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01 Sep 2014

Rethinking Mental Health for the 21st Century

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04 Dec 2012
Good Morning. I’m very pleased to have the opportunity to talk to you about mental health this morning and I hope what I have to say will not be regarded as party political and bland, but will actually reflect my genuine views on mental health – an issue I have had an interest in for a long time.  

I wanted to touch on where the Labour Party is going on its thinking on mental health. I wanted to talk about BME communities and mental health. I also wanted to talk about how we get the best outcomes in mental health service provision in what is a changed health landscape.

My mother was a mental health nurse. She became a mental health nurse at a time when it was viewed as secondary in status to being a nurse in the mainstream health service. And I can remember visiting her in her hospital which has since been knocked down thank goodness, it was a hospital just outside Huddersfield and it was in fact an old workhouse. The state of her hospital and the fact that it was an old workhouse, the fact that it was on the edge of Huddersfield exemplifies something about the lack of parity of esteem between mental health and the health service as a whole.

Mental health wasn’t just physically separate and secondary but the whole approach of the health service to mental health has been in the recent past to deal with it separately and in a secondary way.  One of the things that I am very committed to and that the Shadow Secretary of State for Health, Andy Burnham, is very committed to is this issue of parity of esteem between mental health service and the rest of the health service and taking what we would describe as a ‘whole-person’ approach to good health for too long mental health has been out on the periphery and the rest of the health service has been front and centre.  We want to, in our thinking, in our funding and in our organisational thinking bring these issues together.

We also feel that the world that people faced when the NHS was set up post-1945 is very different from the world that we face today.  On the one hand we have the completely new challenge of long term conditions, blood pressure and diabetes, but you also have what I feel is a very new and pressing challenge in relation to mental health  - It’s partly because we’re not content as a society to marginalise mental health issues in a way we might once have done.

It’s partly addressing an ageing population and issues around dementia. It’s partly a feeling I have that people are living more stressful, less stable and more isolated lives. I often get people coming in to my surgery who would appear to have marginal mental health difficulties. I always say to my staff they may seem paranoid to you but it could be well be the case that their paranoia is based in fact. It’s not that
they think people are out to get them, their experience of institutions in society has been that they are out to get them.

So it is a new challenge, it is a characteristically specific challenge, in an era when perhaps communities don’t have the resilience that they had 50 years ago. As I said we want to move mental health
from the edge to the centre of the NHS. We want to integrate physical, social and mental healthcare, this is actually the best way of making the best use of resources available.


We are also committed to changing wider attitudes to mental health in our society. I was struck before the summer when we had a short debate, on a Friday morning in the House of Commons, about a piece of legislation which most people don’t know exist. It’s a piece of legislation that says that if you have ever had a mental health problem you are legally debarred from being a Member of Parliament.

We had this debate and MP’s from both sides of the chamber got up and said for the first time in public said ‘I have a mental health problem.’  There was a Conservative MP that talked about his OCD. There was a Labour colleague of mine Kevin Jones who talked about his depression and Kevin in particular is almost the archetype of the rough, tough northern MP. And getting up to say in public in the chamber
that he had an ongoing mental health problem was clearly very hard for him – he was nearly in tears. And it struck me that Members of Parliament had been willing to come out about their sexual preferences before they had been willing to come out about the issue of their mental health challenges which I think speak to the level of stigma that we still have in this society around the issue of mental health. I think changing attitudes is all part and parcel of trying to integrate mental health with the wider  health service and to giving it parity of esteem.

And of course to be completely practical if we are to remove the cost that mental health and dementia place on the NHS we have to tackle the issue much more effectively and tackle it at source. I’m hearing about increasing numbers of young people with mental health issues, self harming and so on. It’s so important that young people with mental health issues get the help they need because it may stop their mental health issues blossoming into a very serious problem when they are older.

It’s difficult in the current climate where Local Authorities have been providing some services to young people with mental health issues they are having to reconsider that expenditure, but I do think that in particular the issue of young people and mental health is absolutely key.

On the question of the BME community and mental health, this has been a long standing issue of mine. It remains the case that although people of black and minority ethnic origin are over-represented at every level in our mental health system, including in our special hospitals they are under-represented amongst people who actually make the decisions and frame the policy around mental health as is exemplified by this audience today.

I can remember when I was a brand new MP in 1987 raising the disproportionate number of black and minority ethnic people on our mental health wards with the then director of City and Hackney Health Care. He was clearly taken aback by me raising the issue. He arranged for me to meet him  and to my surprise we ended up talking about the issue of black people in mental health. He had rallied about five of the most senior people in City and Hackney Healthcare around mental health and it was them versus me.

 
Of course none of them were from a BME background it goes without saying.  To my surprise, and this was in 1987, and there had been a lot of work done on BME communities and mental health including seminal work which demonstrated the extent to which diagnosis and treatment of BME men and women who have mental health issues might be characterised by cultural and other issues. 

When I raised the issue with these very senior doctors I said tell me why, why do you think there is such a disproportionate representation of BME people in your beds? One of them said to me, ‘well maybe it’s Ganja Psychosis’. The most senior said doctor said to me ‘well maybe it is the case that they are exporting disproportionate numbers of mentally ill people from Carribbean to the UK.’ I said to the doctor it’s hard enough to get in to the UK if you are sane, let alone the idea that the Caribbean is actively exporting people with mental health issues.

What was striking to me was that even though they could walk the wards any time of day, as I had done, and seen the disproportionate numbers of BME people in their beds it had never occurred to them to apply any serious thought as to why that might be.


We know that when it comes to BMEs and mental health, first of all we are disproportionately represented at every level in the system in the mental health system. Secondly, we present late. Thirdly, we are more likely to be diagnosed as schizophrenic. Fourthly, we are less likely to be offered talking therapies and more likely to be offered drugs or as it were, plugged in to the mains. Fifthly, our care path in the mental health system tends to be because of interaction with the police.

 
These are known about, they have been known about for nearly 20 years.  As long as I have anything to
do with Labours health policy one thing I think needs to happen is that there needs to be a renewed focus on this.  All these years after persons of colour have built careers in the health service we really do need to see more senior people involved in service provision and reflecting the communities that they serve.  We need to build a confidence between BME communities and the mental health system because one of the problems, and I see this very regularly in my constituency is that mothers will keep sons with mental health issues at home, will not present them to the authorities, will not discuss with their GP what is going on even when they themselves are not just having a difficult time but are being assaulted. Very many mothers will protect their male sons from ‘the system’ because there remains a deep fear that in BME communities about what happens to BME persons within the mental health system.

 
So until you can build confidence, until you can demonstrate this is a system which is engaging culturally, which is engaging in a positive way, until you can build confidence we will continue to disproportionate numbers of BME persons with these mental health issues. It is past time, research has been done the writing has been done and the stats have been collected, that this issue is addressed, because unless you are offering a quality service to BME persons with mental health issues in our big cities then in practise you are failing a large portion of your clientele.

The final thing that I want to say about mental health, as I say, first of all it is achieving parity of esteem and some unification between the mainstream health service and mental health, to get away from the situation which was symbolised by my mother’s Victorian workhouse hospital in Huddersfield. We need to have parity of esteem, we need to address more seriously this issue of BME mental health, and I would point out that where there have been advances in relation to BME mental health they tend to have been advanced by the voluntary sector, which is absolutely fine. But when you are in the sort of financial crisis with the austerity that is coming down on the public sector as we speak, the problem with having the expertise and the engagement in relation to the BME voluntary sector is that the voluntary sector tends to be more vulnerable. I am very keen to see these issues mainstreamed rather than in the voluntary sector which tends to be more vulnerable. The leaders in the voluntary sector don’t tend to have pathways in to leadership in to the mainstream NHS and that is where we need to see leadership on BME mental health.

We have to understand that in the new landscape there are going to issues about holding on to the advances we have made in treatment whether within the mainstream or whether within the voluntary sector and building on those advances. I will not pretend that even if a Labour government was in power we wouldn’t have to be looking at austerity measures now. This is why we believe in the long run that bringing these streams of funding together, trying to build and work around the notion of whole-person health care is the way to go.

As I said my mother was a mental health nurse and she nursed geriatrics. She gave them a fondness and care and concern which was in no way reflected in her salary and the esteem that she had as a BME nurse in the health service in the 70s.  When I look through my mother’s old photograph albums there are photographs of me as a child, my brothers christening and family weddings we went to she also has, in
pride of place, photographs of herself with her patients when they went out in
the summer.  Because for my mother, even though many of them were in advanced stages of dementia, that’s why they were in a mental  health hospital, for my mother her patients were people just the same as her friends and her family. They were people deserving of respect and care just the same as anyone she knew as any other health service patient.


Finally what I think is important is that we all think, as my mother thought, that persons with mental health issues are not just the subject of research, books and figures, they are not just a challenge, they are not just a problem, they are just very often difficult and alienating they are people too and deserving of our care and concern. Thank you. 
-ENDS-- 

This speech was followed by a question and answer session

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