Lord Adebowale takes part in a debate on parity to mark World Mental Health Day

News item posted: 19 June 2017

On World Mental Health Day Lord Victor Adebowale, Chief Executive of Turning Point, spoke in a House of Lords debate on the implications of parity of esteem for mental and physical health, as required by the Health and Social Care Act 2012.

A copy of Victor's speech is below.
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I would like to thank the noble Lords Lord Layard and Earl Howe for bringing this debate on what is a vital issue for not only our health and care system but society more widely.  
 
I must firstly declare my interest as the chief Executive of Turning Point and as a Non-Executive Director for NHS England.
 
The strategy No Health without Mental Health, and the subsequent implementation framework, makes it clear that mental health is everyone's business.

• One in four adults and one in ten children in the UK are experiencing mental health issues at any given time.
• 30% of the 15 million people with a long term health condition also have a mental health problem. (Cimpean D., Drake R.E (2011), Treating co-morbid medical conditions and anxiety/depression, Epidemiology and Psychiatric Science 20, p 141-150.)
• Within a prison environment up to 90% of the population experience one or more mental health conditions, often alongside substance misuse or a learning disability. 
 
Given this and the costs of mental health, calculated by the Centre for Mental Health to be £105bn, it is frankly shocking that huge disparity still exists between those with a diagnosable mental health issue and those without. This results in there being an unacceptable difference in life expectancy of those with a severe mental health condition and those without of between 16 and 25 years. (Via the NHS Confederation briefing 267 on Smoking and Mental health, referencing Brown S, Kim M, Mitchell C and Inskip H (2010). Op. Cit. And Parks J et al (2006). Op. Cit.)
 
Case studies
 
I wanted my contribution to this debate to be from the perspective of people who have mental health issues.
 
I have changed their names to protect their anonymity but experiences from people supported by Turning Point demonstrate the different ways the lack of parity within the system manifests:
 
Firstly, a lack of consideration for the individual's whole needs: On coming to Turning Point Fred had a history of poor eyesight which staff assessed as contributing towards his high levels of anxiety. Staff worked closely with Fred, arranging for him to access specialist optical services. A detached retina and cataracts were diagnosed, leading to surgery. However following this surgery a clear decrease in what had been perceived as 'challenging behaviour' was clearly evidenced.
 
Secondly, when professionals fail to work together: Alan had enduring mental health issues when he experienced a stroke and was admitted to the local hospital from one of our residential services. Whilst in hospital undergoing rehabilitation Alan had all medication reviewed by a ward doctor. The doctor, knowing Fred had a mental health condition, decided without any discussion with Alan, the care manager or psychiatrist to stop his medication, even though it had a multiple purpose. It can be used to reduce mood swings but also to treat epilepsy. The hospital doctor stated as Alan did not have epilepsy the medication could be stopped with immediate effect. This had a detrimental effect on his mental health, something the doctor was ambivalent to having not once discussed anything other than Alan's physical needs with any member of his care team.
 
• The most shocking example and immediate if we have any doubt these issues are happening right now. I would like to share with my honourable friends was when one of our support workers found a Do Not Resuscitate note on an individual's file which had been left open. Knowing this had not been discussed with his next of kin the Support Worker challenged hospital staff to be told that because the individual was a mental health patient and under a Home Office order he had 'no priority of life'. Because of our staff challenging this, the DNR was removed but the fact it was there in the first place highlights the discriminatory treatment that people with a mental health condition can face; compounded when other complex needs are applicable, such as offending behaviours of a learning disability.
 
Disparity
 
The implications of introducing parity are wide reaching and highlight the vast amount of work still required to make it a reality.

Rhetoric, commitments and case studies have highlighted the need for parity but there are certain things that have to happen first if it is to be embedded throughout the health and care system.
 
• We will simply not achieve parity of esteem without first addressing equality of access. This means breaking down the cultural barriers that exist which still prohibit people from BME communities receiving the support they need.
o   As the Mental Health Foundation have found:
  - more likely to be diagnosed with mental health problems
 -  more likely to be diagnosed and admitted to hospital 
  - more likely to experience a poor outcome from treatment
  - more likely to disengage from mainstream mental health services, leading to social exclusion and a deterioration in their mental health.
 
• Staff at all levels of the health system, including GPs and A&E staff, must receive adequate training on mental health. So too should be the police, something the Commission on Mental Health and Policing, which I chaired, called for in its report. The police are often the first point of contact for people experiencing a mental health crisis.
 
• The Commission's report found one of the clearest examples of disparity between physical and mental health crisis in regards to how the police and ambulance service respond to a crisis. If I were to have a heart attack an ambulance would be sent. If I were to experience a mental health crisis, the likelihood is that I would be met by a police response and escorted away in a police van, exacerbating my mental health issues. Responding to crisis is a whole other debate, but an issue that highlights that parity is not the sole responsibility of the health service but others including the police, prisons and employment support, all have an important part to play in its achievement.
 
• Finally, and it is something I spoke a lot about when the Health and Social Care Bill, at the time, was going through the House; the issue of integration. Until we have a health and care system that looks at the whole person and designs, commissions and delivers services in conjunction with the community to ensure they are fit for purpose, fragmentation will persist. People will continue to receive disjointed care where their mental health issue is not considered alongside their physical health condition because it's not a priority or understood well enough.
 
The implications of embedding parity will certainly be challenging and require people to work different, but if we do what we've always done, we'll get what we've always got, and the experiences of the people I've highlighted show why this is no longer acceptable.