Health and Social Care Bill

We have heard very powerful arguments from all sides of the House in support of these amendments, from deep and distinguished professional expertise, which in turn is backed by the professional institutions. I know the Minister will want to pay heed to that. I would like to offer a lay view. These amendments would redress a deep imbalance. The Minister may well say again, as he did in his letter to Peers who spoke at Second Reading, that the Government's good mental health strategy, "““makes clear an expectation of parity of esteem between mental and physical health services””." And so it does. But that is not the same as making it happen. The Minister may point out again, "““in law, the term ‘illness’ covers all disorders, both physical and mental, so it is perfectly adequate for any Act of Parliament to refer succinctly to ‘illness’””." The trouble is that however enlightened the intentions in the strategy, and whatever parliamentary draftsmen may say, we live in a culture which has for centuries relegated mental illness to the realm of the weird, the unmeasurable and the stigmatised, as others have said. Even after the great advances of the last 150 years, neither the resources applied nor that general public understanding which supports political action is remotely adequate for a realistic approach. What I have seen is that bouts of mental illness severely erode the ability to cope with the problems that life throws up. They do not mean that the sufferer has to be treated like a being apart but they crucially impair the ability to earn a living. How many of those with chronic mental illness hold down a job? They can irreparably destroy relationships, which I heard a lot about when I was on the board of the Tavistock and Portman NHS Foundation Trust, and as a consequence of this combination the sufferer often loses their home. This is devastating; it is arguably more serious than many physical illnesses in its consequences. When I used to volunteer for Crisis at Christmas, probably over half the homeless people I met were mentally ill. Dedicated professional volunteers came and attended to their coughs and colds, their teeth and their toenails. They sewed their buttons on and gave the heroin addicts methadone but there was never even the most limited talking therapy. I have had colleagues who have kept their proneness to clinical depression secret, even when medication controlled it perfectly adequately, out of fear for the career consequences, and others whose alcoholism was treated as only a disciplinary matter—contrast that with diabetes or severe allergies. This damaging general culture can be changed only if there are enough professional resources to make an impact on it and if there is no excuse, by means of the words—or lack of them—in the statute, to treat mental illness less seriously than physical illness. How is it that, in answer to the Question which my noble friend Lady Thornton asked on 3 October, the Minister was able to say that the Churchill Medical Centre, a GP practice, deregistered 48 patients with dementia and mental disabilities, "““due to the resources required to support those patients””?—[Official Report, 3/10/11; col. WA 102.]" Are patients deregistered because they have asthma or congestive heart disease? I think not. Osteoporosis units are funded—good—but local psychotherapy units, which so often have to deal with the residue left by more superficial, short-term and cheaper treatments, are not. Cognitive behaviour therapy, excellent for some purposes, is so widely offered exclusively that it tends to push out a range of other treatments. This does not happen in cardiology. Counselling is often the initial treatment of choice; cheap and with a lesser degree of qualification required. I heard recently of a single mother, abused and abandoned by her partner, a drug addict, who was not really managing to cope with bringing up small children. She would have had a few weeks of counselling in her GP’s practice and medication, followed by brief interventions by clinical psychologists but, like many others, this did not shift either her depression or her behaviour. Her anxiety was too deeply entrenched for short-term counselling to make much difference or prevent her taking her negative feelings and distress out on her children. In fact, she was one of the lucky few. She had a small, local psychotherapy unit near her and she received huge support from her weekly meetings over a long period but that unit, the Camden psychotherapy unit, will shortly lose its funding. The trend for the full range of mental health treatments to be available only to the rich, or those who can wait a year or more, will be exacerbated if there is not parity of esteem between mental and physical illness. Noble Lords may not be aware that the treatment they or their family might expect is simply not available to more than a very few poor people. It must be emphasised again what is at risk when people's mental health is jeopardised. It is not only their happiness; it is their job, their relationships, their capacity to be effective parents, their resistance to drugs, alcohol and crime, and their home. It is of course also our economy, our well-being and our ease and peace of mind which are impaired. Explicit parity of esteem is essential to redress this cruel imbalance. These amendments serve that purpose. I urge the Minister to accept them.