Nick Clegg: no-one should wait longer than 13 weeks for mental health treatment

8 February 2008

In a key speech on health service reform, Liberal Democrat Leader Nick Clegg unveiled plans to guarantee everyone suffering from mental health problems a first appointment for treatment within 13 weeks of referral.

The plans were launched as the Party reveals new figures showing that the average time for those people waiting longest for mental health treatment is over seven months, with some people waiting over three years for treatment such as psychotherapy and counselling.

Psychotherapy has some of the longest waits in the country with one area recording waits for an assessment of more than three years. Meanwhile record numbers of anti-depressants are being prescribed, with the number of prescriptions to children having quadrupled in just one decade.

A full copy of the speech is below (check against delivery):

Thank you all for being here and thanks also to the Guardian Public Services Summit for their kind invitation to speak today.

As you know, the theme of this year’s Summit is how relationships are altering, and dynamics are changing, in the delivery of public services.

Today’s public service providers are returning to that theme again and again.

We shouldn’t be surprised by that.

Our schools, universities, and hospitals are facing greater challenges than ever before.

The frontiers of our knowledge-based economy are advancing ever further, ever faster.

New technologies, scientific advances - limitless possibilities.

Never before have we understood as much about the world around us –

Nor appreciated how much more there is to learn.

Everywhere we see opportunity and people who are eager to grasp it.

We have schools, colleges and universities offering a wider variety of courses, qualifications and teaching methods than ever before.

And we have clinics, hospitals and surgeries providing more drugs, operations and therapies than the founders of our National Health Service could ever have believed.

These are good things.

The world around us is opening up.

Diversity of knowledge, opportunity and ambition is empowering the majority in our society and driving us forward.

But we must be equally aware that social mobility in our country has declined.

For a sizeable minority of our people, progress has never seemed so remote:

And their opinions never seem to have mattered less.

So I am glad that all that new knowledge and all that new empowerment have raised people’s expectations of their public services.

But we must also recognise that there is a massive challenge to empower the most disadvantaged.

Access to education and health care should be fast, effective and tailored to individual need.

But they should be tailored to the needs of everyone, regardless of background.

To do that we must recognise the failure of the centralising ethos that has marked out Britain’s public services from those provided in every other developed country.

Over-centralisation marginalises the weakest, the most needy.

Bureaucratic complexity favours the strong and the articulate who are capable of making their own voice heard.

We must replace that philosophy – the one that says the man in Whitehall knows best – with an approach that recognises the challenge of providing modern services to Britain’s highly diverse, varied society.

We must hand power down from the centre to local communities and – where possible – to individual people too.

Local services should reflect the needs, priorities and decisions of those who are directly reliant on them.

We must place people, not systems, at the heart of our public services.

Today I want to talk to you about one specific area where I believe that we are failing those who are most in need.

I want to talk about mental health services.

And I want to explain what I believe government must do to improve both their quality and accessibility.

The challenge is daunting.

One in four Britons suffer from a mental illness at some point in their lives:

One in six is suffering at any given time.

Whether it is you, your mother or father, son or daughter, grandmother or grandfather, aunt or uncle, niece of nephew – mental health issues directly affect most of Britain’s families.

And we know that severe mental health illness in a parent has consequences for the whole family:

It can even mean the removal of children into care when the related issues for the whole family are left unresolved.

There is no doubt that the personal and economic effects of mental ill health in Britain are growing.

Look, for example, at the prescription rate for anti-depressant drugs among young people.

In the mid nineties the number of prescriptions written for children in England was around 146,000 a year –

In itself an alarming number.

But in the last financial year the total had reached 631,000:

The number of children being prescribed these drugs has quadrupled in just one decade.

And prescriptions for children are just the tip of the iceberg.

Their parents too are swallowing more anti-depressants than ever before.

In 2006 a total of more than thirty one million anti-depressant prescriptions were issued.

What does it say about our society that we shrug at the explosion in anti-depressant use as if it were of no consequence?

But there are consequences – stark consequences.

Britain has become the true Prozac Nation.

I believe this trend has gone too far.

We must cut the number of anti-depressants prescribed by doctors.

That’s not to say that medication has no role to play in tackling mental health problems: of course it does.

But they should not be the default option, prescribed by doctors because of a lack of access to psychological therapies.

Anti-depressants come with risks associated with all medicine – dependency and the danger that they mask problems rather than cure them.

Pills must not be a crutch for the wider issues in our society which cause mental health problems.

But if we want to achieve that we must ensure that alternative treatments are free and accessible.

The rising human cost of mental illness has brought a rising economic cost too.

Since the current government took office in 1997, the number of people claiming incapacity or other out-of-work benefits due to mental ill health has risen every single year.

Today, the total stands at more than 1,100,000 a year.

But government figures for mental health expenditure don’t include the cost of welfare.

In fact, when the costs of drugs and therapy are added to the costs of incapacity benefit, social care and missed job opportunities, the true economic cost of mental ill health is estimated at a staggering £77 billion every year.

That’s the equivalent to cutting the basic rate of income tax by 19 pence in the pound.

If the Chancellor were to do that, the standard rate would be just one penny.

But why has this crisis in mental health been allowed to grow?

Why is the NHS letting down these service users?

And why have politicians shamefully chosen to turn a blind eye to the scale of mental health problems in Britain?

I say it is time to break the silence.

We must bring the issues surrounding mental health from the shadows into the centre of our national debate on the kind of society we want to live in.

When it comes to mental health the government’s record is one of shameful neglect.

And their failings fall into three broad categories:

Underinvestment, a lack of alternatives to drugs, and disempowered patients.

First, underinvestment.

It is true that this government has invested more money in the NHS as a whole.

A lot more.

And that increase in public spending was justified, though too much of it has been wasted on senseless reform and bureaucracy.

When the battle for PCT resources begins, mental health loses out

Funding has been channelled into acute hospitals and away from mental health because of two Government initiatives.

Acute hospitals and primary care trusts are under extreme pressure to deliver on the 18 week waiting time target by the end of this year.

And the money in acute care now follows the patient under ‘payment by results’.

But neither waiting time targets nor payment by results apply to community mental health services.

The result: PCTs have less money left for block contracts to fund mental health services.

At a mental health trust I visited staff told me that their funding has been cut over the last five years.

That is a hopeless situation.

And with the money that is available for mental health, it has been channelled into acute services which benefit only 2% of mental health service users.

The vast majority suffer from common yet disabling disorders such as depression and anxiety, and most of them never see a mental health specialist.

It’s early intervention, community support, reduced admissions and ideas to help people back into employment that need attention.

Because they are the key to reducing emergency emissions.

But these are the very services that have been neglected.

This in turn exacerbates mental health problems:

And this pushes up the number of detentions under the Mental Health Act.

A cynic might say that the government’s attention has gone into tackling the highest profile illnesses with the most vocal and empowered patients.

Mental health services have commanded less favourable coverage, less government attention, and less money.

Second, a shortfall in alternatives to drugs.

The reality is that the Prozac Nation is founded on our lack of available alternatives to medication – medication which is often expensive.

“Talking therapies” like Cognitive Behavioural Therapy aim to illuminate the underlying causes of mental illness and address them in a fundamental way.

For some illnesses, like schizophrenia, we know that drugs are often essential.

But for many psychological and psychiatric problems, therapies would tackle the root causes of the problem, rather than just help them to cope.

And early intervention can make a massive difference to prognosis.

In theory, a GP should be able to refer people for these therapies.

But in reality, waiting lists can be lengthy, therapists sparse, and specialists unavailable.

NICE has recommended that a range of psychological therapies should be made available on the NHS.

The government says it is trying to make that easier.

Indeed, last autumn the government announced an additional investment of £170 million specifically for psychological therapies.

I welcome that.

But the money was dedicated to building capacity rather than to ongoing running costs.

And there is no guarantee that this investment will ensure access for those in need.

One study by Mind found that 93% of GPs are prescribing anti-depressants purely because they lack viable alternatives.

Medical professionals want to prescribe effective, long-term solutions –

But in the absence of those solutions it is no wonder that so many drugs are prescribed.

Central government has not only under funded services but it has failed to show the same enthusiasm driving up standards and cutting waiting times that it has demonstrated in other areas of the NHS.

Acute mental services will have to wait until later this year for an 18 week target to be applied, years after it has been applied elsewhere in the NHS.

And no target or incentive has been applied to community treatments in mental health – where 98% of patients are seen.

This week my Shadow Health Secretary, Norman Lamb, has compiled a list of waiting times for both initial assessment and starting psychological treatments provided by mental health services across the country.

The results that we have received tell the story of a lottery in mental health service waiting times.

Often the most vulnerable people are waiting scandalously long for access to treatment when all the evidence shows that early intervention is vital.

In Leicestershire, the longest waiting time for cognitive behaviour therapy is almost a year and a half.

In Gloucestershire you can wait almost two years for eating disorder treatment.

And in Plymouth, patients can wait for over three and half years for a psychotherapy assessment.

This is a heartless, brutal way to treat some of the most vulnerable people in our society.

Why is it that our television screens are full this week, rightly, with the suffering of battery fed chickens but silent on the scandalous way we treat the mentally ill in our midst?

Mental health resources have been neglected and the services have suffered.

And my third point on government neglect just makes matter worse:

Mental health patients have been systematically disempowered.

The old “custodial model” of patient care - with high levels of compulsory treatment - robs individuals of their autonomy.

But it remains prevalent in Britain’s mental health facilities.

The most obvious manifestation of patients’ powerlessness is the state of the wards that accommodate them.

Too often they are austere, dark, and deeply depressing.

Many are of a condition that would never be tolerated in a district general hospital – and the assertive patient groups who use them.

Some of the most vulnerable people in our care are being deprived of the basic dignity that stronger and more vocal patients take for granted in other parts of the health service.

(You can read the second half of Nick Clegg's speech here).