All Party Parliamentary Group for
Mental Health
Notes of meeting: April 2004
Are Mental Health Services Improving?
27th April 2004
Sponsored by Novartis
The panel consisted of:
Lynne Jones MP – Chair
Professor Louis Appleby – National Director for Mental Health
Dr Andrew McCulloch – Chief Executive of the Mental Health Foundation
Dr David Taylor – Chief Pharmacist, Maudsley Hospital
Dr Jaqueline Atkinson – Senior Lecturer, University of Glasgow
Professor Louis Appleby – National Director for Mental Health
Professor
Appleby devoted the first part of his presentation to outlining the achievements of NHS
mental health provision since the National Service framework (1999).
He
talked through the expenditure on mental health services and the indicators, showing that
the investment is having some success.
He
gave detailed statistics on the number of beds, admissions, discharges, consultants,
nurses, NHS plan teams, prescribing patterns of anti-psychotic drugs, and mortality rates.
The
prescribing patterns for antipsychotics presented a view that general prescribing of these
drugs is down but the proportion of those prescribed being atypical antipsychotics rising;
and since 2002, exceeding the typical anti-psychotics.
Professor
Appleby outlined the recent progress on mental health, including £35 million for
refurbishments in 2002-3, provision of single-sex accommodation, a national patient survey
and a National Research Plan.
After
his talk Professor Louis Appleby (LA) took
questions from the audience.
Gary
Williams (UCL) asked whether there would be local scrutiny
within Acute Trusts dealing with mental health provision under the Mental Health Bill so
as to ensure that, when financial pressures hit, mental health provision is not the first
‘budget cut’.
LA
corrected
the assertion that Acute Trusts provide mental health services, saying that these services
are, in fact, provided by mental health trusts. He
went on to say that mental health trusts are not immune from financial pressures arising
from elsewhere in the system but that the Government would not be ring-fencing funding and
would rather allocate funding according to policy priorities.
Evan
Harris MP asked
about LA’s measure of pressure on the system, drawing out the bed occupancy measures,
questioning whether they are an accurate measure of the pressure. He mentioned that many people still have problems
getting beds.
LA
noted that there are areas where Government mental health programmes are working well and
have had an impact in reducing occupancy rates and areas where programmes are working well
but having no impact on the situation. He said
that, overall the pressure on the system is down even though occupancy rates may not
necessarily have fallen.
Joan
Penrose
described the treatment her son had received and expressed a desire to see the Department
of Health provide a specific person within mental health trusts to follow the “path
of each patient”.
LA
refused
to defend bad care and said that it is national policy for social work and mental health
care to work closely. He went on to note that
the social exclusion report will be published soon and that a national patient survey is
being undertaken to feed into the new “star rating system”; all geared towards
providing better care for patients.
Sally
Hughes from
MIND asked how far the use of the statutory
powers under the Mental Health Act are an indication of pressures on the system. LA responded by saying that there are many
measures of the pressure on the system.
Martin
Aaron from
JAMI asked for details of the implementation of
the Mental Health Bill and what the budget would be for its proposals. He also asked what the budget is for the current
financial year’s mental health services.
LA
said
that the proposals within the Mental Health Bill have all been costed and are part of
Government spending plans. He said that the
current budget for mental health services is £4bn.
Richard Taylor MP asked whether the 17 week
waiting time target would be applied to clinical psychology.
LA answered that consultant
psychiatrists are covered whilst consultant psychologists are not.
Doris
Jones from
the ME Group asked whether Chronic Fatigue
Syndrome is covered in the Mental Health Bill and associated services.
LA
said
that CFS/ME are only covered if the patient satisfies clinical circumstances. He went on to say that the Mental Health Bill has a
broad definition of “mental disorder” but has a very tight definition of
“clinical conditions”.
Simon Lawton-Smith from the King’s Fund asked about mental health
promotion. LA said that there is not enough emphasis on
promotion of mental health services but that it would be a priority alongside primary care
services.
Adrian
Delamore from
Justice for Patients requested a meeting with LA and asked about people who are wrongly placed
in the mentally ill category.
A
representative of MIND expressed concern about
the near exclusion of mental health services in the Wanless report and asked who would be
coordinating primary care services as developments are currently “piecemeal”.
LA
answered by saying that primary care needs to be properly coordinated and that the
promotion of primary care and mental health services should be a key priority.
Professor
Appleby left the meeting before the three remaining speakers made their presentations.
Dr Andrew McCulloch – Chief
Executive, The Mental Health Foundation
Dr
McCulloch’s presentation focused on the premise that mental health provision is
primarily about protecting human rights.
He
criticised the Government for not listening to the sector and noted that the draft Mental
Health Bill has united the sector in opposition. He commented that the draft bill is wrong
in both principle and practice.
He
urged the Government to re-connect with the field to ensure a level of communication that
will guarantee the concerns of the “industry” are heard.
Dr
McCulloch criticised the draft Bill in some detail and lamented that the current Bill
cannot be “fixed”.
He
called for a clear focus on and statement of basic rights and values for those affected by
any mental health legislation and a level of reciprocity with the mental health charity
field.
Dr David Taylor – Chief
Pharmacist, Maudsley Hospital
Dr
Taylor detailed the NHS expenditure on services for schizophrenia and the response to
treatment which have shown a 40% improvement.
He
detailed the potential adverse effects of antipsychotic drugs and noted that in atypical
anti-psychotics, the level of adverse effects was markedly improved. He also compared the levels of adverse effects of
patients being treated with atypical anti-psychotics with those of typical anti-psychotics
and placebos – the levels of adverse effects were less than 50%.
Dr
Taylor noted that with newer drugs, such as Clozapine, adverse effects such as movements
disorders, cardiac effects, diabetes and weight gain were minimal.
He
then detailed the treatment responses to Clozapine and patient thoughts on the drug –
a significant majority felt better on the drug, felt the advantages outweigh the
disadvantages and prefer Clozapine to previous treatments.
Dr
Taylor then noted the problems with treatment compliance in schizophrenia patients and
detailed the statistics for relapse during one year which is significantly lower when
treated with anti-psychotics than with a placebo.
Before
finishing, Dr Taylor pointed out that in an audit of an urban acute MH trust, only 12% of
patients felt they contributed to drug choice and no-one was prescribed Clozapine at the
appropriate time – contrary to NICE guidance.
Dr
Jacqueline Atkinson - Glasgow University
Dr
Atkinson reported on the progress made in Scotland
since the creation of the Mental Health Act. She
stated that it has been a year since the Mental Health (Care and Treatment) (Scotland)
Act received Royal Assent, despite the fact that the whole process starting after the
reform south of the border.
Public
inquiries (following homicides) aren't held in Scotland
and this has helped to keep issues of risk and dangerousness off the agenda unlike in England.
Criminal justice issues have been kept away from this legislation.
The
Committee which developed the proposals was chaired by Bruce Millan who was very respected
and produced the basis for a good Bill.
Advanced
directives and named persons are recognised under this Bill.
The
Code of Practice was published last week; the Act will be implemented from April 2005. She
noted that there are still vacancy problems in Scotland.
The
panel then took questions from the floor.
Lord
Walton asked
Dr Taylor whether he had figures for atypical
antipsychotics other than Clozapine. Dr Taylor
responded that other than Clozapine, other antipsychotics were not better than typicals. He stated that patient compliance was higher with
atypicals.
Rowena
Daw
from MIND asked about Compulsory Treatment
Orders in the community. Dr Andrew McCulloch replied that mental health
services are not ready to implement this kind of Compulsory Treatment Order. Dr
Atkinson described the procedure for Compulsory Treatment Orders in Scotland,
detailing that a tribunal must approve the order and any care plan. Delays in the Scottish system are mitigated by
proscribing a time-scale for the process.
Simon Lawton Smith from the King’s Fund asked for an estimate of how many
people are likely to be subjected to Compulsory Treatment Orders. Dr Atkinson replied that a global figure is not
useful, rather that there is a need to asses each case individually.
Gary
Williams
asked about the inclusion of people with learning disabilities within the Mental Health
Bill. Dr
McCulloch outlined that 40% of people with learning disabilities suffer from mental
health problems but that the distinction is important.
He went on to say that the Police and Ambulance services need proper
training on handling mental health patients.
Attendees
Martin
Ball-Maca
Roger
Freeman-RCPsych
Simon
Lawton-Smith-King’s
Fund
Dominic
Curran-Sarah
Teather MP’s Office
Lord
Walton of Detchant-House
of Lords
Liz
Blackman MP-
Evan
Harris MP-
Doug
Naysmith MP-
Rowena
Daw-MIND
Tim
Nicholls-Sue
Doughty MP’s Office
Tim
Loughton MP-
Alexa
Knight-RCN
Lord
Northbourne-House
of Lords
Martin
Aaron-JAMI
Sue
Mason-Janssen
- Cilag Ltd
Pete
Hillan-Janssen
– Cilag Ltd
Adrian
Delamore-Justice
for Patients
Garry
Williams-UCL
Institute of Child Health
Agnes
Wheatcroft-RCPsych
Doris
Jones-ME
Group
Lee
Wells -Novartis
Richard
Taylor MP-
Caroline
Hawkings-Turning
Point
Helen
Lord-Lilly
Murray
Benham-Revolving
Doors
Tony
Zigmond-RCPsych
Moira
Fraser -MIND
David
Stone-MIND
Sally
Hughes-MIND
Liz
Burke-House
of Lords (liberal Democrats)
David
Drew MP-
Lucy
Evans-Michael
Jack MP’s Office
Margaret
Edwards-SANE
Freddie
Howe-House
of Lords
Philip
Dixon-Phillips-Hearing
Voices Network
Joan
Penrose-Harrow
Mental Health Partnership Board
Jim
Knight MP-PPS
to Rosie Winterton MP
Tony
Cunningham MP-
back
to mental health
