Peter Black and South Wales West Liberal Democrats

Mental Health

Thank you for inviting me here today, and for asking me to speak.

I should say at the outset that I am no expert in the field of mental health in general or recovery in particular.

I am simply a practical politician who is seeking ideas and ways of working that will both improve the self-image of those of our fellow citizens who suffer from a mental illness, and enable them to live lives that they experience as full and satisfying.

That is why I am delighted to see that the title of your conference is "Looking at What Works."

Effective help starts with ideas and theories, but must be translated into practical steps that benefit real people.

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It has become a commonplace to say that mental health and wellbeing is a 'Cinderella' service within the NHS both in the UK and in Wales.

Indeed the evidence paper put to the Assembly's Health Wellbeing and Local Government Committee by the Minister for Health as part of our inquiry into Community Mental Health Services last month uses this very phrase as part of its preamble.

It is true that mental health has been historically under-resourced.

Such a position is surprising given the incidence of debilitating mental health problems among the population.

The figures are striking.

One in four of us will suffer from a mental illness at some point in our lives.

One in seven will suffer to a sufficient degree as to warrant therapeutic intervention at some level.

The incidence of that all pervasive but ill-defined condition 'stress' is on the increase both for those in work and the increasing number of us without it.

We can speculate long and hard as to why this is; the pace of modern life, the sense of being at the mercy of forces that one cannot easily control if at all, the loosening of community ties, all these and more have been cited.

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Nevertheless, the trick isn't merely to speculate, but to help, and more particularly, to enable those with mental health problems to view their lives positively and live them in an active and dynamic manner.

That is why I find myself drawn to the concept of recovery.

It is an optimistic concept that frees the individual from passive acceptance of 'their condition' and from an over-reliance on the professionals.

Instead it says that the individual her or him self can, with help, build a satisfying life that fulfils the needs hierarchy described by Maslow and others, including the needs for esteem and self-actualisation.

It talks about the importance of hope and how that hope can be nurtured by the building process.

It allows professionals and patients to work together as partners in building wellbeing and strength into their lives of those self-same patients.

It recognises that positive engagement with the communities that patients are already part of is a vital part of life and hence of recovery.

Most of all, it enables everybody to see that a patient is much more than a bundle of symptoms and illnesses to be treated and cured.

It is a more holistic and hence I would argue a more truly human way of giving patients the freedom and dignity to lead their lives in their own way.

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I said at the beginning of these remarks that I am not an expert as many of you are.

I am neither a professional worker, nor am I presently experiencing mental health problems.

However, in common with my colleagues in the Assembly, and Westminster as well as local councillor colleagues I and my staff often find ourselves approached for help by those who are experiencing such problems.

It is rare that the mental health problem is the sole reason for such an approach. More often than not it will be a problem with the person's everyday life; with their housing, their work, their family, their benefits.

But the mental health problem will compound it, and will mean that the individual faces a greater struggle to work through the problem than would otherwise be the case.

It is at this point that all too often the rules surrounding areas like benefit provision prevent people from working as effectively as they might to change their lives in a positive manner.

For instance, almost nobody disagrees with the notion that allowing people to work benefits them in terms of income, but benefits them much more in terms of dignity, in social interaction, in providing structure to their everyday lives.

Yet the benefit rules allow only £5.00 per week to be earned before benefit is lost; rising to a princely £10.00 per week for a couple.

It is in areas like this that politicians like me have an opportunity to persuade government of the need to change things so as to help the process of building, or rebuilding, one's life.

Recovery is good for people.

That being the case, our welfare benefit system should seek to promote it in the widest sense rather than always looking to financial cost alone.

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There is another reason - a national imperative if you will - for promoting the concept of recovery.

Quite apart form the obvious gain to the individual in terms of increasing their sense of personal identity, of wellbeing and of self-actualisation that I have already referred to; there is a clear gain to Welsh society as a whole.

It cannot be the case that each person's success in building a satisfying life in which they set and achieve personal goals is something which happens in isolation, away from society.

John Donne famously wrote that: -

"No man is an island, entire of itself; every man is a piece of the continent, a part of the main; if a clod be washed away by the sea, Europe is the less.."

He was meditating on death and mortality as we know.

But his observation is as true the other way about.

Whatever others might like to pretend for their own political ends, there is such a thing as society.

We are all truly part of the continent as Donne puts it.

That being the case, every man and woman who builds a good and satisfying life in the teeth of their symptoms, whether their condition is chronic or episodic, is benefiting not only themselves but the community in which they live.

There are around 2.9 million of us here in Wales.

This makes us a small nation.

That being the case, we cannot afford to waste anybody's gifts and talents.

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Research done on behalf of the Association for Student Counselling in the late seventies concluded that one of the major determinants of a successful counselling relationship was not the particular theory that the counsellor followed in their practice, but their own personalities.

It is who the counsellor is rather than what the counsellor does that makes the difference.

I would argue that the same is true here.

While theory is vital, the sharing of oneself in a therapeutic relationship is of equal importance.

Clearly for some professionals an emphasis upon recovery could be seen as a decrying of their professionalism.

As I see it, nothing could be further from the truth.

The patient will still be relying upon the knowledge, understanding and insight of the professionals in the team around them in such areas as the suitability of treatments, group functioning, and the reflecting of reality.

However, because of the emphasis upon facilitating the person to self-manage, using a recovery model will in fact give professionals a greater opportunity than hitherto to deploy their own array of skills.

Staff will get the opportunity to engage in what has been described as 'hope-inspiring relationships' by one observer.

As Laurie Davidson says in Recovery - Concepts and Application from the Devon Recovery Group: -

"The development of recovery-based services emphasises the personal qualities of staff as much as their formal qualifications. It seeks to cultivate their capacity for hope, creativity, care, compassion, realism and resilience."

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Earlier, I mentioned the inquiry being carried out into Community Mental Health Services by the Assembly's Health Wellbeing and Local Government Committee.

As part of that inquiry, we took evidence from the British Association of Social Work, the College of Occupational Therapists, the Chartered Society of Physiotherapy, and the Royal College of Nursing.

One of the most striking things was the degree of unanimity with which these professions spoke.

They left us with four key messages.

• Community Mental Health Services in Wales require increased and sustained investment.

• Mental health services should be designed around the recovery model. Multi-professional community teams need to be developed equitably across Wales ensuring a range of interventions to support sustained mental health and wellbeing.

• A workforce development plan including recruitment, retention and post graduate education and training is needed for each of the professions to ensure that a sufficiently qualified specialist workforce is available.

• Multi-professional transition services need to be developed and resourced.

None of this will come about without two vital changes.

First, we need to move away from a medical model that facilitates an over-emphasis upon hospital-based services and towards a social model that emphasizes better integration between health and social care, and joint working in multi-disciplinary teams.

Second, we need the Welsh Government to demonstrate the political will that is needed to both shift resources and make extra resources available to bring this change about.

We will be told that such an investment is at best problematic at this time.

Yet, as I have argued, if we are to make the best use of the talents and skills of all our people for the greater good of this small nation in which we live we cannot afford not to make such an investment.

The recovery model is one that offers better integration, a better use of everybody's skills and talents, and consequently better value for the limited resources - both human and financial - that we have available to us.

More importantly for me it provides a route to hope, optimism, meaning, and a growing self- confidence for those who have all too often had to settle for stunted lives and diminished self-esteem.

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Key to making those changes will be the success of the Legislative Competence Order currently being steered through Westminster by Jonathan Morgan. He wants mental health patients to be assessed and treated earlier than at present and he wants the Assembly to be able to legislate give them greater rights to earlier diagnosis and treatment, which at present takes longer than in England.

Like Jonathan I believe that this could reduce the likelihood of further deterioration in mental health and remove the need for compulsory powers later on.

The order could also instigate advocates for mental health patients who could speak up for them if they become unable to do so for themselves during their treatment.

The powers would also allow for mental health patients to receive independent advocacy services during treatment.

The problem at the moment is there are a substantial number of people who have a level of mental health problems that don't get treatment early on.

The crisis becomes so severe that they are detained under the Mental Health Act. Hafal, the mental health charity, reckon that half the people detained have asked for help at some point but have been ignored or had it denied.

We should be doing more earlier on to make sure they can get that assessment and treatment and the request for powers is part of that.

It's time for a change. All the parties in the Assembly are committed to providing that change. The Health Committee review is crucial to effecting that change. If we can get the extra resources that this service needs as well so that we can invest in support for those suffering from mental illness then we will succeed, but there is still a long way to go.

Thank you.