Nick Clegg at Mental Health Conference
The Deputy Prime Minister spoke about removing mental health stigma and the need to adopt a 'zero suicide' ambition across the NHS.
Imagine breaking your leg, only to be told that your nearest care facility was half way across the country, with a long waiting list and no guarantees about when you’ll actually get the help you need. Or developing diabetes but being too scared to tell your family, friends and your boss about what’s happening, because you’re worried about how they might react and possibly losing your job.
If any of these things happened to someone with a serious physical health condition in our country, there would quite rightly be outrage. It would be on the front page of every national newspaper and dominate Prime Minister’s Questions every week. People would be out on the streets calling for reform. But this is exactly the kind of second-class treatment that people with mental health issues have had to endure for decades.
At the Mental Health Conference on 19 January, held at the King’s Trust, Nick Clegg called for a new ambition for zero suicides across the NHS.
The NHS is one of, if not the, best health system in the world: free at the point of use, incredibly innovative and staffed with hundreds of thousands of dedicated, compassionate and highly trained professionals. And, in some parts of the country, NHS Trusts are providing world-leading mental health services.
Take, for example, the Michael Rutter Centre at South London’s Maudsley Hospital. This clinic, which specialises in the treatment of eating disorders, aims to see every patient within 48 hours of their referral and offers clients access to talking therapies, alongside dedicated support from therapists and other health professionals. Its recovery rates are outstanding.
Yet, that high standard of rapid, expert treatment has never been a given for all mental health patients across the country. For too many years, there’s been an unspoken bias that has always put physical health first.
I’ll never forget one of my first meetings as a newly-elected MP in Sheffield a decade ago, with a family whose daughter was struggling to get the help she needed to overcome an eating disorder. They were at their wits’ end: very scared about their daughter’s future, frustrated at the system and running out of options.
Since then, I’ve heard countless similar stories from people with mental health problems across the country, including unacceptable waits for treatment; problems getting work; and prejudice everywhere they look.
Just last week, I met a man who told me that when he was in hospital for open-heart surgery, he was inundated with visits from family and friends. But, when he was hospitalised due to a mental illness for 5 months, he received just 3 visitors.
This is a vivid example of how people with mental health problems face not only the struggle to overcome their condition, but also the stigma they experience.
View infographics about mental health on Flickr.
It’s a reality that I am determined to start to change in government.
In particular, Norman Lamb, in his role as Care and Support Minister, has made ending discrimination against mental health in the NHS a personal crusade. I want to pay personal tribute to Norman for that.
Critically, we’re righting a wrong that has put mental health care at the back of the queue for funding and reform for years. We’ve written this into law, and are making crucial changes to how the NHS treats mental health. Introducing access and waiting time standards for the first time. Patient choice. Better standards in services. Increased access to talking therapies.
To ensure every part of government is making this a priority, I’ve established a Mental Health Taskforce in Whitehall. This brings together senior ministers from across government to tackle the complex issues that will never be solved by one department alone, like improving mental health services for young people, addressing welfare and employment issues and preventing more people with severe mental health problems from ending up in police cells and prisons.
Norman is also leading the Child and Adolescent Mental Health Services Taskforce, with experts from health, social care and education to focus specifically on the support we offer children and young people.
It hasn’t been easy. This issue has been neglected for decades. We’re making it a priority at a time when money is tight, and I’m pretty sure that right now some of you will be thinking, “These reforms are all well and good, but just last week I read about cuts to services in my local area.”
I’ll be candid with you. Sometimes it can feel that for every 2 steps forward that we take as a country in mental health, local, individual decisions can still take us a small step back. And, it’s true, we have had to fight tooth and nail for the resources this needs.
Since 2011, we’ve invested £400 million to increase access to talking therapies across England. We’re providing an extra £120 million to help implement the maximum waiting times for mental health from this year, alongside an additional £150 million over 5 years to improve services for children and young people suffering from eating disorders.
This includes waiting time and access standards for these conditions by April 2016.
And, overall, the money going into mental health has increased by £302 million in 2014 to 2015.
But most importantly of all, we’re fundamentally changing the way in which Mental Health Trusts get this money in the first place: shifting the method of funding to the per-patient funding received by other parts of the NHS and funding based on results for patients.
This, alongside the introduction of waiting time standards, will end the longstanding financial discrimination which has existed in mental health – because the block grants used to pay Mental Health Trusts in the past, and the lack of maximum waiting times, made them particularly vulnerable to local cuts.
In the last Autumn Statement, we also committed a further £2 billion to frontline NHS Services. And NHS England has written to every clinical commissioning group (CCG) to ask them to increase their mental health spending in real terms, in line with this extra funding.
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Bit by bit, we are making progress: transforming people’s attitudes and putting in place the reforms necessary to deliver long lasting improvements in our mental health services.
A huge part of that change is down to you – professionals working tirelessly to get people back on the road to recovery and campaigners speaking out about your own experiences of mental health, as we so movingly saw on the video clips earlier.
The incredible work that you do isn’t always recognised. But we only have to look at the hundreds of entries we’ve already received for our new local Mental Health Heroes awards to see the difference it makes to people’s lives.
So please, if you know someone going that extra mile to help people with mental health issues in your local area, make sure you nominate them for an award.
Let’s give them the recognition they deserve. We’ll be announcing the winners on Time to Talk Day next month.
I think, however, we’d all agree that we’re still very much in the foothills of our journey towards parity of esteem. If we’re to achieve our ambition to transform the lives of more people with mental health problems in this country, we need to drive a fundamental culture shift in the NHS and in society at large.
So today, I want to focus briefly on 3 critical areas in particular:
- first, embedding waiting time standards for mental health into every nerve and sinew of our health system
- second, doing more to support people in mental health crisis
- finally, helping people at risk of suicide
Kerry, a Rethink Activist who is here with us today, was 19 years old when she started hearing voices. But it would take another 7 years of being passed around the system for her to finally get the right treatment.
As a result, Kerry spent most of her twenties feeling like she needed to hide from the world – scared, confused and in pain and despair. Even then, as Kerry has described, she was only able to access the best possible care after being sectioned.
It is no exaggeration to say this support, according to what I’ve heard from Kerry, transformed her life. With help from a psychiatric nurse to get her back on her feet and access to a course of therapy with a clinical psychologist, Kerry was able to complete her Masters and is now engaged to be married and doing a job she loves.
No one should have to go through what Kerry did to get well.
And the evidence shows that treating psychosis rapidly not only dramatically improves someone’s chances of recovery, it could also save the NHS £44 million a year in reduced hospital admissions.
When Labour introduced maximum waiting times in physical health treatment, it transformed the standards of care people received for heart disease, cancer and other serious physical conditions - boosting investment, research and training across these fields.
In this government, we believe it’s only right to give people with mental health conditions that same kind of certainty, access and support.
So, from April this year, many patients experiencing psychosis for the first time, will start treatment within 2 weeks of referral – the same waiting time for consultations for cancer diagnosis.
If you’re someone who’s anxious or depressed and waiting for talking therapies, you will be guaranteed the treatment you need within 6 weeks – 18 weeks at an absolute maximum – just as if you are waiting for an operation on your hip.
If you are having a breakdown, if you are thinking of harming yourself, or for any mental health emergency which takes you to A&E, you’ll get the expert help you need there and then – just as if you had gone to hospital with chest pains or following a serious accident.
And, we’re also working on implementing waiting time standards for treatment for people with eating disorders from April next year.
All of this is change that’s long overdue. Yet this transformation can’t happen without your strong leadership and commitment: to train staff, inform patients, update IT systems and collect new data.
NHS England is now developing detailed plans to roll out each of the standards in every region across England, and, alongside managing significant winter pressures, I’m clear that implementing them should be a top priority for every leader of a clinical commissioning group and Mental Health Trust in our country. Every area of every CCG and mental health trust in the country will have to report on this.
This is just the start of the radical improvements in mental health treatment we want to see delivered. This includes the provision of better support for people in crisis.
When you’re in mental health crisis, you need to rely on a whole range of public services to keep you safe. Yet, historically, these organisations – such as the NHS, social care teams, police and ambulance services and others – have not worked together as closely or effectively as they should on this.
It’s led to too many people calling local emergency helplines only to be told to leave their details or call back for help in office hours. Others have had police cars instead of ambulances turn up to take them to a place of safety, creating the impression that they’re being arrested instead of being helped.
And just too many people – including children and young people - have been detained in a police cell, under the Mental Health Act, because there’s been no health response to help them.
Incidents like these can, of course, do lasting damage. Most importantly of all, they can be avoided.
That’s why we created the Mental Health Crisis Care Concordat, which commits agencies to work together, at a national and local level, and provide a high standard of emergency crisis support around the clock in their local area.
As Norman confirmed over the weekend, every English region has now signed up to these new standards including work to end the use of police cells under the Mental Health Act.
It’s already making a difference. In the last financial year, the number of people ending up in police cells fell by 24%. In many areas, nobody is being taken to a cell.
But, of course, we need to do more. So, we’ve asked every area for an action plan: detailing how they will end the use of police cells and deliver better urgent, crisis care together.
Several plans are already in place. This includes across Greater Manchester where, in Trafford, a dedicated mental health nurse is now working with neighbourhood policing teams to advise officers and provide expert support on call outs to particularly vulnerable individuals with complex mental health issues.
And, early reports show, this is helping to ensure these individuals receive the most appropriate care, reduce unnecessary calls to the police and also strengthen operational links between public services across Greater Manchester.
I would like to now see this kind of excellent collaborative approach replicated across the country.
Then there’s the final issue I want to talk about today: helping people at risk of suicide. One of the biggest assumptions most people make about suicide is that, if someone is determined to kill themselves, there is absolutely nothing we can do to stop them. Even with the best will in the world, if their mind is made up, their death is tragic but inevitable.
Yet, the truth is that suicide can be prevented. As the Samaritans say: the majority of people who feel suicidal don’t actually want to die. They just don’t want to live the life they have.
That distinction might seem slight, but it’s critical if we’re to save more lives. It shows us that things can and must change.
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It starts with us, breaking the silence around this issue.
Suicide is, and always has been, a massive taboo in our society. People are genuinely scared to talk about it, never mind intervene when they believe a loved one is at risk.
The overriding fear is that by asking someone if they’re feeling suicidal, you’ll either wreck your relationship with them or actually put the idea of suicide in their head. But that’s not the case.
In a TED talk last year, Kevin Briggs – a retired US police officer, who spent years counselling suicidal men and women as part of his beat patrolling the Golden Gate Bridge, said
What would you do if your family member, friend or loved one was suicidal?
In my experience, it’s not just the talking that you do, but the listening… By just being there you may just be the turning point they need.
Together, we need to create a culture in our country where every one can talk about their mental health problems without fear, embarrassment or judgement. And today is the day for us to start that conversation. Because silence costs lives.
Almost 4,700 people died by suicide in 2013 in England – just under 78% of these people were men, and suicide remains one of the biggest killers for men under the age of 50. While emergency departments see 300,000 cases of self harm each year – a telltale sign of emotional distress or suicidal thoughts, with often the same people coming back again and again.
The impact of every one of these suicides on the person’s loved ones and wider community is devastating.
Many families are left in total shock, which can scar them forever. Others speak of their frustration that nobody warned them that it could happen.
This isn’t about blame. It is about doing more in every area of our society to ensure that people don’t get to that point where they believe taking their life is their only option.
This includes in our health system. That’s why today, I’m issuing a call to every part of the NHS to commit to a new ambition for zero suicides of people in their care.
Every Mental Health Trust will have their own ideas about how to do this. But possible measures include: staff continuing to keep in contact with patients who move back home after being on a ward; ensuring patients’ friends and family know where to go for help if they need it, along with regular contact with someone they know and trust; and integrating services so that patients who are at risk don’t fall through the cracks.
We already know this kind of approach can work in dramatically reducing suicides.
A mental health programme in Detroit in the USA, which signed up to the ‘zero suicide’ commitment has reported 2 and a half years without a single patient suicide, as well as a reduction in suicide in the city as a whole.
Three areas – a Mental Health Trust in Merseyside, and the South West and the East of England regions - are already rethinking the way they care for people with mental health conditions to achieve this ambition for zero suicides in our own health system.
And, last week, I saw first hand the excellent work being done by Mersey Care. They’ve given themselves 2 years to ensure that no-one they treat goes on to take their own life.
The team works closely with patients and their families, providing support that has been proven to work in preventing suicides. This includes creating a dedicated ‘Safe from Suicide’ team and developing personalised safety plans with everyone they care for.
These plans help patients identify those issues which can trigger their negative thoughts, give them ways to deal with high risk moments and, critically, ensure they and their loved ones know and can access the right people to help them in a crisis.
All of this is done in close collaboration with GPs, other specialist providers, commissioners, public health experts and others. Above all else, it represents a huge culture change in how the health system and, indeed, the entire community thinks about and understands suicide: first, and foremost, that suicide is preventable, not inevitable.
I now want to see more innovative programmes like this develop across the whole of the country.
In conclusion, over the last 5 years, we’ve taken some critical first steps to transform mental health services across England.
We’ve still got a long way to go, but we must act now to give this issue the parity of esteem it deserves and secure access for people throughout England to responsive, high quality care.
Together, we can make the difference – giving everyone trying to cope with a mental health condition an equal chance of the happy, fulfilled life they deserve.