Norman Lamb attends Mind conference to discuss mental health issues

2.45.00pm BST (GMT +0100) Wed 28th Mar 2007

Norman Lamb visited Bournemouth today to attend the annual conference of the mental health charity, Mind. Addressing delegates, Norman Lamb spoke about mental health issues and the controversial Mental Health Bill, which will be debated in the House of Commons at its second reading on April 16th.

The full text of Norman Lamb's speech is below:

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"In thinking about what I wanted to say today, I turned to Mind's website and found the mission statement.

Mission Statements are frequently bland rather vacuous affairs but it did strike me that this one provides us with a very good starting point from which to judge the Government's approach to the most contentious of current issues, The Mental health Bill.

"Our vision is of a society that promotes and protects good mental health for all, and that treats people with experience of mental distress fairly, positively, and with respect."

Well that seems to be a pretty sound basis from which to assess the Government's approach to this legislation.

Rather than examining the detail of the Bill, I wanted to look at the underlying philosophy of the Government's approach.

These days I am spending one day a week with a consultant psychiatrist. Assisting with policy work.

He was talking to me the other day about 'Dualistic Fallacy' - not a concept I was familiar with. But it is about the fallacy that mentally ill people or criminals are a distinct, discrete group. From this emerges an 'us and them' state of mind.

It is, of course, entirely false. Mental illness affects at least 1 in 4 of us. Understand that mental illness accounts for at least 30% of GP consultations. Most families at some point have been or are affected by it. Ours certainly has been. I am sure that is reflected in this hall. And we are all affected directly or indirectly.

Organisations such as Mind are in the business of debunking myths of the 'us and them variety'. That 'we' need protecting from some other dangerous group.

Government should also be in that business. But this Bill, in its original form seems designed to perpetuate that myth.

The Government seems to be engaged in a process of 'risk inflation'. There is a conflation of mental illness and danger.

Surely the Government has a responsibility to be realistic about risk and danger - to reassure where people have unfounded fears, to educate the public honestly and realistically about the true picture of mental health and serious mental illness in particular. Instead, the impression given is of a tabloid approach to legislating.

One person in 20,000 with schizophrenia commits homicide. Is that the impression given?

It has been estimated that you would have to detain 2000 people to prevent a single homicide. And still you might get it wrong.

So, if the Government gets its way, we could end up with a situation where large numbers of people who will never commit any serious violent crime will lose their liberty or be subject to compulsion.

This Bill demonstrates the Government's worst nannyism, control freakery. You can't trust anyone, you can't trust the professionals. It is an attack on liberty and autonomy.

And then we have the 'dodgy dossier' approach to the evidence available. Isn't it outrageous that that Government waited until the day after consideration of the Bill in the Lords to publish research on the effectiveness - or ineffectiveness - of Community Treatment Orders?

Set against the approach in Mind's Mission Statement, this Bill, as originally drafted, is a massive disappointment. [Expand]

So where are we at with this Bill? Well, after the Easter recess, it arrives in the Commons. The Bill has been substantially improved during its passage through the Lords. A powerful alliance of Lib Dems, Conservatives, cross benchers and Labour rebels achieved this. And here I must pay tribute to the incredible work of the Mental Health Alliance - who have provided expert support. A quite remarkable feat of keeping 79 organisations on board and working together. They have something to teach political parties about the art of collaborative working!

The power of the Alliance has been the fact that it brings together service users, psychiatrists, social workers, nurses, psychologists, lawyers, voluntary organisations, charities, religious organisations, research bodies and carers' groups. Now you would have thought that the Government would listen?

However, what we face now is the prospect of the Government seeking to undo the good work undertaken by the Lords - removing the amendments which makes the Bill just about palatable. So the battle is far from won. Everyone has to hold firm. We can ultimately force the Government to listen.

I want to move on to touch on some other areas of real concern.

The irony is of the Government pursuing legislation which could result in a massive extra burden on mental health services at the same time as we are seeing cutbacks in service around the country because of the impact of deficits.

The Health Select Committee - before Christmas - highlighted the extent to which so called 'soft targets' were being hit as health trusts struggled to clear deficits. And mental health services were one such 'soft target'. In my own county of Norfolk, the Mental Health Trust has suffered a loss of income - not through any fault of its own but because the Primary Care Trust has a £47 million deficit. That is the story across many parts of the country. I have seen services in rural North Norfolk cut back - leaving many really isolated. A GP told me last week that he referred a young lad for anger management. He was told that no service was available. Another teenage girl with a number of mental health issues was turned away. Another patient lost access to their psychiatrist because of 'service reorganisation'. Very reassuring.

And in London, the Brent PCT has been cutting back on a number of public health initiatives and mental health services - including community outreach workers. These services disproportionately serve BME communities. The Commission for Racial Equality is investigating because it appears that the PCT may have failed to carry out a race equality impact assessment.

These cutbacks seem to be widespread. The Sainsbury Centre for Mental Health last year found that nearly 2/3 of mental health trusts had been asked to cut their budgets to cover overspending in other parts of the NHS.

The Government's approach is to force Trusts to clear deficits in a very tight timescale. The approach is driven by the political commitment made by Patricia Hewitt to get the NHS in balance 'as a whole' by the end of this financial year. But look at the damage that is being caused. One of the Chancellor's favourite mantras has been that he has brought an end to boom and bust under the Tories - yet this is precisely what we are seeing in many parts of the NHS. Vast increases of investment but too much of it wasted - and now cutbacks.

I believe that trusts need more time - that they are being put into an impossible position of having to implement challenging reforms and having to meet tough targets at the same time as clearing sometimes large historic deficits.

It is also important to recognise the extreme variations of spending and treatment on mental health services across the country. The Kings Fund has highlighted the extreme variations in spending on mental health services across the country.

Islington PCT is spending 4 times the amount spent in Bracknell Forest PCT after accounting for needs and other factors. Beyond that extreme there is a two-fold difference in mental health spending per head across 90% of PCTs.

This analysis is made possible as a result of the Department of Health's National Programme Budget Project. I just wanted to say a word about this. It has been pioneered by Dr Peter Brambleby, the former Director of Public Health in Norwich. It allows you to compare spending on 21 different disease areas for the first time. You can compare spending to outcomes and you can look specifically at similar areas - inner cities, rural communities etc.

This contrasts with the old approach of comparing traditional budget headings such as GP prescribing, hospitals and community services.

It is in its infancy but it does offer real opportunities to ask the right questions of health trusts and to ensure that spending priorities can be adjusted to achieve the best outcomes - learning from areas achieving the best results.

I wanted to say something about an issue that I feel very strongly about - that is the problems of finding and keeping employment if you have mental health problems. I speak as someone who worked as a specialist employment lawyer before I was elected to Parliament. I spent a lot of time training employers on their obligations under the Disability Discrimination Act.

40% of all new incapacity benefit claimants are claiming for reasons of mental ill health. There are now more people on incapacity benefit because of mental ill health than the total number of people receiving job seekers allowance.

We welcome the Government's announcement last week that all claimants of the new Employment and Support Allowance will be able to earn £86 a week for a year without losing benefit. But it takes more than that. There is evidence that the Government's Pathways to Work pilot project is not succeeding for those with mental ill health. (IFS study)

More investment needed in talking therapies - following the analysis of Lord Layard.

We also need to tackle the stigma that people with mental ill health still suffer.

In New Zealand the Government has funded a campaign specifically to tackle stigma. Its called: 'Like Minds, like Mine'.

The evidence seems to be that it has been very successful in challenging prejudice and in changing attitudes. I know, form my experience that changing attitudes amongst employers is of critical importance.

But the approach of the NZ Government is immensely refreshing - and contrasts tellingly with the mindset that informed the Mental Health Bill.

I want to end by acknowledging that good things have been achieved as a result of the increased investment which has flowed into the health service - investment that the Lib Dems strongly called for and supported when it happened.

Our frustration is that too much has been wasted on botched, centrally driven reform. We need to move away from the command and control approach of this government with more local control and accountability alongside national entitlements to services."