The Royal College of Psychiatrists International Congress
Minister of State for Community and Social Care, Alistair Burt, talks about his priorities for mental health.
Thank you for inviting me here today. This is my first speech since I was made Minister of State for Community and Social Care several weeks ago, and I’m pleased that its focus is mental health, a priority for me and the government.
I want to say immediately that this is not a speech filled with big policy changes. I’m not going to signal a new direction of work or announce a new government-led initiative. Frankly, I am still grasping the complexities of this area.
But I am also grasping at the opportunity to meet those who make such a dramatic improvement to the lives of thousands of people across the country. I also know that my speech stands between you and lunch – so I want to keep this brief.
I follow in the footsteps of Norman Lamb – someone who was such a passionate advocate for mental health care. I want to thank him for his work in the coalition government.
It’s important to recognise what he, and other coalition colleagues, achieved over the last few years across the whole mental health spectrum.
Over 3 million people have entered treatment through Increased Access for Psychological Therapies, with over half of them having completed treatment. Over 1 million patients have reached recovery.
Perhaps it makes a change to have a minister signal continuity of this work as a significant end in itself, as the basis for accelerated improvement rather than yet more reorganisation.
But, of course, all of this change is down to professionals like you – the dedicated people that help some of our most troubled members of society.
I have been the Minister for Social Care and Community for the grand total of 2 months, but even in that time I have seen so much and met so many inspiring people.
I am enjoying meeting the people who run and use services, and those who lead the organisations who work so tirelessly to improve them, and look forward to meeting more, as I believe that is the only way to genuinely understand the challenges that we face, understand the best practice we can learn from and understand the best way to make progress.
My first visit was to the South London and the Maudsley Trust. I was able to witness first-hand how effective person-centred mental health care is being provided to young people in south east London – and beyond.
I was impressed, not just by the excellent personalised services there, but also the emphasis on community-based support for young people and their families. If we want to raise awareness, reduce stigma and promote early intervention for those who need it, then we need these services to become more visible in the community.
I also had the chance to meet Simon [Wessely, President of the Royal College of Psychiatrists] the other day, who impressed upon me the serious nature of your working lives, how many of you treat people who are in long-term secure settings. The complexity and precise nature of your work is something that I am deeply impressed with and want to learn more about.
As I’ve said, we’ve made progress over the last 5 years. My goal, and the commitment I gave to the Prime Minister when he asked me to take on the job, is to make sure that this progress continues, so that every part of the mental health service aspires to achieve equality with physical health.
We know that mental health, and mental health services, are increasingly coming under public scrutiny. This is good – gradually more people are recognising mental ill health as a serious challenge and are looking to the health service, in its wider sense, to provide a response. So while improvements are being made, there is more to do.
I will say more about my direction and my priorities about mental health in the weeks to come - this is early days for me. But, right now, I think there are 3 things that we need to focus on if we want to achieve equality with physical health services.
The first is children’s mental health.
Three-quarters of mental health problems in adult life start by the age of 18, and by not taking action when the first signs of a mental illness occur in our children and young people, we are instilling an impression of inertia in our future generations. They will believe that this is what adult life is like, with nowhere to turn.
Of course, the opposite is true and, in fact, many of you work tirelessly in this area.
The reality is that 1 in 10 children needs support or treatment. When I met with the charity Young Minds, a child psychiatrist and 3 other experts from the children and young people’s mental health sector this time last month, they emphasised this.
They told me how we need to shine a spotlight on this agenda and the need for strong leadership to promote change, which I am committed to achieve.
Through NHS England, we are continuing to expand the Children and Young People’s Improving Access to Psychological Therapies programme, which has already helped so many young people.
I’m pleased to say that NHS England is working to ensure the whole country is covered by this service by 2018.
I am committed to taking forward the vision set out in the government’s report of the Children’s and Young People Mental Health Taskforce, ‘Future in mind’.
I think it’s right that we are ambitious when it comes to improving the way young people and their parents access care, and how that care is organised and provided.
We are working with the Department for Education to pilot ‘single point of contacts’ on mental health in schools to give young people access to seamless and integrated mental health advice.
And one thing we won’t forget is the strong link between maternal mental health and children’s mental health. We are providing £75 million over the next 5 years so that women experiencing mental ill health during pregnancy and the first year after birth will have better access to care.
They will be able to take part in community-based psychological therapy, receive care from specialist community perinatal mental health teams and have rapid access to inpatient mother and baby services close to home for mothers who are very seriously ill.
But, ultimately, we need to focus as early as possible to stop mental ill-health before it starts to develop into a more embedded and longer-term problem.
Children’s mental health is therefore my top priority, and the £1.25 billion will be allocated for improving children and young people’s mental health over the lifetime of this parliament will soon start to make a big difference. Tomorrow, I’m speaking at a Youth Select Committee on children and young people’s mental health services, and I look forward to hearing their views on how to improve services.
I strongly support collaborative working between psychiatrist, schools, charities and communities to create a safety net around the lives of children. This joined-up approach is spelled out in the NHS Five Year Forward View, and I am pleased this type of joint-working is a mainstay in psychiatry. The profession should be seen as leaders in integrated working across our health and care system. And before I leave children’s mental health, I didn’t see the Dispatches programme last night, but I have read the newspaper articles. A valuable piece of work there.
The second thing we need to focus on is getting the basics right.
It is shocking that, up until now, specific waiting times didn’t exist for mental health. There is a glaring inconsistency in our health and care service where, if you have suspected cancer you will see a specialist within a fortnight, but if you suffer a first episode of psychosis you have no such right.
So we are correcting this. Mental health waiting times will be introduced as of later this year.
For the first time, 95% of people seeking psychological therapies for help with common mental health conditions will be seen within 18 weeks and 75% of those within just 6 weeks. For people experiencing psychosis, they will be aimed to be seen within 2 weeks of referral.
We also want to make sure that when people need help and support, they have clear and strong rights.
To explore how we can better do that, the government published No voice unheard, no right ignored – our consultation for people with learning disabilities, autism and mental health problems earlier this year. I appreciate the significant response we have had to that consultation and we will set out our response and next steps on that in the autumn.
The third issue we need to focus on is crisis care.
Earlier this week I visited the West London Mental Health Trust. I saw their section 136 suite where people in mental health crisis are taken by the police and assessed.
I was impressed by the standards they operate under – it never turns anyone away and always makes sure to find them a bed at one of their hospitals if they need one.
I met the service manager, mental health nurses, the police sergeant and we talked about their local crisis care concordat plans – what has worked so far for them and what more needs to be done.
They also spoke a lot about the recent CQC report, which offered some interesting insight into the way that crisis care varies across the country. Since I’ve been in post I’ve become interested in why there is so much variability. Frankly, that lack of consistency is unacceptable and there is still a way to go.
Yes, we are investing more in mental health crisis care, and dealing with years of under-funding, which was no doubt one of the main causes of this variation. When we set out our plan for the first ever national access and waiting time standards, we also announced a £30 million investment in liaison psychiatry services this year.
I look forward to learning more about these services, but it seems clear to me that they allow psychiatry to play a valuable leading role in showing other NHS professionals how to improve holistic patient care, not to mention help them to respond to people compassionately and appropriately.
But clearly we need a united front when it comes to crisis care. This was the basis behind the Crisis Care Concordat, published last year.
It aims to improve the responses that people receive from services, and in particular, to keep people in mental distress, who have committed no crime, out of police cells – and to set national standards for the first time.
The Concordat is clear that local mental health services need to be available 24-hours a day, 7 days a week. Every area in England has now signed their Crisis Care Concordat declaration and agreed action plans to make improvements in local crisis services, and they’re starting to see a difference.
In 2011 to 2012 the number of cases where people were given a section 136 and detained in a police cell was 8,667. We set a goal to halve this by the end of the last financial year. We actually exceeded it – there were 3,996 cases.
This is good progress, but we need to continue working to make that number even lower and improve responses from all services across all pathways. I would like to pay tribute to your profession for the vital contribution of clinical leadership in shaping these plans.
Of course, when we’re talking about mental health crisis, we can’t forget suicide. This week I met with Louis Appleby, Chief Constable Crowther from the British Transport Police and representatives from the 3 areas around the country piloting zero suicide initiatives.
They stressed to me that, if we improve suicide prevention, then we improve the whole mental health care service.
I know many of you help people on the brink of suicide on a regular basis, or who have had the daunting thought to consider suicide as a way out of their problems. I want to continue to work with you, and all mental health care professionals, to improve the type of support we offer to people facing their darkest days.
Finally, in everything we do there is the critical issue of tackling the stigma that often surrounds mental health illness within the NHS.
We are doing more on tackling stigma in society. Our campaign Time to Change is being used across hundreds of workplaces and communities to put an end to the stigmatisation of mental health and to encourage people to talk about their feelings. Because of the campaign, 2 million people have improved their attitudes to mental health illness, which has translated into improved behaviours towards people with mental health conditions.
But, as the CQC report showed, that stigma is still present in parts of our NHS. People who turn up to A&E having a mental health crisis feel judged for what they’ve done, and patients in our community mental health settings felt like their care was sporadic. This isn’t right.
I admire the work of Health Education England to enable half of junior doctors to undertake a psych placement by next year, again something that Simon [Wessley, President of the Royal College of Psychiatrists] mentioned during his remarks to you, which should build more understanding and tolerance.
But I look to professionals like you, who work across the health and care services, to tackle that stigmatisation of mental health wherever it shows its face and challenge it. We cannot operate under a 2-tier system. I don’t want that and I know you don’t, either.
I look forward to working with you to raise the levels of care that people with mental ill-health receive.