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Mental Health Bill [HL]

In my view, one of the most cruel injustices in this country is the failure of our National Health Service to provide the same level of assessment and treatment to people with mental disorders as we take for granted for those with physical illnesses. This injustice, of course, affects both primary and secondary services. Either of Amendments Nos. 7 or 55, by providing a right to assessment, treatment and support for people with mental health problems in England and Wales, could ensure that progress is made to put right this wrong. If we go to our GP with physical symptoms, whether a skin rash, breathing problem or pain, which our GP is unable to treat effectively, we can expect to be referred to a specialist for a skilled assessment and appropriate treatment. If, however, we go to our doctor with depression or anxiety, which may cripple our lives—these are not minor matters; they can destroy our family relationships, our friendships and our capacity to work and, indeed, may ultimately lead to suicide—we may be turned away with little or no help. Only one in four of those who suffer with depression or chronic anxiety is receiving any kind of treatment. This failure to treat is not only a waste of people’s lives, it is also costing a lot of money to employers and taxpayers, as has already been indicated. Many people with mental health problems are in work but their productivity is much lower than it needs to be. Employers are paying huge sums of money in sick pay for people who could work with a small amount of help. A million people are not working at all and are receiving incapacity benefits because of mental illness. One of the reasons for this costly and cruel state of affairs is, perhaps, that until recently we had little confidence that the treatments available could transform the lives of so many people. Now we have evidence-based psychological therapies that we know lift at least half of those treated out of their depression or chronic anxiety. We tend to think of psychological therapies as going on for years, but the new therapies are short-term, forward-looking treatments that enable people to challenge their negative thinking and function effectively. These therapies are supported by NICE guidelines, but those guidelines are not being implemented due to a lack of resources devoted to therapies within the NHS. Either of the two amendments would provide the impetus needed to ensure the implementation of the NICE guidelines. We are not seeking an overall increase in government spending—far from it. Money spent on evidence-based psychological therapies will pay for itself, as the noble Baroness, Lady Wilkins, indicated. Evidence-based psychological therapies cost a mere £750 per person. This would be fully offset if, on average, incapacity benefit claimants worked for just one month as a result of a treatment. The productivity of those in work would improve; the tax take would be enhanced; the numbers who finally break down completely and need costly in-patient care would fall; and, most importantly, millions of people would be healthier. I want to focus on the significance of the amendment for people with more severe mental health problems. A major concern expressed by the Royal College of Psychiatrists and others with respect to the Bill is that it will add to the number of patients under compulsion and will thus take away resources from voluntary patients. The college, rightly in my view, fears that mental health services will be directed away from services such as early intervention, assertive outreach and other developments which are designed to reduce the need for compulsion. The Government have begun to change the focus of the psychiatric services through the national service framework. The new early intervention teams and the idea of bringing psychological therapies and other help to young people in the early stages of a developing psychosis are the right way forward. But these teams are not yet fully developed; trusts have not devoted sufficient resources to this crucial area of work. The result in my own area, the east end of London, for example, is that generally no help is provided until the young person has had a psychotic breakdown and already has been detained in hospital. Surely this is already too late. That young person’s life will never be the same again with the stigma of a psychiatric admission on their record, and the use of a costly in-patient bed could perhaps have been avoided with earlier help. By making it less likely that resources will be devoted to early intervention, the Government are undermining their own excellent policies. Section 117 of the Mental Health Act 1983 imposes a duty upon the primary care trust or health authority and upon the local social services authority to provide after care for people who have been detained in hospital under a six-month order. These authorities have no duty, on the other hand, to provide help to those people in the early stages of their illness. As the noble Baroness, Lady Wilkins, noted, Rethink has established that 50 per cent of people who end up under a detention order in hospital had asked for help and been turned away at an earlier stage when they could have co-operated with treatment and remained at home. This makes no economic sense and it is cruel to the individuals affected. Yet the amendment Bill repeats the pattern. It envisages compulsory treatment in the community, again for people who are under a six-month detention order. But again no duty is envisaged to offer treatment to prevent the trauma and cost of a full breakdown and hospital detention. Either of these two amendments would support all the principles espoused by the Government’s own Social Inclusion Unit. They would uphold the principle of the least restrictive alternative, encourage preventive care and early intervention, reduce dependence on medication, support carers and combat unemployment. Either amendment deserves the Government’s support.