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Speech by the Rt Hon Patricia Hewitt MP, Secretary of State for Health, 10 May 2007: Improving Access to Psychological Therapies National Stakeholder Conference

Thank you, Leslie (Lord Turnberg) for that introduction. I would like to thank Leslie who, along with Lord Richard Layard and Lord Melvyn Bragg, have been instrumental in raising awareness nationally, in parliament and within the Department of Health about the importance of psychological therapies and mental health generally.

I want to thank all of you here who, in your different roles, are helping to improve mental health services. And I particularly want to thank the people who have spoken out about their experience of mental illness. People like Ann Bowling who you heard from earlier this morning. I’m sorry, Ann, that I wasn’t here to hear you speak, but I know that it was a moving and powerful account of your own journey.

Many of us here have personal experience in our own families of mental illness. My own commitment to mental health services comes from my personal experience of my younger  ister’s battles with severe psychosis. I know too from my constituency advice surgeries how often a problem with employment, housing or relationships is also affected by mental health problems somewhere in the family.

So  I am not surprised by the fact that, on any given day, at any given time, one in six adults in this country is experiencing some form of mental health problems.

Yet only two million people each year seek treatment. That suggests a huge amount of unmet need. It’s a need which society cannot afford to ignore on any level. I am still shocked by the fact that four in 10 people on incapacity benefit are suffering from mental health problems.

We all know there is much more to do. But the NHS has made great progress in mental health services in recent years. Louis Appleby, the national director for mental health, is publishing a report tomorrow which shows clearly how much has changed in the last decade.

We now have:

• 1,249 more psychiatrists
• 2782 new clinical psychologists
• 598 new psychotherapists
• 9,444 psychiatric nurses
• More than 700 specialist mental health teams bringing care into people’s homes and responding rapidly to the first signs of psychosis.

It clearly shows the shift from a mental health service based around acute treatment to one based around treatment in the community.

But Professor Appleby will also make it clear there is much still to be done.

‘We need to talk’ – published by a collaboration of five mental health organisations - highlighted graphically the weakness and strengths of the current system and the potential of talking therapies. The Your health, your care, your say consultation with the public – leading up to last year’s White Paper - made it clear that the provision of Psychological Therapies is wanted and needed.

All this reinforces the need for our Manifesto commitment to improve access to talking therapies. We are determined that this commitment will be fulfilled. The Department of Health’s improving access to psychological therapies programme is building on the good work that is already being delivered in the NHS.

The reason I think psychological therapies are a vital tool in our armoury is that they allow us to deliver treatments that work, at the right time, in the right place, to the right number of people and with the right results.

I know that psychiatrists are worried about the focus we are putting on psychological therapies and the particular emphasis on CBT.

By championing psychological therapies we are not saying they are a substitute for other proven treatments. We are saying they are an option we need to offer people because there is evidence they work.

The history of mental health policy has been punctuated with well-intentioned policy decisions, which have not always been adequately tested before being fully implemented. This is why we are continuing to test the most effective ways of implementing improvements in psychological therapy services. This is a process that should be inclusive of a range of therapies that add value and are seen to be effective.

Senior clinicians must be in a position to offer whatever help people need to get better - from a long-stay therapeutic care to a course of computerised CBT.  The only proviso is the treatments must be proven, which CBT is, and overseen by qualified practitioners.

Increasing access to psychological therapies is about investing in the right services for the person’s needs. And at a time when we are battling to reduce the waiting times for other psychological and psychiatric treatments it is going to help us intervene earlier in thousands more cases.

Earlier intervention, as we all know, means that the chances of getting the right result are significantly improved.  That means people feel healthier, have a greater sense of well-being, aren’t excluded from housing, jobs, education or work and experience treatment dedicated to improving their lives.

 Despite record investment in mental health and our manifesto commitment to improve the availability of psychological therapies, there is still an awful lot more we can do for people with mild and moderate conditions.

That’s why I want to announce the publication of two documents today to keep the momentum going.

The Positive Practice Guide outlines the achievements from across the country, particularly the initial successes of the pilot sites we established in 2006, where local services have developed local innovations and sets out the vision for the provision of psychological therapies over the next few years. It describes how we intend to expand the service to improve access for patients and gives examples of how PCTs around the country are already making a positive difference to people’s lives.

In my part of the country there is now a Mental Health Problem Service run by Leicester, Leicestershire and Rutland Common Mental Health Service.  Every GP surgery now has mental health staff who provide assessment and a range of psychological therapies. In addition, it provides a unique service for the homeless and Leicester City’s growing number of asylum seekers and refugees.

The service recently helped Hawa – a 24-year-old Somali woman who was severely beaten when her village was attacked by a rival tribe. She was helped with accommodation, medication and given the opportunity to talk with a psychotherapist every week. Gradually her horrific story came out.

The second document, the Service Specification Guide, invites PCTs to tender to become a pathfinder. We have £2m or approximately £200,000 each, for 10 new smaller sites to complement the work already being carried out in Newham and Doncaster.

The new pathfinder sites will apply the principles laid out in the positive practice guide and contribute to the evidence base we are building about what works and what doesn’t.

The Newham and Doncaster demonstration sites are already showing that integrated services between health, social services and Job Centre Plus can help to improve peoples’ mental health and social inclusion status. For adults, it has been particularly effective in helping people get back to work and keep them at work.

The model emerging from Doncaster and Newham has five elements:

1. Using evidence-based therapies to deliver clinically effective interventions
2. Adopting a stepped care approach to so that treatment is given at the minimum dose to achieve full and sustained recovery.
3. Creating clear care pathways to allow rapid access to treatment
4. Delivering focused outcomes in areas like jobs and health and well-being
5. And collecting routine outcome data to demonstrate progress

On the last point we are developing what we envisage will be the first national standard data collection protocols in the world for psychological therapies, including ethnic monitoring data.

We want people to use this data to show how far services are improving people’s health and lives. It measures a person’s status when they first present themselves and then at regular intervals throughout their treatment. As well as health it measures things like financial status and employment.

It is now time to review and refresh our journey towards better mental health services – to make sure that we have made the best use of all the extra investment that has gone into mental health services since 1997.

Primary Care must take the lead. It must redesign services now. Make investment decisions now to develop and commission talking therapies.

We know that in the past GPs have not been able to refer patients to effective talking therapies and as a result have struggled to provide the kind of care patients want.

Practice Based Commissioning (PBC) offers GPs the chance to redress that balance. It encourages innovation and allows GPs to tailor local services to their patients’ individual needs.

In the Peak District, a PBC Consortium is developing psychological therapy services to enable and improve people’s ability to manage long-term conditions, such as diabetes and heart disease.

Too often we treat things in isolation.  A person with diabetes spends three hours a year with their doctor and 8,757 hours looking after themselves. If they become depressed and fail to manage their condition properly their condition deteriorates and they may end up in hospital.

Primary care is uniquely placed to spot these connections.

A scheme like this one in the Peak District has the potential to fund itself through reduced admissions alone.

Indeed, Sir John Oldham told me just this week of the successes achieved in the Primary Mental Health Care Collaborative, launched in January last year, with over 100 practices covering over 800,000 patients. By bringing new mental health professionals into primary care, the Collaborative has reduced GP consultations – freeing up GP time for other patients and services; dramatically cut consultant referrals; and helped over 800 people back into employment.

The new 'Pathfinder Sites' will seek to harness GP leadership both through PBC and also through encouraging more GPs with a special interest in mental health services to develop innovative local solutions in order to meet patients’ needs.

There is an important role for the various psychological therapy professions in leading service change.

If we are to make good our commitment to offer a 'choice of evidence-based talking therapies' then we will need all the disciplines to work together and play their part.
           
There can never be a single intervention which is effective for everybody at all levels of need. It will, therefore, need strong clinical leadership to bring together the various disciplines and harness their skills.

Conclusion

I hope what I have outlined today will encourage you to go further along the road to ensuring the right number of people access the right services at the right time producing the right results.

Thank you for listening and now I’d like to answer as many of your questions as I can.