9. Submissions on Behalf of Mind by Ms Davies

Ms Davies: Thank you.

My Lady, I’m here to persuade you that although we understand that this Inquiry above all others has to cut its cloth if it’s to be of use for future generations, that the scope of this module should be broadened to include more about mental health services.

I want to divide my submissions into three points: the general importance of the treatment of mental health problems, the weight of mental health services within the NHS estate; why you cannot study CYP in patients, even in detail, and then extrapolate that to understand what happened in the rest of mental health services; and addressing Rule 9 and experts to the Inquiry.

I do want to start with a small correction. Counsel said at the beginning that Mind had raised the issue of dementia being included. We have not, because we don’t have expertise on that. It’s not that we would oppose that, but it’s not a submission we made but would support.

So to put things in context I think, you know, I myself have worked in the mental health service for 32 years, equally split between being a clinician and a lawyer, and we have always been called the Cinderella service. But public attitudes have moved on enormously in just the space of a generation. Just recently a retiring director told us the story of companies who would donate to Mind as long as their names didn’t appear in the annual report and that people did not associate them with mental health problems. But on 5 September, The Times reported that only one in five people felt that mental health services were performing well, and the majority of those under 40 considered mental health as a higher political priority than crime, climate change or the war in Ukraine.

Not just Mind but the British public are at risk of being left feeling short changed by the Inquiry if it does not investigate what happened to the mental health of the nation and why mental health services, much weakened since 2010, were not near to meet the needs of the population.

Now, in terms of the weight of mental health in the NHS estate, firstly mental health problems account for 23% of – these aren’t my terms – disease burden, while receiving 13% of funding. Mental health beds count for 18% to 20% of all overnight inpatient stays. But it’s not that we’re just considering those half a million people who live with severe mental illness who are more likely to be detained under the Mental Health Act.

I guess that probably by now everyone in this room will know someone who has suffered poor mental health during and after the pandemic. So we’re not talking about a niche issue; we’re talking about actually a cast of millions. By August 2021 an estimated 8 million people were deemed not ill enough to get specialist mental health help. This was on top of the official waiting list of 1.6 million, 374,000 of those being under 18s. That figure now stands at over 2 million.

People suffered not just stress, anxiety and depression that you might expect, but psychotic illnesses that they described as life changing, not just because of the illnesses themselves but their experiences in mental health services.

In 2020 psychiatric hospitals were emptied. They did not free up any beds for general medicine or critical care, and that was just the time that community services were also shutting down. Psychiatric professionals have told us that the guidance they received was confusing and they felt they were left to decide on a case-by-case basis who they would visit at home.

This meant that overall, despite greater need for mental health services, that there were less mental health contacts from psychiatric services than previous years. Even to the extent that some patients who did not – who were on depot medication, long-term injections, they cannot administer themselves, were not seen. Moves to remote appointments were not so successful, many people with severe mental health problems are digitally excluded. And at the end of the pandemic, the medical studies have shown that those with long-term mental health conditions were five times more likely to die from Covid than the general population.

Now, we do welcome that the Inquiry is looking at CYP in-patients, but we say you can’t look at that and then understand what happened in the rest of the mental health system. The model of CAMHS is quite different, it’s actually community based. There are disorders in CAMHS, such as behavioural disorders, that don’t exist or aren’t treated in adult mental health services. There are far less long-term forensic beds, and mental health services are often based in non-hospital settings. So, for example, in schools or other places where young people go. Very few people make it into tier 4, that’s the in-patient services, because there is much safeguarding of those beds. Those beds are not commissioned even on a local basis, and young people find themselves, more than others, sent not just out of area but out of their home country.

The stats that we have on inpatient CAMHS are not the same as adult services. So, for example, a majority of girls or young women are admitted into under 18 services, whereas over 18 it’s exactly the opposite. The stats that we have on racism are also slightly different.

So we say, even with a detailed look at in-patients, where you’re fundamentally working on a community care model, is really sort of misunderstood.

The other reason that, you know, I think – we say you should look at mental health services is it’s a microcosm of racism and health. There are very stark statistics about people of colour not getting the help they need, then coming into services through uncomfortable routes such as the courts or the police. If you are a black patient, you are 4.5 times more likely to be placed under section 13, and 11 times more likely to be put on a restrictive community order. Racism runs throughout the mental health system and, you know, we think that studying those factors would be instructive to the Inquiry.

Now, we respectfully submit as a friend to the Inquiry that the Inquiry’s misunderstood the scope and the weighting of mental health services within the NHS estate, but we think there is actually time for this to be remedied.

So far the Disabilities Charities Consortium has been asked for a statement on mental health which, for the purposes of this Inquiry, does not contain a mental health charity. We are the only mental health charity that is a core participant in this Inquiry, and therefore we say we can assist the Inquiry by providing a Rule 9 statement.

This is why we also say that an expert is needed on mental health. We understand you can’t look into every corner, but an expert on mental health services would be precisely there to guide the Inquiry as to the pertinent places that would be most useful to the Inquiry in the matter of mental health care.

You know, since the pandemic, the lesson that has been learnt by government seems to be to deprioritise mental health. Liberty protection safeguards that were passed through Parliament the government has refused to implement. A new mental health act which has been long, long overdue has now been shelved.

We say this is the wrong lesson to learn from the pandemic, that mental health should be re-prioritised, giving the scale of impact that it’s had on the nation.

Now, we at Mind have a saying that we will never give up until all those who have a mental health problem have the support and respect that they need, and though we be considered a Cinderella service, we respectfully ask if we can go to that ball.

So that’s the end of my submissions, unless I can assist you further.

Lady Hallett: I can see you’re not going to give up, Ms Davies, and the mental health services are very fortunate to have you as an advocate, so thank you very much indeed.

Ms Davies: Thank you.

Lady Hallett: Right.

Mr Jacobs. The TUC are very fortunate to have you as an advocate obviously as well.