Friday, 3 March 2017

Labour's Approach to Mental Health

Remember earlier in the year when Prime Minister Theresa May did her big speech on Mental Health where she called for a comprehensive re-think of the service? I tried to find Labour's policy platform; after all it's always good to have at least two policy platforms to read, after all. I remember Jeremy Corbyn does have a Shadow Minister of Mental Health and Social Care (Barbara Keeley) after creating the position after he first became leader and then scrapping it after the attempted coup and then reinstated it again by joining it with Social Care (which was a good idea). So here is a flavour of Labour's policy.

Labour's thoughts on Funding & Staffing of NHS Mental Health Services:

As Theresa May mentioned in her now infamously dubbed "Shared Society" speech, there needs to be a comprehensive approach to tackling the root causes of mental health, considering that 1 in 4 people currently have a mental health related issue in the UK. PM May didn't want to talk much about funding in her speech but Labour believes that chronic underfunding of mental health services is a central issue which needs to be resolved urgently. 21.9% of conditions that patients who attend NHS services have are mental health related yet mental health clinics only receive 11.9% of overall funding from the NHS budget, hence services feeling overstretched. Instead of addressing this point head on, May talked about the success the Government has had in investing £15m into local mental health funded projects such as crisis cafes and community clinics; 88 such places of safety were established using the funding and May wants to invest another £15m over the course of this Parliamentary term. Yet such investment isn't going to help resolve the funding gap for NHS mental health clinics or address the staff shortage issue.  There are 6,000 fewer mental health nurses compared with 2010 and there is currently 1 MH professional to 30,000 people in England, whereas it's only 1 MH professional to 5,300 people in Switzerland. Why would we not want to create a mental health service system that can have 1 MH professional to 20,000 or 10,000 people?  How can we expect the mental health system to cope without having the number of competent staff needed to keep local clinics open so that those people who require advice and assistance can get access to it when they need it, whatever the time of day or day of the week?

Labour's approach to child and adolescent Mental Health:
Labour talks a lot about the need to increase funding for child and adolescent health specifically. It's scary to see that funding has been cut by £86m in the past four years from the NHS budget for children and adolescents with £35m cut in the past year. Andrew Gwynne reminded me that £600m has been cut from the NHS mental health budget as a whole since the Conservatives first came to power in 2010 as part of the Coalition Government.  And we wonder why there aren't enough mental health beds locally? How can services be maintained if funding is being routinely slashed to meet ideologically constructed austerity targets? Young people often talk about the need to access services as soon as they begin experiencing their symptoms. 50% of lifetime mental illnesses, excluding dementia, start by the age of 14 (a stat from the 2005 Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry Report) is one that has been used by both the Labour and Conservative parties in the last year but there are others too. Did you know that "20% of adolescents may experience a mental health problem in any given year"(WHO Caring for children and adolescents with mental disorders: Setting WHO directions report, 2003) or that 10% of children and young people have a clinically diagnosable mental health condition but 70% don't get the intervention they need at a sufficiently early age (Children's Society, 2003). All of these stats I checked out on the Mental Health Foundation website. If mental health professionals are telling us there is a mental health crisis that is affecting our young people, then we need to do all we can to intervene as early as possible. Working with organisations such as the Mental Health Foundation and charities such as Mind is imperative to help make sure that awareness of mental health is increased amongst the population and to encourage parents especially to recognise potential symptoms and get their child to a GP surgery for referral to organisations or NHS services as deemed appropriate. Labour would make sure that NHS GPs had the sufficient mental health awareness training that takes into account all potential cases regardless of circumstance.

It's not just the mental health clinics that need to help improve children and young people's mental health. Schools are on the frontline and Labour recognises this. I agree with Corbyn that mental health education should be a compulsory part of PSHE. What should such education involve? PM May announced in January that every secondary school teacher in the UK would be offered mental health first aid training through Mental Health First Aid UK so that teachers can spot the signs of depression, anxiety etc when they appear in their students. Yet May didn't talk about teaching students resilience and coping strategies so they could help talk about their mental health openly and honestly in the classroom. Labour believes that all secondary school students should go on a "life skills, emotional intelligence and parenting" course because this would help "equip our children and young people to (deal with) the challenges of modern living." Some voters would question the validity of spending time in the classroom teaching how to do bottle feeds properly or how to deal with online abuse via social media (an issue which should hopefully already be talked about in most comprehensive schools in PSHE or ICT lessons). However, every student must feel empowered to talk about their feelings and to know they can seek help whenever they need to do so. Labour wants to make sure that "all schools and colleges have access to school based counselling" whenever needed. May did mention trials that would be taking place that would get NHS mental health professionals liaising with school nurses and teachers but they are only trials and the full information hasn't yet been released as to where in the country and when they will be happening. Time will tell.

Labour wants to "conduct a national study into the mental health of children and young people" because the last study was conducted 10 years ago. Interestingly, May wants to carry out a review children and adolescent mental health services across the UK, headed by the Care Quality Commission (CQC) to ensure that the services are fit for purpose. A Green Paper on children and young people's health is then to be created which looks at transforming services in schools, universities and for families too. As long as this doesn't involve reduction in the number of mental health centres, professionals or unnecessary centralisation of services, this should be a good idea. I don't see Labour objecting to this approach because it means that all parties will find out what extra specific measures need to be taken to improve services and if May's Government doesn't take action once the Green Paper comes out, Labour can promise to implement those actions. Win-Win.

Labour's approach to Loneliness:
Labour wants to "launch a national campaign to tackle loneliness and the stigma surrounding it". When over 9 million people say they are "always or often lonely" but 2/3 of those people never talk about their loneliness with anyone, there is a need for a Government to help improve the situation. The Jo Cox Foundation has partly taken on this mantle by establishing a "Loneliness Commission" and as Jo would have reminded us, loneliness can affect anyone, regardless of gender, sexuality, race, nationality, disability, class, political ideology or age. The commission works with 13 charities, including Age UK and Action for Children to come up with ideas. A multifaceted approach is definitely needed. The funding of projects in local communities such as holding samba classes and tea dances may reach some who feel lonely but not all. Encouraging more people to use social media can help some feel more connected but it can't be the only solution, especially if the person who is lonely cannot use a computer due to their disability. NHS and Social Services need to communicate with local mental health charities to provide "buddy services" for those who are unable to leave home as well as local youth clubs being fully funded to help younger people connect. It should be OK to admit that you are lonely and you want to find a way of meeting people. It should also be OK to ask how someone is and be prepared to engage with them...after all it might be the only time during the day that they speak to someone. Labour is working with other parties to help promote awareness of the Jo Cox Foundation's vital work and I'd expect that it would adopt any ideas within the manifesto created from findings gathered from monthly campaigns undertaken by the Foundation. Early campaigns are expected to focus around new mums, the elderly and carers but I hope it will extend to trans and non-binary/queer/gender-fluid/non-binary people too.

Labour's approach to Mental Health of rape, sexual abuse, domestic abuse and domestic violence survivors:
Labour also realise the importance of supporting rape, sexual abuse, domestic abuse and domestic violence (DVA) survivors who may have developed mental health issues as a result of their experiences. Up to 10,000 victims of sexual abuse for example are estimated to be waiting more than a year for counselling. Is that waiting time acceptable? No.  By funding mental health services properly and increasing the number of professionals who have specialist knowledge of rape, sexual abuse and DVA the waiting time can be brought down. Theresa May has talked about increasing the use of digital therapy and has committed to spending £67.7m on services but that won't be appropriate for some survivors to use. It may be fine for those wanting to check initial symptoms of anxiety or depression but it's not a cure-all. Labour must also ensure that rape, sexual abuse and DVA service provision is accessible for all survivors, regardless of their gender, sexuality, race, religion, disability or age. That means being prepared to fund a variety of organisations and helping to raise awareness of all survivor experiences. A radical bold approach is needed and I hope that Sarah Champion, Paula Sherriff and Jess Phillips will help advocate for this as they have done so successfully with campaigning for Sex and Relationships Education (SRE) to made compulsory in all schools from the age of 4.

Labour's approach to Improving the Mental Health of Jobseekers:
Another area that Labour has talked about more keenly relates to the mental health of Benefit claimants. The Benefit sanction system has been a bone of contention, with one view being that they help motivate the claimant to follow the rules and actively seek work and another being that the system is entirely unfair because sanctions can be imposed "willy nilly" on claimants at an advisor's discretion and the level of sanction may cause significant budgeting worries for the claimants who are affected....how can they afford their food, heating, clothing etc.? Recently the Independent ran an article (http://www.independent.co.uk/news/uk/politics/benefits-sanctions-letter-mental-health-crisis-british-psychological-society-a7600596.html) which mentioned a letter signed by The British Psychological Society, the UK Council for Psychotherapy, the British Association for Counselling and Psychotherapy, the British Psychoanalytic Council and the British Association of Behavioural and Cognitive Therapies warning of a mental health crisis if benefit sanctions aren't scrapped. They've called for "mental health awareness training for job centre staff" and "reform of the work capability assessment (WCA)."  It's true that I've read previously about jobseekers being pushed over the edge  especially if they are already battling drug or alcohol addictions or are in a severe amount of unsecured debt. Jobseekers have literally died after being declared "fit to work" after a WCA (2,380 between December 2011 and February 2014).  If we are meant to be part of a "shared society" where the Government helps everyone to aspire to a healthier life, and gets us all to support each other as citizens, as Theresa May has previously suggested then I believe at the very least there needs to be a review into the benefit sanctions system to make sure it is fit for purpose or is abolished altogether. Debbie Abrahams, the Shadow Work and Pensions secretary has now committed Labour to scrapping the benefit sanctions scheme. That may play well with some voters who have experienced the benefits system for themselves but for those who may never have used it, would they be on board too?

Regardless of your stance on the Benefit sanctions system, I do agree that the mental health form filled in by GPs to prove to employers/Job centre advisors that a person is going through mental illness should be free. It shouldn't cost £300. Those suffering from stress, anxiety or severe depression as a result of getting themselves into long term debt should not have to pay out even more money to get the help they need. A review by the Department of Health isn't enough..it should be phased out immediately.

Labour's approach to Mental Health in Prisons:
One final area worth considering is that Labour are willing to talk about the need to improve the mental health of prisoners. As Luciana Berger has highlighted, there were 37,784 cases of self-harm reported in UK prisons. Prison suicides are at the highest they've ever been; the Centre for Mental Health reported that there were 119 suicides in prison in 2016, up from 89 in 2015. Violent incidents have also increased by 40% (see their February report here: https://www.centreformentalhealth.org.uk/preventing-prison-suicide-staff). Add on top of that the fact that 75% of prisoners who have serious mental health issues that require urgent treatment now face delays in being transferred to specialist mental health units (the target is 14 days) and you can probably see that mental health is an issue in our prisons.

Staff shortages have contributed to these problems; there are now 7,000 fewer prison officers since 2010 and you can't expect prison officers to take up the slack completely when suicides and self-harm cases are increasing.  A prison officer anonymously wrote an article in the Guardian (https://www.theguardian.com/public-leaders-network/2017/feb/18/mental-health-issues-prison-privatisation-violence-drugs-liz-truss-reform) where they talked about what the effect of losing 7,000 prison officers was like on the prison system; for them it wasn't just about the sheer number of officers going; it was the experience they took with them: "Officers with 20 years of experience of the prison system and dealing with challenging individuals were replaced with recent graduates and young people with limited life experience. The fact that this has caused significant problems is not surprising." When an organisation experiences a shortage of experienced professionals, it will inevitably underperform. So perhaps that 2010 measure introduced by Chris Grayling where he benchmarked public prisons against private ones was the wrong one to take. The prison officer in the article said that getting more staff into prisons is now the number one priority to help improve prisoner and prison officer safety and mental health.

However, prisons are not just understaffed; they are also overcrowded. The Ministry of Justice publishes prison population figures on a weekly and monthly basis (check them out here: https://www.gov.uk/government/statistics/prison-population-figures-2017).  As of 27th February, the UK prison population stands at 85,442 which is down from 85,753 a year ago but the useable operational capacity stands at 86,720 down from 88,001 only a year ago. Capacity has decreased despite the UK prison population remaining fairly stable. It's clear to see from these figures that prisons are near "breaking point" as Berger has argued.

Now some will argue that prisoners do not deserve "any special treatment" but  Labour thinks there is a genuine need to reform prisons to make them safer for prisoners and for officers. It all starts with when a prisoner first enters the prison system. If a prisoner enters the prison displaying symptoms of a mental health issue or has a history of mental health issues, they should be monitored by prison psychiatrists so that steps can be taken to prevent them from self-harming or becoming violent towards staff. The Centre for Mental Health calls for a "stepped care" approach where they tailor help to individual need which stems from the "robust risk assessment" carried out on entry. The Centre for Mental Health also believes that prison officers need basic mental health awareness training so they feel equipped to deal with situations appropriately; they need to know when to call for a prison psychiatrist or mental health professional. It was quite shocking to read examples of self-harm that the anonymous prison officer had witnessed: prisoners rocking in their beds, prisoners saying "unspeakable things" because they couldn't cope with being in prison and sitting with a young man who had sliced his tongue open and handed a cup to him "so he could spit the blood in there instead of on the floor" because any attempt to talk to him had been "futile". In these situations, it'd be difficult to argue that these prisoners need more than nurses patching up any physical wounds or prison officers trying to communicate with them to resolve the situation.

Some mental health issues may be caused or made worse by drug taking (a study from 2003 found that 3/4 of drug users experienced mental health problems). The anonymous prison officer mentioned that novel psychiatric substances (NPS) have made the situation in prisons a lot worse; in fact the officer said NPS have "brought the prison system to its knees." Prison officers save lives of drug users on a regular basis; the prison officer witnessed an overdose incident where his colleague performed CPR on an inmate even though everyone thought he had died. The inmate was discharged from hospital the same day despite being "clinically dead". Thank God that our prison officers are dedicated and compassionate enough to try and save lives! Labour believes that every effort must be made to stop drugs from entering prisons (through drone drop-offs and friends smuggling them in) and to make sure rehabilitation services are available to prisoners as soon as they disclose their addiction or their addiction is disclosed by others. If a prisoner comes in displaying symptoms of drug abuse, they need to start their rehabilitation ASAP. That means ensuring drug counsellors can visit them regularly to help them which requires dedicated funding.

Conclusion:
I've only discussed a few elements of Labour's policy platform in this blogpost but I hope you can see that it is more comprehensive than some might think. I believe the platform does need to be disseminated more successfully by members, council and parliamentary candidates so that voters know exactly what the Labour Party would do should it win the next General Election. It's not just about funding the mental health services but also addressing how schools help teach resilience skills to students to equip them for the modern world. Labour needs to be crystal clear when it comes to who would be tasked with creating and delivering such a course...whether they'd continue working with Mental Health First Aid UK or work with charities such as Mind.  Labour are right to highlight the plight of vulnerable groups and look into getting counselling to them but they must ensure counselling is available to as many people as possible in as many areas as possible, not just in the cities but in rural communities too. Broadly speaking I support any suggestion that sees mental health intervention being available as early as possible and I'm more inclined to see an end to the benefits system. Labour, under Corbyn's leadership does have a good policy platform but all wings of the party have to work together and talk about policies with colleagues, friends and family. Mental Health may be only one policy area but with 1 in 4 people having a mental health issue, it's one policy area worth talking about.