Mental Health — House of Commons, 2015-12-09
Topic: Health
Lisa Cameron (Scottish National Party, Centre-left): I congratulate the hon. Member for Liverpool, Wavertree (Luciana Berger) on initiating such an important debate. It is a privilege to contribute to it I must begin by declaring a professional interest, having worked as a forensic and clinical psychologist for 20 years in the NHS and beyond, specialising in mental health, at consultant level for 10 of those years. I continue to maintain my skills and engagement in line with the professional requirements of my registration with the British Psychological Society and the Health Care Professions Council. Earlier in the year, I had the privilege of contributing to the evidence taken by the Youth Select Committee during its inquiry into child and adolescent mental health services I want to say a little about three topics: the adult mental health service and strategy, child and adolescent mental health services, and mental health services for veterans. Mental health is an extremely wide field, ranging from major mental illnesses such as psychosis and depression and anxiety disorders to trauma and eating and adjustment disorders. Developmental disorders such as attention deficit hyperactivity disorder and autistic spectrum disorder are also sometimes included in the sphere of mental health, and I would welcome future debates about those important conditions, because I fear that we shall not have time to do them justice today The British Psychological Society has reported that one in four people in the UK will experience a diagnosable mental health problem, with mental health problems accounting for up to 23% of all ill health in the UK and being the largest single cause of disability. In Scotland the figures are currently one in three. Mental disorders are strongly related to risk of suicide, and it should be known that high levels of comorbidity with substance disorder and physical ill health are prevalent Mental health services across the UK are not the finished article wherever you go. We are continually striving towards improvement, and that should always be guided by patient need and by research underpinning most effective clinical practice When I started practising in the 1990s in Scotland, the funding of mental health services severely lagged behind other areas of NHS funding. That resulted in far too few practitioners and what seemed to be never-ending waiting lists for both patients and clinicians. At the start of my career, patients routinely waited to see psychologists in mental health specialties for six to 12 months, and in some areas for over a year. That was clearly ineffectual, often meaning that problems were exacerbated over time and that a mainly medical model persisted. That is not what patients wanted, nor did it fit with best practice; evidence indicates that patient recovery is improved with access to talking therapies alongside medical management. That is evidenced clearly in National Institute for Health and Care Excellence guidelines In 2014, the HEATs—health improvement, efficiency, access targets—were adopted in Scotland and across the UK, meaning that patients should be seen from referral to assessment in 18 weeks. In Scotland in 2014, 81.6% of patients were seen in 18 weeks and the number of people seen was 27% higher than in the same quarter the previous year. Demand is increasing, which is a good thing: it means that we are starting to tackle stigma and that access is improving Matched stepped care involving psychological therapies and practitioners at differing levels, depending upon clinical effectiveness of therapy type for different disorders, was rolled out in all boards within NHS Scotland, and NHS Education for Scotland took a primary role in workforce capacity modelling and training. Use of self-guided help has also been developed. Technological advances are important in terms of access for patients in this modern world and in relation to early prevention. Suicide rates have been brought down and the target met of training high levels of front-line staff in suicide prevention and risk identification. Quality ambitions have also been developed as benchmarks in relation to person-centred, safe and effective care I fear, however, that demand on mental health services will continue to increase dramatically. Evidence suggests that recession increases mental health problems, including depression, suicidal behaviours and substance abuse. Unemployed individuals, particularly the long-term unemployed, have a higher risk of poor mental health compared with those in employment. Stress is now the most common cause of long-term sick leave in the UK and the more debt an individual has the more likely they are to suffer a mental health problem. A social and policy climate of austerity, affecting the most vulnerable to a greater degree, is a likely aggravator of mental ill health I welcome pledges from both the Westminster and Scottish Governments to increase spending on mental health significantly: the figure is £100 million in Scotland. Mental health services, however, have not achieved parity with physical health services over the decades since I started in the field and we need to be clear that much more is needed to fill the gap. I commend Ministers and MPs to visit mental health services and spend quality time with clinicians on the front line. Managerial statistics often occlude a multitude of issues and it is only with that front-line insight that the true patient journey and daily clinical barriers can be identified. Those often include excessive paperwork, repeated reviews and service changes that diminish morale Mental health problems in childhood are extremely serious. They can destroy educational potential at worst and impede it when problems are less severe. Difficulties must be assessed and recognised at an early stage. HEATs for child and adolescent mental health services were set at 18 weeks as of December 2014. NHS Scotland data suggested a significant reduction from 1,200 waits of over 26 weeks in 2008. In the quarter ending June 2015, 76.6% of CAMHS patients were seen in 18 weeks and the average wait was nine weeks. In the past two years, there has been a 35% increase in demand due to productive work completed on stigma and in improving access, and since 2009 £16 million has been invested in the CAMHS workforce; it is at its highest ever level. To improve waiting times further, £15 million more has been pledged to CAMHS in Scotland. Widespread staff training has been undertaken in modalities such as cognitive behaviour therapy, family therapy, interpersonal therapy and specialist interventions such as for eating disorders, with a focus on seeing patients as close to home as possible. More progress is required across the UK and in Scotland to meet the 90% target I must say that in-patient treatment for children and adolescents should be a last resort. It takes children away from family and pathologises their difficulties. Best practice highlights intensive outreach approaches enabling children to be seen at home and treated in their natural environment, so maximising key family and peer supports. Children who need in-patient services suffer psychosis, intractable eating disorders, severe obsessive compulsive disorder and a variety of neurological conditions and neuro-developmental disorders. Currently there are 48 beds available in Scotland and this year £8 million was pledged to build a unit for children and adolescents with mental health problems in Dundee. My clinical experience suggests a lack of available beds in forensic and in learning disability child and adolescent mental health services. Constituents who have contacted me have also suggested that further work needs to be done to improve access to specialist eating disorder in-patient care outwith the private sector Increases in the number of children presenting with self-harm and receiving brief overnight admission have been high. Clinically, this is quite a difficult decision. Often, clinicians are faced with the issue of sending adolescents for a brief stay miles and miles from their home—which makes it difficult for carers and parents to visit them—or admitting them briefly overnight. Surely the optimum treatment would be to see and assess them and to ensure that children are safe and able to go home with the strongest possible package of care as quickly as possible.