Ed Miliband's speech on mental health: full text

"It is the biggest unaddressed health challenge of our age."

It is excellent to be here with you today at the Royal College of Psychiatrists.

I spoke a few weeks ago in Manchester about the future of our country.

About the huge challenges Britain faces, as we attempt to rebuild our economy and create a stronger society.

A country where everybody has a stake, where prosperity is fairly shared and where we protect and improve the institutions that bind us together.

I called this approach “One Nation”.

One Nation means nobody is left out, or written off.

Because it is wrong.

And we can’t succeed as a country if that’s what we do.

And today I want to talk about one of the most serious challenges our country faces.

One that writes people off in just that way.

Affecting:

North and south.

Rich and poor.

Old and young.

Those who work and those who can’t.

Disabled and non-disabled people.

A problem that can strike anyone.

It blights millions of lives.

And undermines the welfare of our nation.

And it is also a challenge that affects our competitiveness as a country.

That places a huge strain on our public services.

And that costs our economy tens of billions of pounds a year.

I am talking, of course, about the challenge of mental health.

From the people living with schizophrenia and bipolar disorder to those fighting bouts of depression and panic attacks.

Now, you would think a widespread and important challenge like this would be something we would all talk about.

That it would be top of the political agenda.

That every leading politician would be obliged to address to it.

That we would be falling over each other, as we do, to prove that we had a solution.

But that doesn’t tend to happen.

For far too long leading politicians from all parties, including my own, have maintained an almost complete silence about mental health.

Only in emergencies and at the extreme end of conditions do we tend to talk about the issue.

Now there will be some people who say that mental health is the kind of subject we can talk about in the good times, but not when the economy is such a priority. 

In my view, that is the opposite of the truth.

Because mental health is an economic challenge holding back prosperity.

Because however hard the economic challenges, we cannot forget about people’s quality of life.

And, finally, if we want a politics that talks directly to the challenges that British people face in their everyday lives, we cannot allow the silence to continue.

Taboo

And it’s not just politics that is too silent.

It is a taboo running across our society which infects both our culture and our politics. 

It is a taboo which not only blights the lives of millions but also puts severe strain on the funding of our NHS and threatens Britain’s ability to pay our way in the world. 

It is a taboo which must be broken if we are to rebuild Britain as One Nation. 

Mental health is subject we all, whoever we are, still instinctively avoid.

At home, in the workplace and in our communities, it tends to be brushed under the carpet.

Teachers and our parents are unlikely to talk to us about mental illness when we are young. 

And we all fear the unknown.

Today in 2012, far too many people in this country still feel as if they have to pretend they have something else wrong with them when they are struggling with depression.

People can be scared to tell their boss.

Intimidated by the culture that still surrounds mental illness.

Scared into silence.

And it's not just their employers. 

It's their family and friends who don't know how to react either.

As Kevan Jones, a Labour MP who has bravely spoken out about his own depression, said to me recently: if you have a serious physical illness, the get well messages tend to flood in.

But when a friend of his was struggling with depression recently and Kevan sent him a message, his friend told him it was the only one he had received.

Mental ill health can affect anyone, but it is more openly talked about in some sections of society than others.

For people to talk about it and get help, there needs to be a common language and understanding.

If it isn’t recognised, it is as if it doesn’t exist.

People pretend they are OK, family and friends turn a blind eye, nothing happens until it is often too late.

A change of culture has happened with illnesses that have previously been taboo: from cancer to aids to other sexually transmitted diseases.

But it hasn't yet happened as much as it needs to with mental health.

I’ve seen it in Doncaster, in my own constituency.

Just last Friday, I was at the Depot Community Drugs Project in a town called Mexborough, which does a brilliant job helping with drugs treatment and education, training and rehabilitation.

A man probably in his late forties happened to walk in and told me his story.

About fifteen years ago, his sister died of cancer and his marriage broke down soon after.

He couldn’t sleep.

Because of stress. 

The trauma.

Anxiety and depression.

And he didn’t know what to do.

As he leaned on his gatepost one day, someone he knew walked past and said he could provide something to help him sleep.

It was heroin. 

Having previously smoked cannabis, he tried it and pretty soon he was hooked.

It took eight years of him being pushed to the brink by drugs for him to seek help.

Now six years later, he had found paid work probably for the first time since his addiction.

I talked to him about what had happened.

And he volunteered that if we lived in a culture where the trauma of bereavement and the need to get help for mental health problems were more clearly recognised, things could have been very different for him.

Think of how much better that would have been for him, and think how much better it would have been for the country.

This is the reality for many people today.

From mothers struggling with post-natal depression, young people in schools, people facing stress and anxiety at the workplace, to some of our ethnic minority communities who face a higher incidence of some conditions. 

Mental ill-health is a cradle to grave problem with nothing like a cradle to grave service.

The Scale of the Problem

As I speak here today, one in six people across Britain are affected by a mental illness.

That is one in six people in each town or city, each workplace or community.

Of course, this covers a range of illnesses. 

From people facing catastrophic crisis and collapse to those whose condition is less severe.

There is some evidence that mental illness has become far worse in the 21st century.

Growing as a result of unequal societies, a long-hours culture, and from the erosion of social bonds.

But even if that is not the case, and it was always there, and never fully recognized, the scale of the problem is clear.

According to the World Health Organisation, one in four of us will have a mental illness at some point in our lifetime.

And that really means that mental illness affects everyone in some way.

If it is not you yourself who is struggling, it is your mum or dad, son or daughter, nephew or niece, friend or loved one. 

The WHO predicts that by 2030, depression will be the leading cause of disease around the world.

Physical or mental.

And people can lose years off their lives as mental illnesses undermine their physical health too.

Increasing their vulnerability in the face of cancer, heart disease and all the other great killers of our new century.

It is the biggest unaddressed health challenge of our age.

That means mental health must be at the top of the agenda of the next Labour government.

Fighting the taboo

Fighting the taboo is the first thing we need to do.

People like Marcus Trescothick, Stephen Fry, Fiona Phillips, Labour’s Alastair Campbell and Kevan Jones, and politicians from other parties, like Charles Walker, have all been exceptionally brave in sharing their own painful stories with our country.

And some newspapers from the Sunday Express and Observer have tried to break the taboo and they too are to be congratulated.

But far too often there is scepticism and abuse.

Abuse that reinforces the taboo.

And it’s not just casual name calling in the streets or the school playground.

There are still people who abuse the privilege of their celebrity to insult, demean and belittle others.

Such as when Janet Street-Porter in a shocking article says that depression is “the latest must-have accessory” promoted by the “misery movement”.

And Jeremy Clarkson, who may have at least acknowledged the tragedy of people who end their own lives, goes on to call them “Johnny Suicides” whose bodies should be left on train tracks rather than delay journeys. 

It is attitudes like these that reinforce the stigma that blights millions of people’s lives.

And holds our country back.

The fight against racism, against sexism and against homophobia, made the acceptable, unacceptable. 

So we should join the fight against this intolerance.

It is wrong.

It costs Britain dear.

And it has to change.

But it is not just open prejudice that we have to overcome.

We have to confront the unspoken discriminations too. 

Like the vast inequalities in funding for research.

Like the lack of training in mental health of many NHS staff – whether in GP surgeries, outpatient clinics or A&E. Eight out of ten primary care professionals say they need more training in mental health than they have.

Like the lack of understanding of mental health that seems to characterise parts of the social security system.

And like the willingness of governments to make the first and deepest cuts in services for mental health.

Indeed, it is a very troubling sign that for the first time in a decade we have seen a cut in total spending on mental health.

A reduction of £150million, including cuts in crisis services and out-reach programmes.

Imagine if this had happened in one of the key killer physical diseases. 

People would have been up in arms, and rightly so.

The Consequences of our Inaction

The toll of all this neglect is enormous.

In the trouble stored up over the years as minor problems become major ones. 

The extra physical healthcare necessitated by mental illness costs the NHS a further £10 billion a year, according to the London School of Economics.

The criminal justice system also picks up the bill.

Seventy percent of those in our prisons have a mental illness.

But it is not just our public services that bear the burden.

British business does too.

In time off work.

In unproductive days at work.

Mental ill health costs Britain’s businesses almost £8.5 billion in sickness absence each year.

The single biggest cause of long-term sickness absence.

It costs almost £2.5 billion in replacing staff who are unable to continue at work.

And it costs £15 billion in reduced productivity.

That’s almost £26 billion a year.

Or £71 million each and every single day.

And think how little we talk about this major burden on business.

Costs our economy cannot afford.

So mental health is an economic as well as a social challenge.

Our failure to act is a national failure.

It’s one we must put right if we are to be a One Nation Britain, where everybody has a stake and we build shared prosperity.

One Nation

So can we do it?

It is often hard for a country to admit that the time has come to confront new problems.

Particularly when economic times are difficult.

But our country has faced these kind of challenges before.

Major unaddressed challenges that affect the whole country.

Challenges that seem to too big to overcome.

It was true in the 19th century.

The speech that Benjamin Disraeli used in 1872 to launch the idea of One Nation was, in fact, about sanitation.

He called upon Britain to rise to the challenge of public health.

To take on the squalor in our towns and cities and to reject “unsanitary living conditions” wherever they were to be found.

Because it was in all of our interests.

It took at least thirty years for British politics to respond fully.

It was only when unfit and unhealthy soldiers were sent to the Boer War and were unable to rise to the demands of the conflict that governments dared properly to act.

In the 20th century, in the Great Depression of the 1930s, it was apparent that the patchwork of private and charitable health services was inadequate.

But it took the Second World War and the great reforming Labour government that followed it, to rise to the task and establish the National Health Service.

The 21st century challenge of mental health is as profound.

Like sanitation, it is a massive public health challenge, affecting millions.

Like the demand for an NHS in the 1930s, our national response is wholly inadequate against the scale of the challenge.

In both the nineteenth and twentieth centuries, it took war to shock us out of complacency.

This time we can’t wait for greater crisis.

We must act.

It means changing the ways that we do things in this country so that we actually save money.

And improve lives.

But it requires us to break the taboos, to build a consensus for action, to change our NHS and to deploy all the resources of Britain - a truly One Nation solution - to put it right.

One Nation Solutions

So, we need to change the status of mental health in our National Health Service and in our wider society.

I don’t come today with all the solutions but a clear direction of travel.

The last Labour government began to transform mental health provision in our country.

It made well-respected, evidence-based therapies available to more people than ever before.

Taking mental health treatment into communities that had never received them.

We need to do all we can now to protect those programmes.

But even the last Labour government did not do enough to acknowledge the scale of the challenge.

Too often governments have been stuck in a mindset that thought that physical health should always take priority.

That waiting lists for cancer or heart surgery were always going to be more important than those for mental health.

I am proud that Labour peers won the fight to go further than we had in government and ensure that the Health and Social Care Act contained a commitment to “parity of esteem” between mental and physical health.

This was accepted by the Government.

But here is the problem.

Governments are in the habit in this country of passing laws and then forgetting about them.

Think how radical a commitment to parity of esteem between mental and physical health really is.

Waiting times.

Access to treatment.

Professional knowledge.

Patient experience.

Making “parity of esteem” real is a monumental and generational task.

Here’s where we should start.

We should rewrite the Constitution of our National Health Service.

The Constitution is a great thing because it sets out the rights and guarantees patients have. 

But it is inadequate in mental health.

For example, the Constitution does give patients the rights to drugs and medical treatments, for mental health problems. Something I suspect that many people don’t know.

But it doesn’t give them the right to therapies.

This seems the wrong approach, particularly given concerns about over-prescription of medication in mental health.

So we should re-write the NHS Constitution and create for citizens a new right – for the first time – to psychological therapies that help people recover from conditions like anxiety and depression.

Currently there is money allocated in the NHS budget for this purpose, but reports suggest it is not always being spent on what it was intended for.

This is a completely false economy.

Wrong for patients.

And wrong for the country.

Talking therapies can help people and can save money, so they must be a NHS priority.

And we need to look right across the board at how we can make parity of esteem real in practice.

And we need to match parity of esteem in the NHS with an end to the artificial divide between physical and mental health services and ensure that they are properly integrated.

As Andy Burnham has said, the commitment to proper integration of mental, physical and social care will run through Labour’s whole approach to health care.

We need to see more mental health specialists working in teams with GPs, nurses and carers.

We need to look at extending personal health budgets that enable patients to select the best combination of services and treatments for themselves.

Both mental and physical.

We also need all health professionals to see promoting good mental health and spotting signs of mental ill-health as part of what they do.

So we should ensure that the training of doctors, nurses and all professional staff who work in the NHS includes mental health.

So a One Nation solution to the challenge of mental health starts with our National Health Service.

Beyond the NHS

But fully to rise to that challenge, we need also to look beyond the NHS itself.

Too often we act as if the answer to our health crises starts and stops with new government programmes.

And we don’t ask enough of others in our society.

Thinking of the service provided by government as the answer on its own misses the point of how we can succeed as a country.

Mobilising the contribution, the talent, the expertise of the patient, the parent, the carer, and changing the way our wider society works, is as important in determining whether any public service can succeed in its intentions. 

Good mental health doesn’t start in hospital or the treatment room.

It starts in our workplaces, our schools and our communities.

So the task falls as much to organisations like British business and the CBI as it does to the Royal College of Psychiatrists.

In fact, everybody has a part to play.

Only a nation acting together can overcome the challenge we face. 

That is what One Nation is about.

There are already some excellent examples of new plans for mental health in Britain today.

Take British business.

A few years ago, British Telecom acknowledged that mental ill-health was costing their firm dear.

Holding them back.

So they implemented a new mental health strategy across the whole firm.

They abandoned pre-employment medical checks that had blocked opportunities for those with mental health conditions. 

They saved £400,000 a year in the process. 

And instead they said that mental ill-health should be no barrier to working at their company. 

And they offered new training to managers so they could help everyone in the firm play their part.

And they found that after four years, sickness absence rates due to mental health problems had not risen, as you might expect, but had fallen by a third. 

Despite all the pressures and stresses that people have been facing in recent years.

It is the kind of transformation we need to see across our economy.

One encouraged by the campaign Time to Change, which has done a fantastic job in tackling mental health discrimination at work and the new Mental Health Discrimination Bill currently before Parliament.

And it’s not just business that needs to change.

The same is true in our schools. 

The last Labour government placed an emphasis on the mental well-being of their students.

To give them the emotional, psychological resilience that they need. 

To help them face the challenges of the twenty-first century.

But David Cameron’s government dismisses these concerns as peripheral and they’ve told the school inspectors to ignore them.

Offering no incentives to innovation.

No encouragement to teachers who know that children who are mentally and emotionally tougher are also better able to pass exams and make their way in the world.

It is a short-sighted, old-fashioned, conservative in the worst sense of the word, way of running British education.

It is as simple as that.

So too we need to tackle mental health issues in criminal justice, which I have already talked about, in the social security system, in families.

So we need a mental health strategy outside as well as inside the National Health Service.

Tackling the culture and changing the way our society treats mental health.

A One Nation solution will bring together people from every walk of life to address this problem. 

And that’s what I have asked Stephen O’Brien, chair of Barts NHS Trust and Vice President of Business in the Community, to do as he leads our new Mental Health Taskforce.

We will ask searching questions about the culture of work in Britain, about the impact of inequality, about the way our schools work and relate to their wider communities. 

We will learn from the best of the rest of the world.

We will plan what needs to be done.

And when we are in government we will act. 

Conclusion

I don’t remember people talking about mental health much when I was growing up.

Times were different.

The taboo was even more intense then than it is now.

The problems hidden even deeper under the surface.

I am proud to live in a country where that taboo has been challenged by some.

To live at a time when some people are beginning to speak out.

But I know that not enough has yet been done.

I know that far too many still suffer in silence.

Too many stay away from their GP.

Or work in offices and factories not set up to help.

Or live in communities with far too few services.

Or feel isolated and alone.

The next Labour government won’t be able to put all this right overnight.

Silences in our culture are hard to break.

Taboos are resistant to being overcome.

But just as Disraeli was right back in the nineteenth century that we could not build One Nation unless we addressed public health, so it is true today we cannot build One Nation unless we all speak out about mental health.

The next Labour government will reform our health service to guarantee that mental health enjoys real equality of status.

The next Labour government will work with British business to improve our workplaces, helping people stay in work and make their contribution.

And the next Labour government will work with our schools to prepare our children for the demands of life.

But most of all the Labour Party I lead will speak out against prejudice.

We can’t prevent all mental ill-health.

There are not cures for all conditions.

But we can help change the culture in our country. 

We can insist that everyone counts.

That everyone matters.

And that no-one dealing with any form of illness should ever feel ashamed.

That’s how you bring real change to Britain. 

That’s how you build One Nation.

Labour leader Ed Miliband delivered his speech on mental health at the Royal College of Psychiatrists. Photograph: Getty Images.
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What are the consequences of Brexit for the refugee crisis?

Politicians neglected the refugee crisis whilst campaigning – but they shouldn't now concede to the darker undertones of the debate.

In the chaotic aftermath of Brexit, the refugee crisis seems like a distant memory. Yet not even a year has passed since the body of a young Syrian boy washed up on a Turkish beach, shocking the world.

When campaigning for the EU referendum began, politicians neglected the crisis. Not because the situation had ameliorated, but because the issue had become strategically toxic. Nigel Farage's infamous poster aside, the Leave side preferred scare stories about economic migrants rather than refugees; the Remain side because the refugee crisis, more than anything else since its inception, highlighted the fragility of the ideals that underpin the European Union.

Many of the main issues aired in the course of the referendum debate were related to the refugee crisis, regardless of how little it impacted on them in reality; immigration, strain on public services, national identity. The refugee crisis became a proxy issue; implied, but not addressed, for fear of detrimental impact in the polls.

However, in his repugnant posters (it should be stressed, nothing to do with Leave campaign itself), Nigel Farage made explicit what he thought posed the greatest threat to the UK. Rightly, the posters have been condemned by both sides of the referendum debate, but the underlying suspicion of refugees it reflects has concerned many organisations.Their concern has only been exacerbated by the result of the referendum. The spike in hate crime compounds their fears.

Paul Dillane, head of UKLGIG, a charity that supports LGBTI asylum seekers to the UK, expressed unease at the reaction of his clients: “The asylum seekers I work with do not understand the decision that has been made – they feel vulnerable, they feel unwelcome. Yes the law hasn’t changed, and if they’re at risk of persecution, they will be protected. But they don’t feel like that now.”

Despite the troubling situation, the result of the referendum changes little when it comes to refugee law. “Refugee policy is shaped in London, not in Brussels”, said Stephen Hale, Chief Executive of Refugees Action. “The decision about how well we support refugees in terms of integration is a matter for the UK, not Brussels. The number of Syrian refugees we choose to resettle is a matter for the UK, not Brussels.”

Although the law may not have changed, from a diplomatic or political perspective, the same cannot be said. This does have the power to negatively impact legislation. Post-Brexit reaction in France surrounding the Touquet Treaty typifies this.

The Touquet Treaty, reached between the UK and France in 2003, permits each country to carry out passport checks on the other countries’ soil. It is what, according to French politicians in Calais, has accelerated the growth of the "Jungle", which currently accommodates close to 5,000 refugees.

Because the agreement was signed outside the auspices of the European Union, Brexit does not affect its legal legitimacy. However, for France, EU membership was crucial to the nature of the agreement. Speaking earlier this year, Harlem Desir, French Secretary of State for European Affairs, said the Touquet Treaty is “a bilaterial agreement. So, there will be no blackmail, nor threat, but it’s true that we cooperate more easily in both being members of the EU.”

Natacha Bouchart, mayor of Calais and a long-time critic of the treaty, has been vocal in her demands for legislative change since the result. Speaking to French broadcaster BGM TV, she said: “The British must take on the consequences of their choice. We are in a strong position to push, to press this request for a review and we are asking the President to bring his weight to the issue.” Some have adopted the slogan of the Leave campaign, telling them to now “take back control of your borders.”

Modification of the Touquet Treaty was branded part of ‘Project Fear’ by the Leave campaign. Because of this, change – if indeed it does happen – needs to be handled carefully by both the British and French governments.

The reaction of Natacha Bouchart is already a worrying sign for refugees. Firstly, it perpetuates the toxic narrative that casts refugees as an inconvenience. And secondly, any souring of relations between the UK and France over Brexit and the Touquet Treaty only increases the likelihood of refugees being used as political bargaining chips in the broader EU crisis over Schengen.

A divided government and disintegrating opposition do little to aid the situation. Furthermore, come October, how likely is a Brexit Tory cabinet – governing off the back of a manifesto predicated on reducing immigration – to extend the support networks offered to refugees? Even before the referendum, Theresa May, a supporter of the Remain campaign, said that Britain should withdraw from the European Convention on Human Rights, replacing it with the more questionable Bill of Rights.

Uncertainty of any kind is the most immediate danger to refugees. “Everyone is talking about it,” said Clare Mosesly, founder of Care4Calais. “But opinions on the impact are divided, which is creating yet more uncertainty.” Refugees, unsure whether Brexit will lead to increased fortification of the border, are prone to take ever more dangerous risks to reach the UK. Even economic uncertainty, seemingly distinct from issues such as the refugee crisis or immigration, has a negative impact. “The thing that worries me about a fragile economy”, said Paul Dillane, “is that when a country’s economy suffers, minorities suffer as well. Tolerance and inclusivity are undermined.”

The government must stress that the welcoming principles and legislation Britain had prior to Brexit remain in place. Andrej Mahecic, from the UNHCR, said “we will continue to rely on the UK’s strong support for humanitarian responses to refugee crises. Our work with the government on the UK’s asylum system and refugee resettlement schemes continues.”

The will from NGOs is there. The political will is less assured. In the aftermath of Brexit, the government must not concede to the darker side of the referendum debate.