic Relief is providing, to Time to Change, the brilliant anti-discrimination campaign run by Mind and Rethink Mental Illness, so that it can continue its work through to March 2015. My hon. Friend and others who have spoken out about their own mental health problems are helping to address the stigma and make mental conditions more acceptable.

I should also say a word about black and minority ethnic service users, because they are over-represented in in-patient care and often stay longer than people from other ethnic groups. We are discussing those long-standing issues with a range of leaders and organisations from BME communities with a view to tackling them.

There is a clear need for organisations outside Whitehall to work much better together. The NHS, social care and other services need to work hand in hand to ensure that patients with mental health problems get effective, safe and streamlined treatment. Together, they need to identify the risks and manage them appropriately. The NHS Commissioning Board will directly commission specialised services, including secure mental health services. That is a great opportunity to ensure that there is high-standard, recovery-oriented and consistent practice across the country, with clear transitions for patients between different parts of the mental health system.

The Department of Health funds a wide range of research on schizophrenia and other psychoses. We have awarded nearly £49 million over five years to the biomedical research centre for mental health, based at the South London and Maudsley NHS Foundation Trust. It collaborates with the Institute of Psychiatry to translate promising research into effective practice. Psychoses are a major focus of its work. The National Institute for Health Research funds a clinical research network, which allows patients across England to take part in trials and other types of clinical study. The network is currently setting up and recruiting patients to about 90 projects to study schizophrenia and psychoses. Through the “Strategy for UK Life Sciences” the Government will provide an environment and infrastructure that supports pioneering researchers and clinicians to bring innovations to market earlier and more easily, making the UK the location of choice for investment.

The Government believe that people with schizophrenia, and indeed any severe mental illness, have a right to the care and support they need in a safe and comfortable environment where they are treated with the dignity and respect they deserve. They have as much right as anyone else to a fulfilled and productive life, free from discrimination and stigma. The coalition is making valuable changes from the centre, but this cannot be the Government’s responsibility alone. We need everyone everywhere to take what responsibility they can, including the commissioners who must purchase the care that meets people’s needs, the providers who have a duty of care to each and every individual for whom they are responsible, and the regulators who are responsible for ensuring the quality of that care. I have set out some of the recent developments at government level that will improve services for people with schizophrenia. However, I acknowledge that we are still some way from where we want to be. We must not relent in our pursuit of that.

To that end, I am convening a round-table meeting on schizophrenia next week with leading charities, members of the Schizophrenia Commission, the Royal College of Psychiatrists and others. My hon. Friend the Member for Broxbourne is welcome to attend if he is available. The aim of the meeting is to identify the further practical actions that key players can take to improve the quality of life of people with schizophrenia and other severe mental illnesses.

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