Sojan Joseph MP: speeches

Speeches

• 12 Jun 2025 · Mental Health Bill [ Lords ] (Third sitting) · Hansard source

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  What the hon. Member read is absolutely right. I was talking about sections 135 and 136. I am talking here about sections 2, 3 and 5. I absolutely stand by what I said about sections 135 and 136, and I am happy to come to that. As a former mental health nurse, I certainly would not support giving the police greater powers under sections 2, 3 and 5 of the Mental Health Act. I am also opposed to the amendments passed in the other place because I believe that the extension of legal powers held by the police to other healthcare professionals would represent a major shift in the roles and responsibilities of healthcare and care professionals, placing significant additional pressure on the NHS and social care providers. The Royal College of Psychiatrists, the Royal College of Nursing and the British Medical Association are among the health and social care organisations that have warned against such an extension, saying that it is “a radical proposal with a number of serious and potentially dangerous consequences”. Those organisations also point out that the proposed extension has not been properly tested with relevant health and social care professionals and has been given minimal serious consideration during the eight years in which reform of the Mental Health Act has been under discussion. The majority of assessment under the Mental Health Act already happens without police involvement. However, where the police may be required to make a detention, I know from my experience working in mental health that the presence of officers can often ensure that an otherwise risky situation remains contained and everyone remains safe. Entering someone’s home without permission is fraught with huge risk and currently is done only with the assistance of police intelligence. Under section 135, health professionals ask the court for an order to remove somebody forcefully from their residence and the police use that order to do so; sometimes, they have to break in. That is the power that the hon. Member for Hinckley and Bosworth spoke to earlier. Without it, health and social care professionals would be expected to enter homes without police help, and without crucial intelligence that could ensure their safety. As Dr Lade Smith, the president of the Royal College of Psychiatrists, said: “It is well known that at times, people experiencing a mental health crisis cannot be safely reached and cared for without the assistance of the police. Delegating police powers without proper consultation or planning is likely to disproportionately affect those from minoritised backgrounds and would increase risk to patients and compromise the safety of others. It sets a dangerous precedent.” I am also concerned that the amendments passed in the other place granting police powers to authorised persons risk damaging their therapeutic relationships with patients. They would have the effect of lessening clinicians’ ability to treat patients, and I fear that patients would be less likely to attend an appointment if they thought they might be forcibly detained by the clinician.

• 19 May 2025 · Topical Questions · Hansard source

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  T8. Joining a cadet force offers young people a fantastic opportunity to develop key skills, including enhanced communication skills, and to improve their self-confidence and physical and mental wellbeing. What steps are the Government taking to support the cadets, and to encourage more young people to join and obtain life-changing skills?

• 3 Apr 2025 · Business of the House · Hansard source

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  I have previously raised in this House how the use of Operation Brock to queue freight lorries heading to Dover on the M20 causes disruption to large parts of my constituency. My constituents are not against it being used as an emergency traffic-calming measure, but I have been extremely disappointed by the decision of Kent county council and the Kent and Medway resilience forum to routinely deploy it over the school holidays—this time, it will last until 22 April. Will the Leader of the House find time for a debate on traffic management, so that we can discuss how measures such as Operation Brock should be used only as a last resort?

• 13 Mar 2025 · Mental Health Support: Educational Settings · Hansard source

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  I agree, and I have many similar cases. I want to refer some real-life examples. There is an excellent exhibition in the Upper Waiting Hall this week about the Mental Health Act, which has been put together by Mind. It features artwork and written pieces by people who have been detained under the current Act. I had the pleasure of meeting some of them on Monday, including a young lady called Afeefa. Afeefa is 19 but was first detained under the Act when she was 14. She spoke powerfully and movingly about the treatment that she endured while she was under section. When I asked her if there was one thing that could have helped her, she said without hesitation that if she had received mental health support at an earlier stage, her experience would have been very different. I recall two examples from my experience of working in mental health system that demonstrate the difference that early intervention and support can make. They are of two young people of similar age: one is a teenage boy, who unfortunately has not been able to access the support he needs and, as a result, is struggling to cope. That is not only impacting on his mental health but is having a detrimental impact on his family, especially his parents. By contrast, in the second case, the parents of a teenage girl who had been diagnosed with a mental health condition knew that I worked in mental health at the time and came to see me. I was able to ensure that she was referred to CAMHS at an early stage. As a result, both she and her parents are doing well. She is due to sit her A-levels in the summer. These examples underline how children who receive support quickly are less likely to develop long-term conditions that negatively affect their education, social development and health later in life. I welcome the fact that my right hon. Friend the Secretary of State for Education has been clear that children’s wellbeing will be a priority for this Government. Research from the British Association for Counselling and Psychotherapy indicates that children whose mental health difficulties are initially too complex for lower intensity interventions, but not complex enough to be referred to higher intensity interventions such as CAMHS, can easily miss out on the mental health support that they need. Ensuring enough mental health support for children and young people in educational settings will help to free up NHS time and resources, while making sure that we have a healthy and productive population in the future. We should also make sure that support exists in the community. Can the Minister provide an update on the Government’s plans for Young Futures hubs? Does he agree that open access drop-in hubs could be an important step in providing community-based mental health support for children and young people? There is clear evidence that the places and circumstances in which people are born grow, study, live and work have a powerful influence on their mental health. As Place2Be has said, children and young people from low-income families are four times more likely to experience mental health problems than children from higher income families, while one in four children and young people with a diagnosed mental health condition live in a household that has experienced a reduction in household income. This is why I want reform of the way that we deal with mental health. From Westminster, I would like greater cross-Government working to address the social detriments of our mental health. At a local level, I believe that greater co-operation between schools, colleges and universities, along with local health providers and others in the local community, can help create education settings that are effective at protecting young people’s mental health and general wellbeing. Taking that long-term approach will help create a society that prevents mental ill health for children and young people in the first place.

• 13 Mar 2025 · Mental Health Support: Educational Settings · Hansard source

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  I congratulate my hon. Friend the Member for Redditch (Chris Bloore) on securing this debate, and I am grateful to the Backbench Business Committee for finding time for it. I know from experience that our mental health system is overstretched and under-resourced. In fact, there has never been so much demand for mental health support from children and young people. In June, the number of active CAMHS referrals in England was a record 840,000. It is clear that this Government inherited a crisis in children and young people’s mental health. We all want young people to be happy, healthy and safe, and to be equipped with everything that they need to achieve and thrive as adults. But with half of mental health issues developing by the time that young people reach the age of 14, and three quarters before the age of 24, early intervention in mental health support for children and young people is essential.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I rise to speak briefly to amendment 296. We all know how the NHS operates, how the appointment system works in the NHS and how long people have to wait to see a doctor. I do not think that my hon. Friend the Member for York Central tabled the amendment with any ill thought, but just to highlight the issue. I do not think that the amendment will make the Bill any safer or stronger, or safeguard anything, but the Committee needs to acknowledge it. I will quote the Royal College of Physicians, which represents 40,000 doctors who primarily work in hospitals, including on palliative care. The Royal College of Physicians took a neutral position on the Bill. In its written evidence, it highlighted, “We recognise that the ultimate decision on assisted dying rests with society through Parliament, however any changes to the law will significantly affect clinical practice beyond palliative care…Should the law change, the RCP strongly argues that assisted dying must not divert resources from end of life and palliative care provision, which are not currently adequate.” With amendment 296, my hon. Friend the Member for York Central is trying to get the Committee to acknowledge that some NHS departments work with vacancies of 50 medical professionals. A patient who has been waiting for six months should not have their appointment cancelled because the provision here is prioritised. I think that is what my hon. Friend meant with her amendment, and I commend her thought about wider NHS provision.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  Could the Minister clarify whether the requirement for one year of residency in the UK means that a foreign citizen studying at a university here would be able to consider assisted dying?

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I thank my hon. Friend for her timely intervention. I was going to say that having tabled amendment 1 asking for a psychiatrist to be involved, and having now been through many Committee sittings, I wonder whether I influenced an unconscious bias among Members to table more amendments relating to mental health, capacity and suicide. I say to my hon. Friend that although there can be a psychiatry referral, if we are talking about unconscious bias, as soon as the first and second doctor make the decision that the person has capacity, is terminally ill and is eligible for this process, the subsequent assessments can be influenced by the first assessment. That happens quite often in NHS healthcare, and especially mental health. When the chief medical officer, Sir Chris Whitty, was before the Committee, I asked him about mental capacity assessments. He said: “I would hope that most doctors are capable of identifying that someone has some degree…of mental health distress, or mental health illness”. However, he went on to say: “What not all doctors will feel comfortable doing is actually deciding whether that is sufficient to interfere with someone’s ability to make a decision with full capacity. That is where help from colleagues from psychiatry, and mental health more widely, is going to be useful.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 38, Q17.] We have spoken about this many times, but in written evidence the Royal College of Psychiatrists said: “A person’s capacity can change, and it is decision specific. While we are of the view that a person’s capacity to decide treatment can be reliably assessed, an assessment of a person’s mental capacity to decide to end their own life is an entirely different and more complex determination requiring a higher level of understanding.” In a previous sitting, we discussed having a panel that is able to do a psychosocial assessment. I know that the new clauses are yet to be discussed, but the relevant new clause does not specify who the members of the panel will be and whether it should include a psychiatrist or a social worker. That is yet to be made clear, so I am not convinced about that.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I thank my hon. Friend for confirming that. That is reassuring but, as I said earlier, I would like to know when the patient will have access to the panel. It is important that they access it early in the process, rather than later, because that is where unconscious bias comes in. The purpose of my amendment is to save resources, because I know about the pressure on the NHS. Rather than having an additional psychiatrist on top of the two or three doctors, my amendment would simplify the process and save resources. Although I acknowledge that the evidence I cited referred to the application of the Mental Capacity Act 2005 to the Bill—an issue on which the Committee has already decided—I would argue that it can equally be taken into consideration in this context. After all, in its written evidence, the Royal College of Psychiatrists said: “Mental disorders, such as depression, are more common in people nearing the end of their life. Delirium is more common… Hopelessness is a common symptom of depression”, and people’s capacity and consent can be affected when they are going through that condition. I can categorically confirm that I have seen that in my own practice. A person could be absolutely normal, but when they are diagnosed with a terminal illness, that can have an impact on their mental health. We have heard about post-traumatic stress disorder and many other events that can have an impact on people’s mental health and, in turn, on their decision making and capacity. If the Bill enters the statute book, we should ensure that at least one of the doctors assessing a terminally ill adult who wants to use the legal mechanism to end their life is properly qualified to carry out mental capacity assessments. I know from my own experience that psychiatrists deal with complex mental capacity assessments and other cases every day. For example, psychiatrists who work in accident and emergency departments regularly see people who are intent on ending their life—that is the bread and butter of their work.

• 4 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Sixteenth sitting) · Hansard source

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  There are other people who support this concept, and they are the people who will be having the conversation—we have both sides of the argument. I believe that the best person to have that preliminary discussion would be the doctor who knows about that patient the most—about their circumstances, prognosis, family situation and pain. We talk about compassionate care, but where is the compassion in here? I am not saying that another doctor would deny that—but I am talking about compassion. Someone going through the most difficult time in their life would have the confidence to talk to the person who knows the most about them, which is why I fully support that the initial discussion should happen with them. I am not saying that they should say yes or no, but they should be talking about the care provisions and options available to the patient. Amendment 342 is one of the most important amendments we will debate. I will move on to amendment 425. When I tabled amendment 1, my thinking was that a psychiatrist should be involved in these discussions, but I think amendment 425 will safeguard most of the concerns we have discussed in previous sittings. Amendment 425 talks about a “multidisciplinary team” and having a psychiatrist involved as well. Written evidence was sent to us on 29 January by the Royal College of General Practitioners, which recommended that a separate pathway that “covered every stage of the process would ensure healthcare professionals of multiple disciplines…who wanted to do so could still opt in to provide assisted dying, but this would be arranged through a different pathway.” The hon. Member for Sunderland Central spoke earlier about how patients may be going through many multidisciplinary teams already, but it could be that none of those multidisciplinary teams have talked with them about assisted dying. They could have been pharmacists or nurses talking about the patient’s care—not assisted dying. We are talking about setting up a multidisciplinary team with a mental health nurse, doctor and social worker who can look in detail at evidence of the patient’s capacity, whether they are choosing it because they feel they are a burden, and whether there is any coercion. I think that is a safeguard for most of the concerns we have discussed in previous sessions. I would love to see a psychiatrist involved, because psychiatrists deal with some of the most challenging patients, including those with suicidal thoughts, on a day-to-day basis. They are the most experienced people to carry out a capacity assessment and, if they are a part of the multidisciplinary team, it will safeguard the Bill. I strongly support amendment 425 and I urge Members to consider it. It will reassure many people who are concerned about some of the discussions. I know it also talks about giving power to the Secretary of State to formalise who should be part of the multidisciplinary team, which would be a discussion for later. I thank the Committee for giving me the opportunity to speak in support of the amendment.

• 26 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Fifteenth sitting) · Hansard source

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  I would be happy to see the Bill make a strong case that the people who will take part in this process have training before they do so. My larger issue is around the independent doctors. Again, I will use some examples of how the Mental Health Act 1983 has been carried out in its current format. Those cases always use a section 12-approved doctor, who is a second doctor and they may not have had any kind of contact with the patients. We may or may not end up in that sort of similar situation. That is the point I was making earlier. As the Royal College of Psychiatrists mentioned, capacity can change and decisions are opinions with margins of error. I mentioned my experience working in mental health wards earlier, and the hon. Member for East Wiltshire talked about the capacity assessments carried out when patients are standing by or threatening to jump off a bridge. I am not comparing these situations or saying that they are similar, but we have to make decisions based on capacity. In my experience of discharging people from hospital in a mental health unit, when somebody is threatening, “I’m going to kill myself if you discharge me”, the multi-disciplinary team—the doctors and the nurses—have to make a decision on whether to discharge the patient based on their capacity at that time. Capacity is assessed based on whether someone is able to understand information—can they retain, use and weigh information, and can they communicate their decision? We cannot compare that with the situation of somebody asking for assisted dying. I want to make it clear that the capacity assessment is the key. I would love to support this amendment. As I said earlier, this issue was one reason I voted against the Bill on Second Reading, but passing this amendment might change my position and I would love to support it.

• 26 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Fourteenth sitting) · Hansard source

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  I rise to speak in support of the amendments. Having worked as a mental health nurse for 22 years, I completed mental capacity training many times in my career, and I carried out capacity assessments as part of my day-to-day job. I think that the capacity assessment proposed in the Bill is not safe enough. That was one of the main reasons I voted against the Bill on Second Reading. I have spoken to many people who oppose the Bill, and one of their concerns is about the capacity assessment. We have talked about capacity assessments every day in this Committee. It is one of the key issues that we will need to resolve to strengthen the Bill if it goes through. One of the Royal College of Psychiatrists’ concerns is that capacity decisions are “opinions with a margin of error and are time specific. A person’s capacity can change”. I will talk about my experience with those margins of error. A person’s capacity can be influenced by various factors, including their life circumstances, the medication they are taking or severe pain. Suicidal thoughts due to their mental state or depression can also influence their capacity. I have worked in acute mental health units. Every day, we carried out capacity assessments, including before we let someone out of the ward, whether they were admitted under the Mental Health Act or were receiving treatment as a voluntary patient. If somebody wanted to leave the ward, before the member of staff opened the door, they had to assess that person’s capacity. Sometimes a person might have said, “I am going to kill myself,” and the nurse would have had to decide whether or not they had capacity before opening the door. My hon. Friend the Member for Bradford West has talked about unconscious bias. The initial capacity assessment when a person comes to a hospital is very important. If a doctor has assessed at the beginning that the person has capacity, the following assessment can be influenced by that initial assessment. I totally agree with my hon. Friend’s argument about unconscious bias in capacity assessments. As Members have mentioned, the Bill proposes many occasions in the process when capacity will be assessed, but I am still not confident that each capacity assessment will not be influenced by the initial assessment. The amendments would strengthen that area of concern.

• 24 Feb 2025 · Breakfast Clubs: Early Adopters · Hansard source

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  I welcome this announcement, under which my constituents in Ashford will benefit from free breakfast clubs in three schools: Downs View infants school, Kingsnorth primary school and Chilmington primary school. Giving children a chance to settle down and start their day at a club with friends will have a positive long-term impact on their mental health. Does my right hon. Friend agree that this needs to be rolled out to every primary school as soon as possible?

• 11 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Ninth sitting) · Hansard source

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  We heard many pieces of oral evidence from expert psychiatrists, including from the Royal College of Psychiatrists, saying that the Mental Capacity Act is not fit for the Bill. Even if we use the Act, many conditions such as depression or delirium —or the effects of some medication—can impact on people’s decision making. It is worrying when someone like Dr Rachel Clarke, who has extensive experience in the Mental Capacity Act and has been training medical students and nurses, says of those mental capacity assessments that “it is often the case that they are…poorly conducted.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 71, Q85.] Would my hon. Friend agree that rather than use the Mental Capacity Act, the “ability” amendment tabled by the hon. Member for Richmond Park would be more suitable and make the Bill safer?

• 30 Jan 2025 · Terminally Ill Adults (End of Life) Bill (Seventh sitting) · Hansard source

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  Q Professor Owen, written evidence from the Royal College of Psychiatrists states that 65% of psychiatrists “are not confident that consent can act as an adequate safeguard”. On mental capacity, it says: “These decisions are opinions with a margin of error and are time specific. A person’s capacity can change”. What is your view? Professor Owen: That is important evidence, because it comes from a body of practitioners who are very used to doing mental capacity assessments. I think that the vast majority of that sample were consultant psychiatrists, so the pool, as it were, was one of considerable experience. That conveys questionable confidence in the consent processes, of which mental capacity is part, in relation to the decision to end one’s life. It is significant evidence about the confidence that is out there among experienced practitioners. It is true that psychiatrists—liaison psychiatrists particularly; I have had experience with this myself, clinically and in relation to Court of Protection matters—will be involved with assessing capacity to make decisions to refuse life-sustaining treatment. Those decisions can be quite vexed and can go to the court, and the court can struggle with them. An important question for the Committee is the distinction—or the similarity and difference, but I think that there are key differences—between the decision to refuse a treatment that is life-sustaining, of which the Court of Protection does have experience, and the decision to decide to end one’s own life. They are conceptually different decisions. I can outline some of the similarities and the differences now, but it might be helpful to take submissions specifically on that question, because it is very important and I think that there is some confusion about it. If you would find it helpful, the complex life and death decisions group could write a statement to elaborate on some of the issues. In summary, I think that that evidence from the Royal College of Psychiatrists is significant, in terms of the confidence.

• 30 Jan 2025 · Terminally Ill Adults (End of Life) Bill (Seventh sitting) · Hansard source

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  The evidence is from the Royal College of Psychiatrists, but anybody can answer the question. Dr Mulholland: As GPs, we feel that we need a stand-alone service to take people through this process for assisted dying. We do not feel that the GP is in a place to make an assessment of capacity for this process. That is beyond anything that any of us have ever trained in or understood, and it will need people who are trained in assessing capacity at that point. As GPs, we are very used to assessing whether somebody has the capacity to take a course of antibiotics or to be referred for something that we understand, but this is an issue that will require a much deeper level—the Royal College of Psychiatrists has probably thought more on that level about the next steps. Dr Price: Yes; to refer back to the written evidence, if we think about people with palliative care needs towards the end of life—so the people who would qualify under this Bill—around 20% will have diagnosable depression, around 10% will have a wish to hasten death, and around 4% will have a more persistent wish to hasten death. Those wishes may not be expressed unless they are assessed for. One of the things that I would do in my clinical practice would be to look for treatable mental disorder in people who express a wish to hasten death. I do not do that alone. You asked about a panel. When I am thinking about the needs of people who are nearing the end of life, and I work with people nearing the end of life most weeks of my working life, I work in a multidisciplinary team. My own small team comprises doctors, nurses and occupational therapists, but I work closely with social workers, the safeguarding lead, chaplains and all my medical and surgical colleagues to make good decisions about my patients in a biological, psychological and social way. Not all difficulties that are psychological can be fixed with a psychiatric intervention. We would advocate as a college, and I would suggest as a clinician, that good decisions about our patients’ needs are made in a multidisciplinary way. That should be considered in the model of how to meet people’s needs in whatever way they present, but particularly for people who have difficulties and are suffering in a way that makes them feel that they do not want to continue living.

• 30 Jan 2025 · Terminally Ill Adults (End of Life) Bill (Seventh sitting) · Hansard source

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  Q I want to come to you, Michael. The Royal College of Psychiatrists has given a written statement, which says: “Mental disorders, such as depression, are more common in people nearing the end of their life. Delirium is more common… Hopelessness is a common symptom of depression…And people’s capacity and consent can be affected when they are going through this condition.” In the last few days, we have heard much evidence that expressed concern about capacity assessment and that said, as Dan mentioned, there should be an advocacy service available. Rather than having the current model of two doctors and the court, if we have a panel with experts on it who can consider psychosocial assessment and capacity, would that make the Bill stronger, with more safeguarding being introduced to it? Dr Mulholland: Sorry—can I check whether that was a question for me at the Royal College of GPs or a question for the Royal College of Psychiatrists, because I think that statement was in their evidence?

• 28 Jan 2025 · Terminally Ill Adults (End of Life) Bill (Second sitting) · Hansard source

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  Q When the RCN Scotland director gave evidence to the Scottish Parliament during the discussion of the Assisted Dying for Terminally Ill Adults (Scotland) Bill, he expressed the RCN’s concern that there were not sufficient safeguards in place to protect nurses and nursing practice around assisted dying in Scotland. Are you satisfied that the Bill we have before us in England and Wales addresses those concerns, or would you like to see amendments to ensure that the mental health and wellbeing of nurses involved in the process are protected, should the Bill become law? Professor Ranger: Yes, we would want to see more support and protection for nurses. Of course, in the exploring of assisted dying legislation in Scotland, the second clinical decision maker is a nurse—so it a doctor and a nurse, whereas in England and Wales we are looking at two medically qualified practitioners. We absolutely want to make sure that the skills and support is there for nursing staff, and the ability—as I heard our medical colleagues saying—to not be involved in assisted dying absolutely has to be supported. It cannot be an expectation of the role; it has to be something you choose to proactively take part in as a conscious decision. It cannot ever be just an expectation of a nurse. We are absolutely adamant about that. The Bill cannot just support the needs of medical staff—nursing absolutely has to be included within that, both in skills and support.

• 21 Jan 2025 · Terminally Ill Adults (End of Life) Bill (First sitting) · Hansard source

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  I want to talk about amendment (b). The right hon. Member for North West Hampshire said that all members of the Royal College of Psychiatrists are already members of the General Medical Council. But not everyone on the General Medical Council is doing the same job. Psychiatrists are experts whose day-to-day job is to manage people’s mental state, and deal with people with suicidal thoughts and depression. They are the experts. I do not think that all members of the Royal College of Psychiatrists are for or against the Bill, so it would be reasonable to listen to those people who are experts in assessing people’s mental state and whether they are having suicidal thoughts—that is part of their job. I strongly support that part of the provision.

• 10 Oct 2024 · Mental Health Support · Hansard source

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  I beg to move, That this House has considered improving support for mental health. It is a pleasure to see you in the Chair, Mr Dowd, and I am pleased to have secured this important debate. As today is World Mental Health Day, it is particularly appropriate that we have the opportunity to raise awareness of mental health issues and the mental health system in this country. It is important to reflect on how far we have come in this country in removing the stigma around mental health, and I hope this Parliament will play its part in continuing that progress. However, if we are to do so, we must be honest about the many challenges we still face. I also want to declare a personal interest: before being elected in July, I spent 22 years working in the NHS, primarily in mental health. One of my main motivations in standing for Parliament was to play my part in building an NHS fit for the future. Improving support for mental health will be an integral part of that. With that in mind, I want to put on record my thanks to my former NHS colleagues working in the mental health system. They do an incredible job in incredibly difficult circumstances. It is important to say at the outset of this debate that any criticisms of the current system are not directed at the workforce. Without their hard work and dedication, the problems faced by those in need of mental health services would be far worse. I know from my own experience that in recent years, their work has often been made more difficult by policies imposed at a national level by the last Government. Even when it was clear that those policies were having a detrimental impact, Ministers were unwilling to make concessions. Although the mental health workforce has expanded in recent years, it has only reached the same number of staff as it had when the last Labour Government were in office in 2010. More needs to be done regarding the recruitment and retention of staff, as underlined by the high number of vacancies. NHS data shows that in September last year, there were 28,600 vacancies, amounting to 19% of the total workforce and causing an increased reliance on agency staff. In the year to September 2023, there was a 19% turnover in the overall workforce. Those figures from the King’s Fund highlight the extent of the recruitment and retention crisis. From my work as a manager in mental health services, I know that experienced staff play a vital role, and a vast amount of time has to be spent recruiting new experienced staff when they move on to different posts. That has meant that often the most challenging environments have been run by staff with the least experience. That obviously has a negative impact on patient care and can lead to an increased incidence of aggression and abuse of staff. It is therefore not a surprise to see staff shortages having a negative impact on staff morale. The King’s Fund has shown that in in-patient services, staff regularly work extra hours or additional shifts and often find themselves in environments and with patients they are unfamiliar with. Similarly, staff in community services say they are worn out and find their work frustrating and stressful. For 14 years, we have had a string of Prime Ministers and Ministers speaking about achieving parity of esteem between physical and mental health in the NHS. While I do not doubt the intentions behind achieving that goal, after 14 years of Conservative Government we do not have that parity. Indeed, as Lord Darzi made clear in his excellent report: “There is a fundamental problem in the distribution of resources between mental health and physical health. Mental health accounts for more than 20 per cent of the disease burden, but less than 10 per cent of NHS expenditure.” Although there has been increased investment in mental health services at a higher rate than the overall NHS budget, there is still a large gap between resources and demand. It is little wonder that all the talk of parity has seemed little more than warm words. I genuinely hope that under this Government things will finally change. I should point out that when we talk about waiting lists, those waiting in the mental health system are never included. Will my hon. Friend the Minister say something about that and explain how the Government plan to put parity of esteem into practice? Can he also say whether the Government will continue to increase investment in mental health services at a higher rate than the overall NHS budget during this Parliament? Lord Darzi’s recent report states that around 3.6 million people are in contact with mental health services, and in April this year around 1 million people were waiting for mental health services. As he makes clear, it has become all too normal to have to wait a long time to access mental health services. The NHS’s own data shows that in April this year, 10% of people who had been in contact with mental health services and were waiting for their second contact in adult community mental health services had been waiting for at least 116 weeks. All the evidence indicates that today we have a mental health system that is overstretched and under-resourced. In fact, there has never been so much demand for mental health support, with one in four people experiencing a diagnosable mental illness each year. Figures from the British Medical Association indicate that last year there were a record 5 million referrals to mental health services in England. That is up by 33% on the number of referrals in 2019. The increase in the prevalence of depression over the last decade is a good example of how our mental health as a nation has got significantly worse. In 2012, the prevalence of depression was 5.8%. By 2022 that had more than doubled to 13.2%. In my own constituency of Ashford the figure was even higher, at 17%. Given the increased prevalence of mental health issues, I was pleased that in the first King’s Speech of this Labour Government we saw mention of legislation to modernise the Mental Health Act 1983. The proposed legislation has been welcomed across the sector. It is an important opportunity to improve care and strengthen safeguards for people who are admitted to mental health hospitals. I hope the new Bill will address the fact that someone who is black or living in a deprived area is almost four times as likely to be sectioned under the Act. Will my hon. Friend the Minister tell me when we can expect to see the Government’s legislation introduced in Parliament? As Lord Darzi identified in his report, the lack of capital investment in places where people are sectioned means that a lot of those places are unsuitable, outdated and unsafe. From my own experience, I know that nurses, managers and matrons spend a lot of time trying to get capital works done in an NHS trust. People living with a long-term physical condition are 50% more likely to suffer from mental ill health, while those with Parkinson’s disease are twice as likely to be at risk of suicide. That underlines the importance of a wholesale change so that support can be accessed at an early stage. Too often, people can access support only after they have ended up in crisis. NHS figures show that in July there were just over 40,000 new urgent, very urgent or emergency referrals to crisis care teams. At that point, the treatment that patients receive is not only more intensive for them, but more costly for the NHS. The difficulty of accessing mental health services explains why increased numbers of people who require support end up being admitted to accident and emergency departments. To illustrate that, I will use the example of my own integrated care board in Kent and Medway, which has recently launched several safe havens to provide support for anyone in a mental health crisis. They have helped to reduce the number of people who seek support by going to hospital emergency departments when they experience a mental health crisis. In my constituency, there is not yet a safe haven. That may explain why William Harvey hospital in Ashford has one of the highest rates of individuals presenting with primary mental health needs at an A&E. I welcome plans that are under way for a safe haven at the hospital in the near future. When patients end up in hospital, there are significant difficulties in getting them a bed. This is a challenge in Kent and Medway, but the picture is not dissimilar across the rest of England. The Royal College of Psychiatrists recommends a maximum occupancy rate of 85% of beds for mental health patients. However, between April and June, the average occupancy rate of the 444 mental health beds in Kent and Medway was 91.7%. Across England, the average occupancy rate was 89.9%. Then there is the issue of discharging patients. When they are clinically ready to leave hospital, there is often nowhere for them to go. That leaves them stuck in hospital, causing blockages in the system. In my own experience, nurses, doctors, managers, matrons and directors spend many working hours looking into moving people out of hospital, when they should be focusing on patient care. I believe that more appropriate housing must be built that is open for people leaving hospital. I urge the Department of Health and Social Care to work across Government to ensure that as the Government’s planning reforms are introduced, that point is taken into consideration. We have seen an increase in adults being treated in hospitals for their mental health, and the situation is the same for children and young people. A recent report from the Education Policy Institute shows that the number of young people admitted to hospital increased by one fifth between 2017 and 2023. As the report indicates, that suggests that more young people are reaching a crisis point and are experiencing multiple admissions. The evidence also indicates that a large number of young people are not getting the necessary mental health support. A survey for Young Minds revealed that at least 60% of children considered to have a diagnosable mental health condition had not had contact with the NHS. Research from the Maternal Mental Health Alliance published last week shows that more than 20% of women will face mental health challenges either during their pregnancy or in the perinatal period. It is clear from the research that many women struggle to access support, particularly those from racialised communities, young mothers and those experiencing domestic abuse or living in poverty. We know that intervening early to ensure that people are kept in good health is not only better for the individual but tends to be far less costly. However, until now, efforts to prevent mental ill health have been severely underfunded and they have not been given the priority they deserve. I hope we will see a marked change in approach under this Government. With that in mind, I ask my hon. Friend the Minister whether greater priority will now be given to community-based support for mental health services. I hope he will agree that the easier it is for people to access mental health services locally, whether in a traditional health setting or through more informal drop-in services, the quicker they will be able to get the treatment they need. Will my hon. Friend update us on the Government’s plans for Young Futures hubs for children and young people? These open-access drop-in hubs will be an important step in providing community-based mental health support for children and young people. Will he say something about the roll-out of those hubs? Our manifesto commitment to introduce a specialist mental health professional in every school will be important in helping to identify mental health conditions early on so that they can be prevented from developing into more serious conditions in later life. Will that include access to counselling? Research from the British Association for Counselling and Psychotherapy indicates that children whose mental health difficulties are initially too complex for lower intensity interventions but not complex enough to be referred to higher intensity interventions, such as child and adolescent mental health services, can easily miss out on the mental health support they need. They could instead be helped by forms of provision such as counselling. All the evidence shows that being active helps people’s mental health. Helping them back to work will also help to grow our economy. Lord Darzi’s report identified that, since the pandemic, the number of people who are economically inactive has increased by around 800,000, with people with mental health conditions accounting for most of the increase. I welcome the Government’s new initiative to work across Departments and create links between long-term unemployment and health. I also hope that they will look to reform the benefit system, ending the blame culture identified by the Secretary of State, so that we can treat people with mental health problems with dignity. I welcome the greater emphasis that Ministers have said will be put on prevention of illness, and I hope that my hon. Friend the Minister will be able to reassure me that the same emphasis will also apply to mental health. As the Mental Health Foundation has said, there is clear evidence that place and the circumstances in which people are born, grow, study, live and work have a powerful influence on their mental health. Therefore, there must be a fundamental reform of the way in which we deal with mental health. We should be addressing the complexity of interactions and relationships, and how they affect individuals, families and communities. Rather than starting from the point of treating mental health, we should put the emphasis on creating a society that prevents mental ill health in the first place. Beginning with central Government, I want to see a co-ordinated approach to developing effective policies to protect people’s mental health. With that in mind, the priority that this Government have already given to cutting pollution and building high-quality houses is welcome. I also welcome the proposed pre-watershed junk food ban and the steps that Ministers are taking to create a smokefree society. Going forward, I want to see greater cross-Government working to address the social determinants of our mental health. In the coming months, the Government are set to publish their 10-year plan for the NHS. As my hon. Friend the Minister and his colleagues work on that, I hope that they will consult with campaigners and organisations working in mental health, as well as representatives of the workforce. By doing that, the Government will be able to grasp the opportunity to transform the way we approach the issue of mental health, ensure that there is true parity of esteem and provide real, meaningful change in the mental health system.

• 10 Oct 2024 · Mental Health Support · Hansard source

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  I thank the Minister for his brief answer, and I thank the shadow Minister and the Liberal Democrat spokesperson for their responses to the debate. I also thank the other Members who took time out of their busy schedule to be here. I thank all the organisations that contacted me in advance of the debate. There are too many to mention them all, but they include the Education Policy Institute, the Royal College of Paediatrics and Child Health, the Royal College of Psychiatrists, the Royal College of Nurses, the Children and Young People’s Mental Health Coalition, the British Association for Counselling and Psychotherapy, the Maternal Mental Health Alliance, YoungMinds, the King’s Fund and, finally, Flourish, which is based in my Ashford constituency. I hope that the Department of Health and Social Care will actively engage with these organisations from across the sector to draw on their knowledge and experience. Question put and agreed to. Resolved , That this House has considered improving support for mental health.