All Party Parliamentary Group for Mental Health

Notes of meeting: January 2002

Tuesday 22 January 2002

Speaker: Prof. Louis Appleby

Members present: Dr Lynne Jones MP, Sandra Gidley MP, Dr Brian Iddon MP, Ian Gibson MP and Jim Cousins MP

Prof. Appleby gave the group some information about his background in mental health services. He is Director of the National Confidential Inquiry into Suicide and Homicide and a consultant psychiatrist based in Manchester. He was appointed by the Department of Health as National Director for Mental Health in April 2000 and is overseeing the implementation of the National Service Framework (NSF) and the NHS Plan. His remit is with adults of working age in England. Prof. Appleby said that mental health services had always been a poor relation in the NHS but he believed there was greater reason for optimism than ever before.

Prof. Appleby reminded the Group of recent major policy developments in mental health. The National Service Framework was published in September 1999 and was designed to serve as a blueprint for mental health services across England and Wales. It included seven standards for services and good practice and was aimed at the full range of mental health care.

In July 2000 the Government published the NHS Plan of which one chapter was devoted to the three clinical priorities, including mental health. Prof. Appleby said that the fact that mental health was named as one the Government’s main clinical priorities in the NHS Plan, alongside cancer and heart disease, ‘had opened many doors’ in the Department of Health, the National Institute of Clinical Excellence and the Commission for Health Improvement.

The Government has funded 1000 primary care mental health workers to deliver psychological care to people in the short-term. This figure equates to a notional 10 people per Health Authority area. 500 ‘gateway staff’ are planned to act as initial triage and will give advice (including by phone) and arrange services based on urgency/need. Prof. Appleby said there were few alternatives for people who were acutely ill, however home treatment can be just as good as in-patient care for many people. Therefore 300 crisis resolution teams would be appointed to provide home treatment. 700 more staff would also be recruited to strengthen carer support networks by 2004.

Most of the funding for these projects will not become available until years 2 and 3 of the current spending review period (starting April 2002). He acknowledged that expectations had been raised for those involved with mental health services and there had been some demoralisation since the original announcements.

The establishment of the National Institute for Mental Health for England (NIMH) was announced in July and would be a major vehicle for research and service development. It was designed to link large scale and effective research with clinical priorities. A national research plan would be created alongside a network of development centres through which people can learn from other services.

On the issue of dual diagnosis Prof. Appleby said that it was probably the main problem faced by mental health clinicians. Dual diagnosis was best defined as severe mental illness plus substance misuse that was destabilising the illness. The problem usually spanned two services (mental health and addictions) and this could result in people ‘falling between’ them. Drug services were usually concerned with the more serious end of abuse such as heroin rather than less serious drugs such as cannabis.

Prof. Appleby said that people with dual diagnosis problems had in the past had a poor level of service but assertive outreach was now making them a priority for care and treatment. People in prison, many of whom had dual diagnosis problems, often required assertive ‘in-reach’.

It was noted that a major problem with dual diagnosis was the lack of major research in the best ways to treat it. The Department of Health had informed the Medical Research Council that dual diagnosis should be a major area for studies in mental health.

Questions

Martin Aaron of JAMI asked whether there had been funds designated by the Treasury for the schemes and projects that Prof. Appleby had mentioned. He said that the NHS Plan had been announced alongside £330million extra funding – a significant proportion of this had been dedicated for mental health services. However, most of the funds would become available only in years 2 and 3 (ie 2002-03, 2003-04).

Dr Lynne Jones MP asked how the money was shared between local health authorities – via a bidding process or shared out on a proportionate basis. Prof. Appleby said there had not been a bidding process and the funds would in future go to the Primary Care Trusts.

Ann Garrett from MACA said that there was a problem with funds not being ring-fenced specifically for dual diagnosis services. She also asked whether the Government consider alcohol part of the dual diagnosis problem. Supporting this statement, Dr Brian Iddon MP mentioned the report on dual diagnosis from the All-Party Parliamentary Group on Drug Misuse produced in April 2001. He asked if there had been any interaction between the NIMH and the National Treatment Agency (NTA) bearing in mind at least 40% of users of mental health services had some form of dual diagnosis. Prof. Appleby said that he did regard alcohol as part of the substance misuse picture and that the implementation group for dual diagnosis did include the NTA. The relationship between the NIMH and NTA would be vitally important.

Concerns were raised about the level of integration of substance misuse and mental health services. Prof. Appleby said that services did need to be integrated at local level. He did not believe that the establishment of Primary Care Trusts would lead to fragmentation because there would be a lead person in each PCT for mental health.

Dr Ian Gibson MP asked whether the NIMH would encourage closer work between the voluntary organisations in mental health, as had recently been the case with cancer charities. Prof. Appleby said that the NIMH would encourage good practice and try and give roles to those doing innovative work. Regional Development Centres would be responsible for work at local levels.

Simon Lawton Smith from Maca, asked about the level of awareness of mental health among GPs. 30% of all patients went to see their GP about mental health problems but the level of training for GPs on mental health was poor. Dr Lynne Jones added that some GPs were able and willing to treat extra people with mental health problems but were unable to get the appropriate funding. Prof. Appleby said that the recent Workforce Action Team report has included the training needs of GPs and this was being put into effect by the DoH. There was a need, however, for evidence to prove which training provided which skills. Mapping was currently taking place within higher education to establish what constituted good training and for primary care this project was at the half way stage. The DoH were also developing plans for GPs to have a particular extra speciality.

Prof. Appleby was asked about the mental health needs of people who were on drugs and that sometimes they were excluded from services. He answered by saying that people should not be excluded and mental health services should be driven solely by needs. He was challenged by Dr Iddon who said that people were often asked to leave psychiatric wards because of drug use and that there was a need for a change in the law. Prof. Appleby said that people should not be denied services. However there was a problem in that drug use within in-patient care could intimidate others on the ward. The DoH was in the process of formulating guidance on this issue – and it would be one of a number of papers on in-patient care. Angela Russell of Breakthrough said that in her experience people with dual diagnosis problems should not be kept on the same wards as those with fewer mental health needs because it could often be a terrifying experience. It was noted however that there would be problems if separate wards were to be introduced, for example staffing and the need for other extra resources.

Lynne Friedli of Mentality emphasised that mental health should be discussed in schools as part of Standard One of the National Service Framework on mental health promotion. On this subject Dr Lynne Jones said she thought that the Government’s Mind-out for Mental Health campaign had had a low profile so far. Prof. Appleby responded by saying that the campaign had been targeted at employers, young people and the media and had been asked to examine their attitudes to mental health. The campaign had involved mental health service users meeting employers who were developing new policies, and also journalists. Prof. Appleby agreed that the campaign should be reviewed after 2-3 years to ascertain whether it was being successful.

Jim Cousins MP asked what role local MPs could play. Prof. Appleby said they could attempt to ensure local services made mental health a priority by contacting the Chief Executives of Primary Care Trusts.

Dr Lynne Jones asked about the Department of Health’s relationship with other parts of Government, in particular the Department of Work and Pensions. Prof. Appleby said that joint work between the DoH and the DWP had been slow and he agreed that there was often a lack of sensitivity from people in benefits offices to people with mental health problems. He had recently contacted officials in the DWP to check on progress and would be continuing to do so.

Dr Lynne Jones thanked Prof. Appleby for his time and it was agreed that he should be invited back at a later date to give an update on how mental health services were developing.

back to mental health