Schools (Mental Health Professionals) Bill [HL]
Monday 27th November 2023
(1 year ago)
Lords ChamberRead Full debate Schools (Mental Health Professionals) Bill [HL] 2023-24 Read Hansard Text
Schools (Mental Health Professionals) Bill [HL]
Friday 1st March 2024
(9 months, 3 weeks ago)
Lords ChamberRead Full debate Schools (Mental Health Professionals) Bill [HL] 2023-24 Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Tyler of Enfield
That the Bill be now read a second time.
Baroness Tyler of Enfield (LD)
My Lords, I am delighted to introduce this Bill on a subject that is very close to my heart. I have been calling for counselling to be available in all schools since I first entered the House. I declare an interest as vice-president of the charity Relate. My heartfelt thanks go to the many organisations in the sector that have shared their expertise and briefings with me in preparing for this debate.
Only last Thursday, we had a good debate on the vital role that schools play in promoting good mental health and well-being. Along with other noble Lords, I talked about the need for a whole-school approach to mental health and highlighted evidence pointing out the links between children and young people experiencing mental health difficulties and attendance, exclusion, bullying and academic attainment. My Bill, which provides for all schools—primary and secondary —to have a counsellor or equivalent-level mental health professional, very much fits with that whole-school approach.
Our many previous debates on children’s mental health have revealed a fair degree of consensus that the scale of the problem is growing and requires an ambitious and comprehensive response. It is also clear that the Government take this issue seriously and have taken important steps to improve mental health support in schools, the NHS and the community. I have always welcomed that action. The only real difference is whether that action is sufficient and nationally available. My Bill is about plugging one vital gap in mental health support teams that many who are active in the sector have highlighted, which would improve much-needed mental health support for many young people.
Our debate today is timely. This week’s Resolution Foundation report, on poor mental health preventing people in their 20s working, provoked a predictably wide range of reactions in the press. However, there is simply no getting away from the fact that, unless they are tackled early, mental health problems can easily escalate as a young person enters adulthood and the workplace.
Let me briefly explain why the state of our children’s mental health and the support available to them is so important. I know that it is familiar territory for many noble Lords here, but it is vital to put my Bill into context. According to NHS statistics, almost one in five—18%—of children between the age of seven and 16 years old have a probable mental disorder. For slightly older children, almost half—44%—of those aged between 17 and 18 were classified as experiencing high psychological stress.
According to a report last May by the Children’s Commissioner, the number of young people urgently referred to mental health services had tripled since 2019. Last year, less than half—44%—of the 1.5 million children who needed additional support had received a CAHMS appointment. The average waiting time in England between referral and the start of treatment is the highest it has been in two years.
According to a survey conducted last year by Young Minds, 65% of the young people surveyed who were struggling with their mental health had not asked for any sort of formal help. Critically, 61% of those waiting for some support had stopped attending school, college or work, with one in five children waiting for support missing six months or more of school. According to a YouGov poll commissioned by Barnardo’s, 61% of parents with school-age children experiencing mental health difficulties said that those difficulties were affecting their performance at school. Almost half noted a drop in concentration and focus on their schoolwork.
The cause of this increase is much debated, including in this Chamber. In last week’s debate, although I recognised that many schools are doing a great job, I pointed to the increasing pressure from the academic environment, the growing influence of social media and the online world, and the lasting impact of the pandemic. Indeed, surveys show that most parents are worried about their children’s mental health, with the impact of social media a major cause of concern.
In January 2023, the House of Commons Education Committee stated that it had seen
“overwhelming evidence indicating a radical increase in mental health difficulties amongst school pupils since the Covid-19 pandemic”.
Additionally, the committee argued that the capacity of mental health services was “grossly inadequate”.
I turn to the detail of the Bill. Clause 1 places a duty on governing bodies of state-funded schools in England to provide access to a qualified mental health practitioner or school counsellor. Clause 1(2)(b) states that the qualified mental health professional or school counsellor should be an individual with a graduate-level or postgraduate-level qualification of that name accredited by NHS England. Normally that would be a counsellor or a psychotherapist. Clause 1(2)(c) states that schools with 100 pupils or fewer may collaborate with other schools and share access to this provision, while Clause 2 places a duty on the Secretary of State to give, or make arrangements for, financial assistance to state-aided schools to help them to meet their duty to provide this mental health support.
Before explaining precisely what the Bill would achieve, I reiterate my support for the concept of mental health support teams in schools, which were first piloted in 2019. These teams support a whole-school approach to mental health, working closely with school staff and delivering group and individual interventions offering low-intensity therapy—that is what cognitive behavioural therapy is called in the trade—for children and young people with mild to moderate mental health difficulties.
The teams are mainly staffed by educational mental health practitioners—I am sorry about all the jargon today—who study on a one-year postgraduate course. By last December, nearly 400 mental health support teams were operating in schools and colleges across England covering some 3 million children, which is roughly 35% of pupils. The Government have said that they aim to increase that coverage to 50% by April next year, although that will be considerably lower for primary schools and of course it still leaves millions of children and young people without any support.
An early evaluation of the programme found that many schools reported that they needed most help for children and young people whose mental health exceeded the threshold that the mental health support team practitioners could provide but either did not meet the threshold for CAMHS or needed support while they waited, so a gap in provision is becoming clear. However, I was encouraged by the evaluation showing that, where mental health support teams and counselling services were already working together, the teams were able to pick up and deal effectively with the lower-intensity need, enabling counsellors to work with the more complex issues. Those are two different roles and skill sets but they are a mix that works well together.
I was struck by the research evidence from Barnardo’s, which delivers a number of these teams across England. It found that support teams are effective at supporting children and young people with mild to moderate mental health problems; they improve outcomes for those with access to them and, critically, are cost effective, saving the Government £1.90 for every £1 invested. However, the research also identified a specific gap in the current model in addressing the needs of children with moderate or more complex needs, those with special educational needs or younger children for whom cognitive behavioural therapy is often not appropriate or who do not respond well to its structure. Simply put, some children need to explore their feelings more fully in other ways that are not time limited. The report recommended that the model should include school counsellors to fill this gap, which is what my Bill is all about: ensuring that every school also has access to a qualified school counsellor or psychotherapist.
I shall explain what has been called this missing middle in what I hope are everyday terms. Qualified counsellors and psychotherapists can work safely with young people who are experiencing trauma and abuse, self-harm, suicidal thoughts, violence, anger, issues with food and eating, bereavement, bullying and so on but none the less still do not meet the threshold for CAMHS. Lower-intensity interventions that are currently delivered by existing mental health support team practitioners might include such issues as motivation, exam anxiety, mild to moderate anxiety and depression and behavioural difficulties. Please do not get me wrong: existing practitioners within these teams provide a vital and valuable role, working with children experiencing less intensive symptoms linked to their poor mental health, but many are not trained to work with children who are seen to be at active risk, such as those who may be self-harming or experiencing suicidal thoughts.
There is a clear need for a wider range of therapeutic interventions to be delivered in schools by counsellors and psychotherapists, whose training generally lasts between two and four years, which enables them to hold a greater level of complexity and risk. Without a clear pathway to counselling where required, issues can easily spiral, increasing pressure on already overstretched CAMHS. It is very much a question of both/and, not either/or.
I turn briefly to workforce considerations. When we have had these debates before, Ministers have often raised workforce issues as the reason for the slow pace of rollout or the limited scope of support teams. However, there is good news to be had. The workforce challenge is not simply a question of training more practitioners from scratch. The major counselling and psychotherapy registration bodies—BACP, UKCP and NCPS—collectively represent over 25,000 therapists who currently work with children, most of whom are trained to work with considerably greater levels of complexity than existing support team staff. According to BACP’s most recent member survey, these existing therapists have the capacity to offer over 50,000 counselling sessions for children and young people every week. I strongly urge the Government to look at ways of harnessing the capacity of this workforce in schools, including exploring the integration of counselling within the national mental health support team model. This model has a richer skill mix and the benefit of providing important career progression opportunities and learning opportunities for existing staff, where there have been high levels of turnover.
I cannot end without a quick word on funding. Of course, it is important to acknowledge that the last couple of years have seen welcome increases in funding, but the money is not ring-fenced, nor is it presented in a format that easily enables us to look at total spending across the NHS, schools and elsewhere. There is simply no getting away from the fact that years of underfunding and neglect of children’s mental health services have taken their toll. Recent increases do not in any way match the scale of demand. Back in 2022, the House of Commons Health and Social Care Committee, in those days chaired by the current Chancellor, called on the Government to increase the funding and scale of mental health support teams to cover all schools by 2027-28. Might we expect to hear something to this effect in next week’s Budget?
To conclude, we have the opportunity to transform the landscape if mental health support teams are rolled out to all schools and colleges, as I fervently hope they are, and within that model include a school counsellor in every school, as my Bill proposes. I beg to move.
Baroness Berridge (Con)
My Lords, I thank the noble Baroness, Lady Tyler, for this Private Member’s Bill, which enables your Lordships’ House to focus once again on the mental health needs of young people. The figures of the increased prevalence in young people of mental health symptoms and illness are alarming and I dare say that there is no one in today’s debate or in your Lordships’ House generally who does not know of a young person struggling like this.
The underlying mischief that the Bill seeks to address is to get mental health support early through school counsellors to avoid those mild to moderate symptoms deteriorating and therefore to sustain access to education, which is vital. Whether through the mental health support team, designated senior lead, school nurse, educational psychologist or school counsellor, mental health services need to be accessible via schools. I suggest that the school counsellor could also be the person who co-ordinates the education provision when a child is so mentally unwell that they can no longer access education in school, a cohort that I think is even beyond that outlined by the noble Baroness.
Within the statistics on this issue, one of the most startling is the rise in the prevalence of eating disorders. Among 11 to 16 year-olds, the incidence rose from 0.5% in 2017 to 2.6% in 2023, while among 17 to 19 year-olds it rose from 0.8% to 12.5%.
When the Mental Health Act was passed in 1983, it was not envisaged that children would be detained, save possibly under the Part 3 criminal justice provisions of that Act, but many children are indeed detained under the Act. NHS Digital recorded 997 detentions under the Act of people aged 17 and under in 2022-23, although the true figure will be higher, as not all providers submitted data. The figure also did not include those children who consented to be admitted, or whose parents consented to them being admitted, to a secure institution. The Children’s Commissioner report in 2020 outlined not only racial disparities in admissions to secure facilities, but more girls being detained and consenting to admissions than boys, which may of course be due to the rise in eating disorders that I outlined, which are more prevalent among girls.
Continuing education for those in secure units is so important. Although education can be provided remotely, it may be more difficult if the child has been placed out of area—an issue that I know His Majesty’s Government have been grappling with for years. Can my noble friend the Minister outline whether out-of-area placements of children and young people have ended if they are detained under the Act? If you are so detained, do you then come out with an EHCP, or is it the obligations under Section 117 on aftercare that help you get additional resources to catch up on lost education?
In 2018 the Department for Education prepared a very helpful research paper into the education provided for children in secure mental health institutions, but only 58% of units providing education in the secure estate responded to the call for evidence. Encouragingly, in most units that did respond, discussions with home schools were reported to take place at all points during the pupil’s time in the unit—their admission, their stay and as part of reintegration to the home school. But units had mixed experiences when obtaining sufficient information on baseline levels and progress from pupils’ home schools, with only 60% indicating that this was provided for more than half their pupils. That is 60% of the 58% that replied, so less than half of those trying to teach children in these units have significant information.
We need to ensure that teachers whose careers are dedicated to teaching in the secure mental health estate—I pay tribute to them—have all the necessary information about the child’s previous education. The Bill’s suggestion of every school having access to a school counsellor would provide a person who could ensure that secure units have sufficient information about a child’s current education. It could reassure noble Lords that someone is informed or aware of what is happening in the 42% of institutions that did not respond to the research paper. That represents hundreds of young people whose education we do not know about while they are in the secure mental health estate. It is a gap that I believe needs to be filled.
While the need for mental health expertise in schools is obvious, I am not convinced that legislation is needed to achieve this. It could, in fact, be counterproductive. What if one school has a major event, such as the school next to Grenfell Tower? If that had been part of a multi-academy trust, which it was not, could not all the mental health professionals be reassigned to that school for a period of time? Sadly, that could not happen under the Bill as currently framed, for fear of acting unlawfully.
What is the sanction if a school does not provide access to such support? Sadly, recourse to the courts by way of judicial review looks like the only enforceability option. Do we really want to encourage that? Is a school leader not free to say, “I will spend my resources elsewhere, as my school is in one of the 75 local authority areas that has a family hub and students have access to mental health support and counsellors there”?
I also wonder why the requirement in the Bill is not proposed to extend to the independent sector, as to provide such services would match the requirement to provide PSHE in independent schools. While arguably, of course, some will have access to private mental health support, often late diagnosis there will put the same strain on resources in the NHS that the noble Baroness seeks to avoid, and it will have similar adverse effects on the student’s prospects. As 70% of secondary schools and 52% of primary schools in England already offer counselling services, this causes me to doubt the wisdom of needing to legislate.
It is so encouraging that 14,400 settings have claimed a grant to train a senior mental health support lead. Can my noble friend the Minister reassure me that she has used her well-known expertise with data to look at the settings that have not applied? Are they in areas of deprivation? Is there cross-referencing with NHS data for areas where young people are most at risk of poor mental health outcomes to check whether these are the settings that have not applied for the grant and to enable them somehow to do so?
I am grateful to the noble Baroness for giving your Lordships’ House the opportunity to focus on the mental health of children and young people. While the progress by His Majesty’s Government could perhaps be quicker in its rollout, I regret that I cannot support legislation as the appropriate means to fulfil this important aim.
Lord Watson of Invergowrie (Lab)
My Lords, we are indebted to the noble Baroness, Lady Tyler, for introducing this important Bill. It is certainly welcome because the extent to which young people are exhibiting mental health disorders in school has increased dramatically and the measures introduced thus far by the Government are proving inadequate to the task in hand.
In her powerful opening speech, the noble Baroness demonstrated an existential crisis in the mental health of far too many school students. Why should that be? To paraphrase The Who, one of the seminal bands of my childhood, the kids are not all right—at least, not according to the Programme for International Student Assessment, PISA. Its 2022 survey, whose results were published recently, showed that 25% of UK students reported that they are not satisfied with their lives, compared with the OECD average of 18%. The question is why, but I am afraid it is not one that we can begin to answer today.
As the noble Baroness said, around one in five children and young people aged eight to 16 years in England had a mental health disorder. That in itself is most worrying, but even more so is the fact that, as reported by the Local Government Association, evidence suggests that NHS specialist mental health services are turning away one in three children and young people referred to them for treatment. The NHS, the Government, the system—point the finger wherever you want—but the reality is that young people who need support with their mental health are being failed.
It is hardly necessary to add that experiencing mental health problems can impact educational outcomes, including attainment and attendance, in only a negative way. On the other hand, there is evidence to show that, when effective, mental health interventions are likely to improve educational attainment, particularly in high-risk groups. One example, a study of school-based interventions delivered by the children’s mental health charity Place2Be, found that school-based counselling positively influences educational engagement.
Clearly, although the extent of mental health cases among children and young people had been increasing before the Covid pandemic, they exploded following the weeks and months of school closures. Those latest figures that I mentioned earlier showed an increase from one in eight in 2017, with three-quarters of a million children and young people accessing NHS-funded mental health services in England during 2023. The extent of the crisis is greater than those figures suggest, because the Royal College of Paediatrics and Child Health reported a year ago that more than 400,000 children and young people were waiting for treatment. We can only imagine the compounding effect that being denied the treatment they require will have on their conditions.
The most recent parent survey by Parentkind, the membership association for PTAs, showed that the most common causes of school stress and mental health problems were exam stress, homework-related stress, anxiety, depression and bullying. In each of those categories, the figures were considerably higher for pupils in academies—part of a MAT or stand-alone—compared with maintained or community schools. I am not sure what that tells us, but the disparity requires closer scrutiny.
It is clear that too many children are going into school not ready to learn. This places additional burdens on teachers, many of whom are taking on responsibilities that go way beyond their teaching and learning responsibilities. Last year a survey undertaken by Education Support, a charity dedicated to supporting the mental health and well-being of teachers and education staff in schools, found that three-quarters of education staff often helped pupils with matters beyond their academic work, while almost 70% helped pupils to process their emotions and talked to them about their mental health. A third had even helped pupils to resolve a family conflict. A significant number of education staff feel that there is insufficient support for their pupils from other public services such as CAMHS, social services and the NHS; 11% said there was no such support at all.
These additional demands naturally increase staff working hours and have a negative impact on their own mental health and well-being. This matters, because schools cannot properly support children and young people if their workforce is mentally exhausted or unwell. Healthy teachers are more engaged and effective in the classroom. Proper mental health support in schools is needed to support children and the staff responsible for their learning. Mental health support should be embedded in every school, accessible to every pupil through a school-based counsellor or mental health practitioner. School-based mental health services need to deliver both targeted and universal provision through a whole-school approach.
The Children and Young People’s Mental Health Coalition has called for the Government to embed whole-education approaches to mental health and well-being in all their policies and across all education settings to promote positive mental health and well-being for both learners and staff. This would have a universal impact on the health of every child and young person. The coalition estimates that a whole-school approach programme in England would cost approximately £530 million a year. In the longer term, the cost of not adopting such an approach would be much more.
In fairness, the Government recognised the mental health issues associated with children and young people’s support as long ago as 2017, when they published the Green Paper that led to the introduction of mental health support teams, based on the principle of early intervention. However, by the end of last year, the Government reported that although nearly 400 mental health support teams were operational in England, these covered a mere 35% of school pupils. Understandably perhaps, the Government did not look beyond 2025, by which time they have projected that the figure will have increased to 50% of pupils, which of course means that 50% will not be covered—an entirely unsatisfactory position for the parents and families of children waiting for help, support or treatment.
The other strand of the Government’s approach has been the establishment of mental health leads in schools. That is well intentioned, but cannot be seen as a replacement for adequate capacity in children’s mental health services. Making teachers social workers or therapists by stealth cannot be the answer to this complex challenge. It requires greater funding than the £1,200 grant that schools and colleges can apply for to train a mental health lead. Last month, the DfE reported that more than 15,000 schools had applied for the grant, which equates to around 60% of all schools, again leaving many thousands of children and young people without access to even that limited level of mental health support.
It is to be hoped that the Bill will ramp up the level of support provided. Noble Lords may be aware that the Labour Party has promised to legislate for the provision of quality mental health support in every school, giving every child the support they need to transition back to school and manage personal challenges, with access to qualified in-school counselling staff. It remains to be seen what that means for the level of staff provided. The Bill of the noble Baroness, Lady Tyler, spells out that a qualified mental health professional or school counsellor is an individual with
“a graduate-level or postgraduate-level qualification … earned through a course commissioned by NHS England”.
That is a reasonably high bar, and it suggests that funding will be required to attract people qualified at that level. I certainly hope that will be the level to which a Labour Administration will aspire in their aim to place mental health within their children’s recovery plan.
For now, we can only wish the noble Baroness, Lady Tyler, well with her excellent Bill and hope that it receives the support and fair wind from the Government that it certainly deserves. I hope that the Minister will not tell us that she believes it is unnecessary because the Government are already doing all they can to support the mental health needs of children and young people. What they have done is good, but, as the young people’s organisations that have provided briefings for today’s debate have made clear, it is not nearly good enough.
Earl Russell (LD)
My Lords, it is a great pleasure to speak in this debate in support of my noble friend Lady Tyler’s Bill. I pay tribute to the years of work that she has done in this area.
The first line of the House of Lords Library briefing reads:
“This private member’s bill would require every school in England to have access to a mental health professional”.
My first reaction to this was: why is this not the case already? I declare my interest to the House again as a parent of a child who has gone through a past prolonged period of very poor mental health. In her case, the illness arrived like a freight train on the level crossing of her life. I am pleased that she is better now, and I am aware and, frankly, feel profoundly guilty that perhaps the only reason that she is better is because we, as parents, were able to find and financially afford the means to pay many tens of thousands of pounds for a prolonged period of private residential care.
I am all too aware that many other children are also suffering, often in silence. Too many children are struggling right now to keep themselves safe and well. Equally, too many parents and carers are not getting the help and support that their children need. Poor mental health is a trauma that affects and impacts whole families. I speak only as a parent and, I hope, as a voice for other parents who are going through similar situations and are struggling to find access to the support and care that they need.
I want these children and young people who are suffering to understand that we, as politicians, get them, and that we are here to work together to try to make their lives better. I shall probe and pressure, but my voice is intended to be a constructive and helpful one. I know that Ministers in this place and across government are not only aware of this issue but are working on it and have already provided significant resources to meet these needs.
I will run through some of the arguments again here very briefly, as I have made them before. We face what I call a children and young people’s mental health emergency. There is an unprecedented crisis in children and young people’s mental health. As we have heard, one in five young people now has a probable mental health condition, up from one in nine in 2017. The causes are many and complex, but the headlines are clear, and they are that our young people are suffering. The demand for services is at an all-time high: nearly half a million young people require help, and 2023 saw the highest number of emergency referrals ever. Despite this, many children—perhaps two-thirds—do not have any contact with the NHS.
CAMHSs suffer from chronic underfunding. The average wait time is 21 weeks for a first appointment, and 80% of CAMHSs say they are not able to meet the demand. Many young people are effectively denied treatment, even after episodes of self-harm and attempted suicide. I have called on the Government to accelerate the rollout of mental health support hubs to all schools and colleges nationwide. I ask the Government to commit to bringing forward their target of 50% access by 2024-25 and making it 100%. While I recognise that resources have already been delivered, I hope that the Budget next Wednesday brings some extra much-needed money to this important issue.
The Bill, put simply, is about plugging a service-level gap, the physical health equivalent of which would be only doing blood pressure checks and urgent cancer operations but not providing any other healthcare in between. The rollout of mental health support hubs is welcome and vital, but their intended purpose is for lower-level issues, such as mild depression and low self-esteem. Treating these issues before they worsen is essential. At the same time, many children with already moderate to severe needs are either waiting far too long for access to CAMHS treatment or are being denied any treatment at all.
This is exactly where the Bill comes in, to plug this real and considerable service-level gap in the system. Frankly, it is a very innovative and clever proposal, and I ask the Government to give some serious consideration to it. Even with the rollout of mental health support hubs, it has been estimated that some 6 million children with moderate-to-severe needs will remain in this treatment no man’s land. The Bill will cover what is known as the missing middle—those children with moderate to more complex needs, such as those experiencing trauma, abuse, self-harm, and suicidal ideation. These matters require help to be provided by therapists and councillors with a higher degree of training.
Filling this missing middle under a whole-school approach, in combination with mental health support teams, begins to get us towards the united service delivery system that we need. This system will help to provide early access to treatment, to help to prevent matters escalating and to help to keep children in school, where they need to be. This would also help to relieve the pressure on CAMHSs and help them to specialise as well in the most urgent and challenging cases of all—providing the more immediate treatment that is so desperately required. The number of briefings provided to Members on these issues shows the level of interest in the wider professional community, where these measures carry support.
Finally, while I am aware that there is extra cost associated with these measures, this comes against a background of chronic underfunding in these areas. Only 8% of mental health services spending was allocated to children and young people’s mental health in 2021-22, despite children and young people’s referrals accounting for 18% of the overall NHS mental health demand.
Lord Jackson of Peterborough (Con)
My Lords, it is a pleasure to follow the noble Earl, Lord Russell, who made a sincere and moving speech. I wish him well in his endeavours, and his family for the future.
I welcome the Bill presented by the noble Baroness, Lady Tyler of Enfield, not least because we are both members of the Chartered Institute of Personnel and Development. She obviously has enormous expertise arising from her time with Cafcass and with Relate. However, I take a similar view to that of my noble friend Lady Berridge, in that I am not wholly convinced that new legislation is what we need. We need a holistic, joined-up, integrated and co-ordinated strategy for children and young people’s mental health, and I am not sure that new primary legislation would deliver that.
The noble Baroness was good enough to refer to the great progress the Government have made following the Green Paper, Transforming Children and Young People’s Mental Health Provision, in 2018, which gave rise to the mental health support teams. I accept that there are now 398 teams and that only a third of children are covered, but there is good progress, and we are going in the right direction. Integrated care boards also have a mandate to provide the appropriate commissioned services for children and young people in their areas. Reference is made in the 2019 NHS Long Term Plan for staffing to putting significantly more money into mental health services. That is good.
I am indebted to my noble friend the Minister for her very helpful Answer, which just got in under the wire and came yesterday, to the Question I tabled on 19 February. It talked about
“delivery of the Special Educational Needs and Disabilities (SEND) and Alternative Provision Improvement Plan, which was published in March 2023”,
which is of course a work in progress. It went on to say that the department
“is establishing a single national system that delivers for every child and young person with SEND, so that they enjoy their childhood, achieve good outcomes, and are well prepared for adulthood and employment”.
We have had heavy briefing and lobbying on this Bill. I make the point again that it is a very laudable Bill and I agree with the spirit of it. We would of course support a full national rollout of mental health support teams in all schools and a fully resourced national implementation programme to support every school, college and university. My own daughter has just gone to university, and I know that that is a big mental health challenge in terms of loneliness, homesickness, socialisation and other issues.
However, I am going to concentrate on a particular area of interest of mine. I declare an interest in that my brother, Stephen, is a professor of cognitive neuroscience at Nottingham University and has occupied that position for 20 years. He has done an enormous amount of work on human movement studies, in relation not just to Parkinson’s disease but to Tourette’s. I want to talk about a specific area of concern, children with Tourette’s. It is an acute issue, in that those children and young people fall between the gaps in provision in NHS specialised commissioning services and between mainstream and SEND education. They are often bounced around the system—the term is “service neglect”. Often, they are expelled and removed from schools and then, even if they get to the NHS, they are stuck between paediatric services, neurology services and other mainstream services. Often, they have no diagnosis. When they do have a diagnosis, it is a document that lies unused, in effect, and they do not have any follow-on care. Often, as the noble Earl, Lord Russell, made clear, parents are forced to pay for private provision. Those children often suffer isolation, school refusal and alienation. There is only one clinic in the whole country that specifically looks after children with Tourette’s syndrome and provides out-of-area referral, and that of course is Great Ormond Street Hospital.
Tourettes Action has done what it can over the years, and I am indebted to it for the help and support it has given me. In fact, I led a Westminster Hall debate 14 years ago when I served in the other place—so long ago that we had a coalition Government, and the Health Minister was Paul Burstow. That was in October 2010 and, in all fairness, there has been great improvement since but there is more to be done. Tourettes Action is involving itself in training and support, not just in schools and colleges but workplaces, where it supports employers who have employees with Tourette’s, as well as in youth centres and job centres, disability advisory facilities and prisons.
Just to recap, Tourette’s syndrome is an inherited neurological condition. It is not rare and affects one schoolchild in every 100. This is a similar prevalence to autistic spectrum disorder and paediatric epilepsy. However, unlike with the latter, there are no NICE guidelines in place for its care. Over 300,000 children and adults are living with TS in the UK and, as noble Lords will know, the key features are tics, involuntary sounds and movements. In many areas, there is currently no pathway for children or adults to be accepted into local or even regional services for the diagnosis and treatment of Tourette’s syndrome.
Specific support in schools is vital for children with TS. Children with the condition have to live with the consequences of their education. If they are not given the right support in school, to which all children are entitled, they risk ending up facing unemployment and social exclusion. Special educational needs teachers are currently not given any specific training on Tourette’s syndrome, even though TS prevalence in SEN classes is high. Tourette’s syndrome has hitherto been treated as the subject of risqué jokes and ribaldry, but for the children and young people afflicted with the condition, who are fearful of its effects on themselves—and of the understandable fear and ignorance of strangers—it really is no laughing matter. They too deserve to have a hearing from our policymakers.
I hope that my noble friend the Minister will reassure us that there is at least a commitment to develop a policy on the condition between the Department for Health and Social Care and the Department for Education, because a coherent strategy across government will not only save taxpayers’ money in the long run but help to relieve TS sufferers and their families of a lonely burden that they have carried for many years. I hope that my noble friend can address some of these issues in her response, or at least write to me at her convenience on the issues I have raised. In the meantime, I again thank the noble Baroness, Lady Tyler, for this debate and the opportunity to discuss these very important issues because, at the very least, we are all committed to improving the lives of children in our country.
The Lord Bishop of Winchester
My Lords, I am grateful to the noble Baroness for bringing this Bill to us for its Second Reading. We indeed face a crisis in this area and need to be aware of the long-term consequences of not addressing it.
The Bill would pave the way for just the kinds of interventions that are sorely needed. The NSPCC and our own Library briefing state that more than 20% of children and young people are living with poor mental health. CAMHS referrals are provided for only the most severe presenting issues, while early intervention, though widely recognised to be key to good long-term outcomes, is now a thing of distant memory. The sobering fact is that children are taking their own lives while they wait to be seen, and that is deeply shameful.
Last summer, the Church of England published the document Our Hope for a Flourishing Schools System, which makes specific mention of mental health, it being the issue school leaders most often raise with us. It states:
“Children’s mental health and wellbeing is prioritised and resourced generously by a society that invests in the long-term future of its nation by placing children first in funding and political direction. The fulfilling of a child’s potential should never be hindered, blocked or prevented by the system in which they find themselves”.
However, those words are, sadly, far from being the current reality.
There is, of course, much good practice out there. In my own diocese, Abbotts Ann Primary School has a group of “gardening grannies”, who have helped the children plant and maintain their own veg patch. Milford uses its “beach school” activities to engage pupils with beach art and games, to help them feel better connected to the natural world. St Katherine’s in Bournemouth has “head, heart, hands” time every Friday, to promote mental, spiritual, emotional and physical health. St James’ school in Pokesdown has just rethought pupils’ mental and emotional health, with several designated rooms where children can receive extra support—in the sunshine room, the rainbow room and the harbour.
There are many other excellent examples I could cite, but, excellent as they are, they are not a substitute for policy consistently applied. Schools need specific training in children’s mental health and on its impact on pupils’ behaviour, their attendance and their ability to access learning. This should be for all staff, not just for one individual, as all staff have contact with pupils. Schools also need access to specialist expert support to support and manage children’s mental health in their own settings. This is critical, since access to CAMHS has become so limited over recent years. Schools should not have to find the funding for this from their own budgets.
The intersectionality of mental health with poverty, those involved with social care and other disadvantaged groups must also be considered, since pupils are much more likely to be excluded or refused schooling the more disadvantaged they are. I chair the ChurchWorks Commission, and it is no surprise that our three priorities are vulnerable children and families, tackling poverty, and mental health and well-being. This issue sits at the intersection of all three. According to the Church of England’s toolkit on UKME mental health, a disproportionately large number of people from a GMH background will come into contact with mental health professionals not through the NHS or education system but through the criminal justice system. School and government policy needs to recognise all of the above, and not negatively disadvantage pupils who struggle because of their mental health, leading to yet more severe issues and, ultimately, to disengagement from education.
More broadly, we must recognise that the quality of education matters much more than standards in education. I welcome the fresh approach of Ofsted to include mental health training for its inspectors, but it is tragic that it took the death of a dedicated head teacher to precipitate that. Quality must always trump standards, for without high quality you will not have high standards. Specifically, a narrow focus on attendance statistics might be positively counterproductive. Poor attendance needs addressing by prevention, via high-quality, value-rich education, rather than by simply penalising non-attenders, because poor mental health is the main reason that children—especially those with special needs and disabilities—give for failing to attend. So investing more broadly in mental health via holistic person-centred education would effectively address the Government’s narrower focus on attendance.
In closing, I will set this in an even broader context: we must look at causes. There are abundant reasons why young people today might suffer from poor mental health. The world in which they are growing up is an increasingly dark place. They live with the growing threat of climate change and against a background of the rise of aggressive, dominant and domineering global powers. Is it any wonder that they face the future with anxiety? We may feel that we have little agency in the face of such pressures, but we have much more than the children of whom we speak today. I feel this very much as a new grandparent. What kind of world will Josiah Arthur Zachary, just five weeks old, grow up in? What kind of world are we making for him? I hope and pray we will not let him down, nor so many others like him.
Baroness Wyld (Con)
My Lords, I refer the House to my education interests as set out in the register, including as a non-exec board member at Ofsted, though of course I am speaking in a personal capacity. I am also the mother of three young girls, aged 13, 11 and nine, all in state schools. I am not sure whether that makes me more or less qualified to speak in this debate—I think they would probably say less.
Before I get to the noble Baroness, Lady Tyler, I say to the noble Earl, Lord Russell, as my noble friend did, that I was profoundly moved by what he said about his daughter. I know he has referred to her in a previous debate, and I send my very best wishes to the family. I very much back his point about continuing to speak up and talk about these matters. We are fortunate to have someone such as him to speak on them, as we are to have the noble Baroness, Lady Tyler, whom I congratulate on her Bill and her tireless work for children and families. I have been lucky to work with her on numerous committees in this House, and it is a pleasure. We are very lucky to have her.
I want to try to weave a message of hope into my speech, without sounding like I am being dismissive or not calling out where there are major problems. We all care passionately about this issue, and inevitably we have to call out where things are going badly wrong. It is essential that we do that for the children we want to help.
It is also very important that young people know that many people are committed to this cause, including, I know, my noble friend the Minister. The tone of the debate generally has recognised some of the work that the Government have already done, and I endorse that.
I absolutely support the principle of the Bill. Like the noble Baroness, Lady Tyler, I have campaigned for better mental health provision in schools for some years. I promise that this is not a co-ordinated move, but I share most of my noble friend Lady Berridge’s concerns and am not completely convinced that the practicalities of the proposed legislation would work. However, I acknowledge that the noble Baroness, Lady Tyler, would want to explore this if the Bill were to get to Committee. I think it will take a lot of work.
I want to use my time to talk a bit more about the wider context and the critical role that schools play. I have three points to make. My first point is about homes and families. I agree with the analysis of the noble Baroness, Lady Tyler, of the scale of the problem. Everybody has set it out very well, so I will not repeat what has been said. Under the strain of the pandemic, every young person in this country, at whatever stage they were at, spent some formative years at a time of extreme national anxiety. I do not think we yet fully understand the full impact that that has had, but we are recognising it and we are taking children’s mental health seriously. It is important to do this thoughtfully.
To go back to parents, one of the most important and hardest jobs for parents and carers is being able to strike a balance and understand when difficult feelings are normal and part of growing up and when professional intervention is appropriate. I do not know who said that there is a lot of jargon in this area—and there is—but somebody apologised for the jargon which makes it more difficult for parents and families. I have raised before the difficulty of navigating the system.
Even before we get to the school stage, I draw attention to the family hub model, which again has been mentioned. It should be able to help with this and create a partnership between homes and schools. In the same way that, in the early years, people have been able to turn to their health visitor and ask whether development is normal, we need to have a culture whereby people can say, “Is this mental health development normal, or do we need something else here?” The partnership between homes and schools is so important.
Attendance at school is so important for mental health and well-being. I see the stress on attendance as coming from a place of caring, not wanting to be punitive. The Chief Medical Officer was entirely right to say that it is often better for children with mild or moderate anxiety to be in school. I saw myself, during the pandemic, the impact on many children in our local community, and how they missed the structure and the social side of school, and the fun they had, even if they were not missing double maths.
However, provision has to be there. The noble Baroness, Lady Tyler, is entirely right: the key point about mental health is the importance of early intervention and tackling problems, rather than letting them fester and escalate. We should applaud, and we have, the work already being done in many schools. I am grateful for all the briefings we received. I am aware that I am beginning to sound like a stuck record in my pleas to the Minister, which are straightforward, but this needs to be prioritised in funding decisions.
I hope my noble friend is shining a spotlight on the evidence base; I know she will be. The data from NHS Digital and Place2Be around school attendance is compelling, and I have seen the impact of these projects myself on school visits. I have seen the work of charities such as Place2Be. When you hear it from the children and see the development that is made, it is really heart-warming. We should acknowledge that the Government are rolling out services and targets.
Like everyone else in this debate, I remain hugely worried about the number of children who fall through gaps in support. The “missing middle” is a horrible term, but there is no other way to say it quickly. We need to make people’s experience of navigating the whole system kinder and more human, because the people who work in this field are kind and human, and there is help out there, but the system sometimes feels impossible to navigate. Signposting and possibly better use of government communications could help with this.
My final point, and the thing I really want to say, is about admiration for the current generation of children and young people. As policymakers, we all need to be more adult in the way we talk about them. I hate seeing anything about “snowflakes”, or “Why aren’t they more resilient?”, because on Select Committees with the noble Lord, Lord Hunt, and the noble Baroness, Lady Tyler, we have taken evidence from the bravest, most resilient children I have ever met. It is our job to speak up for them. I wish they did not have to be so brave and resilient, because the fact is that they are having to be resilient every single time something happens to them and it is impossible not to be despondent when a young person does not get the treatment that they deserve.
However, there are absolutely brilliant people working in this area. There is proof that early intervention works. The system can work incredibly well, with insightful triaging and access to the right help at the right time. Young people need to know that feelings do not have to last for ever. I was trying to think of an equivalent song to counter the example from the Who and I cannot think of one—but we have got to give them some hope.
Once again, I congratulate my noble friend Lady Tyler and thank her for her commitment to children and young people. I know that I keep saying, “Can you just do more?”, but that is my message: just do more.
Lord Storey (LD)
My Lords, I obviously start with a big thank you to my noble friend Lady Tyler for this Private Member’s Bill. She is a worthy parliamentarian to take up this issue and to stick with it until she gets the result that is so needed for our children, schools and colleges.
I have rarely been in a debate where I have agreed with every single point that colleagues have made, whether it is about eating disorders, gardening grannies or Tourette’s. I was so glad the noble Lord, Lord Jackson, talked about it, because I had not thought of the effect on children themselves. I suppose that, in some respects, it has all been said before. Indeed, we had the precursor to this Private Member’s Bill last week. Good: the more we talk about it and the more we raise these issues, the more we all learn, and Governments of the day take action.
I look back on my 23 years as a head teacher, and mental health was not talked about in schools. Yes, there was bullying, and schools had bullying policies. Yes, there were behavioural problems, and schools had behavioural policies. Yes, there were children who perhaps behaved in odd ways, and did not turn up for school, et cetera. The right reverend Prelate the Bishop of Winchester and the noble Baroness, Lady Wyld, were absolutely right to say that you do not deal with non-attendance by penalising but by finding out the reason why pupils are absent—it might well be because of a mental health problem. The last thing that we want in the world is for those people not attending school to suddenly decide to be home educated so they will not be penalised.
So these things did not happen and then gradually local authorities and the health service started establishing CAMHS. That was a lightbulb moment for all of us; we saw how effective CAMHS could be in supporting children and young people. And then, sadly, through no fault of politicians perhaps, along came the recession and Covid. Everything ground to a halt. Cuts were made and services suffered. I look back, as I have said many times before, to my local authority of Liverpool. We lost a third of our budget and so looked for things that had to go. Some support services were lost.
I will make a few brief points. We talk about mental health support for children and young people, but get this: it is also needed for teaching and non-teaching staff in schools. Two months ago, I met a head teacher of a very large primary school who had had a serious mental breakdown. He was so busy being concerned about and supporting his staff and pupils that his own health suffered. He should have had support readily available.
As my noble friend Lady Tyler said, across the political divide, we all want the same result: qualified and readily accessible mental health support provided in our schools and colleges. There are variations in what we can provide and how we make that provision. We on these Benches feel that it should be for all schools, not just secondary schools, although we recognise that it may make sense to share that provision across smaller primaries. As my noble friend points out in her Bill, we need properly qualified staff, with wraparound support from other professionals. We understand that there will have to be a rollout, but this should not be an opportunity for delay and penny-pinching.
I also make the obvious observation that early intervention by proper diagnostic support is the most effective provision. The earlier the support needs are identified, the better the pupil, student or staff member can be helped.
The noble Lord, Lord Jackson of Peterborough, used the term “lobbying”—well, the more they lobby me, the better. We have had important briefings from a number of organisations, such as the Mental Health Foundation, Barnardo’s and the Centre for Mental Health. The Mental Health Foundation makes the important point that levels of mental health awareness within education settings remain highly variable. It calls for a minimum level of provision and qualified mental health professionals in every school. It also stresses how important anti-bullying programmes are to young people, as the noble Lord, Lord Watson, pointed out. Mental health issues often start with low-level bullying.
The Centre for Mental Health called for the full rollout of mental health support teams in schools and colleges and a fully resourced national implementation programme to support every school, college and university so they can adopt a whole-education approach to mental health and well-being.
Barnardo’s backed the call for mental health support in all schools, but made the important point, as did my noble friend Lady Tyler, that mental health support teams do not work for all children. Many with moderate or complex needs cannot be supported by MHSTs and do not meet the criteria for child and adolescent mental health support—CAMHS. It believes that the model should be expanded to include counsellors to allow children to access a consistent offer of support.
I think we were all moved by the personal tale from my noble friend Lord Russell. Perhaps “courage” is the wrong word for it, but good on him for being able to stand up and use his own personal experience.
I have two questions for the Minister, which may already have been raised. First, where does mental health figure in the training of teachers, if at all? I think the right reverend Prelate mentioned that. If it does not, why not? Secondly, we are talking about schools but there has been some mention of universities and higher education. I am conscious that universities and the higher education sector are either wholly autonomous or semi-autonomous, but how do we make sure that the necessary support and provision are there? Is it just left to those stand-alone institutions to provide it?
Finally, we must all hope that my noble friend Lady Tyler is successful with her Private Member’s Bill, and I once again say a big thank you to her.
Lord Hunt of Kings Heath (Lab)
My Lords, it is a great pleasure to wind up for the Opposition. I agree with the noble Lord, Lord Storey, that this has been an incredibly well-informed debate. We are all grateful to the noble Baroness, Lady Tyler, for bringing the Bill forward and for the way she argued for every school to have access to a qualified mental health professional.
The growing increase in the incidence of mental disorder suffered by so many young people is alarming, as the noble Baroness, Lady Berridge, rightly said. My great fear is that we are storing up so much trouble for the future that, unless we deal decisively with the issues now, we as a nation will face severe problems in the decades ahead. That is not confined to mental health: last month, the Academy of Medical Sciences released a very stark report highlighting wide-ranging evidence of declining health among children under five in the UK. More than a fifth of five year-old children are overweight or obese, one in four are affected by tooth decay and vaccination rates have plunged. Although we are focusing on mental health today, we must recognise that there is a much wider health dimension to the situation for many of our young people. As the right reverend Prelate suggested, this will have an impact on them for generations and on our economy, in terms of the number of people who will be fit to work in the future.
My noble friend Lord Watson correctly asked why that is happening and the noble Baroness, Lady Tyler, had a go at answering. She suggested that it was because of pressure in education and I agree with her. I will not mention SATs much today, but there are issues around the pressure that some children feel because of the insistence on the SATs process. There is also the impact of social media and the pandemic. The right reverend Prelate also mentioned concerns about climate change. I think he was thinking of malevolent, dominant global powers; we know what he means by that.
This issue, however, is surely also linked to the persistent absence of children. In dealing with that, we have to understand the underlying causes. I look forward with interest to the Minister giving her analysis of why she thinks it is such a persistent and worrying problem.
The second major issue that comes across is the challenge for us all—particularly as parents, grandparents, guardians and those concerned about young people—in what to do when faced with a young person in distress and the problem of navigating the system. Again, I ask the Minister to explain more about what she thinks is, and ought to be, the response of local agencies to that gap. I particularly want to understand the relationship between education and the integrated care services in the health service. What mechanisms are there to provide some kind of point where one can go to seek help? I am afraid that, at the moment, barriers are set up and rationing processes are put in place. For parents desperately concerned about the impact of mental health issues on their child, it becomes alarming, so we need to think about what immediate help we can give.
Noble Lords quite rightly commented on the number of young people affected by mental ill health and the problem of providing appropriate access to services. The scary thing for me is that one in three children and young people referred by a professional was unable to access any mental health treatment whatever. That has been called the missing middle—the gap. We also heard the noble Lord, Lord Jackson, speak very movingly about a small coterie of people struggling hugely to get the support that they need.
The noble Earl, Lord Russell, spoke so movingly about some of the challenges that parents face. Again, can the Minister say what we are going to do, faced with this massive number of children—it is estimated to be 232,000—who cannot access any support whatever? Of course I recognise that schools can be tremendously helpful in this regard. As I understand it, in research they are the most commonly reported source of advice and help by families. However, the question is whether they have enough resources or enough access to other resources to be able to fulfil that responsibly.
The economic case for investing in support for schools is pretty overwhelming. There is a direct link between the number of children with poor mental health and those who do not do well in education. The Resolution Foundation found that if children aged 11 to 14 suffer poor mental health, they are three times more likely not to pass five GCSEs, including English and maths, compared with healthy children. That, of course, goes right through the system. They do not get into work as effectively and their life outcomes are very poor. As a society, if we are concerned about the future, and are therefore concerned about the number of people in the working-age population who are not in work at the moment, as we certainly ought to be, the case for investment in young people’s mental health and in schools in particular is very strong indeed.
Like other noble Lords, I acknowledge that the Government, through NHS England, have rolled out nearly 400 mental health support teams, and more are planned. The Minister will of course know that one can hardly resist the temptation to quote Jeremy Hunt at her; he said that the current programme is “unacceptable” with regard to progress in rolling it out to the rest of schools. I ask her again whether at this point the Government will review this and listen to the arguments that have been put today to ensure that we give it the right priority.
As regards the Opposition—the Labour Party—we believe that we have to put far more energy and focus into: improving mental health services; cutting waiting lists for mental health services by recruiting more staff; introducing specialist mental health support for children and young people in every school; having open-access children and young people’s mental health hubs in every community to meet some of the gap that noble Lords have identified today; and passing legislation for a new register of home-schooled pupils to keep track of those not in mainstream schooling, as part of a new package of measures to deal with persistent non-attendance.
In conclusion, in welcoming the Bill of the noble Baroness, Lady Tyler, and what she said today, we cannot be complacent. The scale of mental health disorder among young people is now so great that their future and the country’s future are very much at risk. I hope the Minister will be able to respond positively to this afternoon’s very well-informed debate.
The Parliamentary Under-Secretary of State, Department for Education (Baroness Barran) (Con)
My Lords, I also offer my congratulations to the noble Baroness, Lady Tyler of Enfield, on securing a Second Reading for her Bill. I thank all those noble Lords who shared their personal experiences of how the mental health issues of their children and wider families have had an impact on them. I join noble Lords in recognising the extraordinary job that our schools do in supporting pupils every single day and, of course, I thank those charities that work in our schools and outside them to support young people.
I am grateful to my noble friend Lady Wyld for stressing the importance of good attendance as a protective factor for children’s mental health. As she rightly said, the Government approach this with a very caring intention. There must be boundaries around it as well as consequences in certain cases where children do not attend and parents facilitate that without good reason. The intention is clear. Of course, enabling children and young people to thrive is a priority for this Government, which is why we actively explore approaches that could improve young people’s mental health and well-being.
Of course, I welcome the noble Baroness’s tireless commitment to ensuring that mental health support is available for all children, but I must express reservations about this Bill. As the noble Baroness acknowledged, most schools already have in place mental well-being provision, including counsellors, educational psychologists and pastoral support staff. All of those can play a valuable role, but maintaining a school’s flexibility to choose what works best for its pupils is paramount. For instance, depending on their needs, not all children will benefit from specific mental health interventions such as psychotherapeutic counselling. Schools are well placed to decide which approach will be most effective, drawing on specialists where necessary.
Beyond this, it is important to reiterate that schools are not health services and should not be expected to act like one in terms of managing specialist staff. They may choose to do so where they have appropriate expertise, but we believe that our current approach, which encourages collaboration with specialist services where appropriate, avoids putting the extra role and burden on schools that the Bill would involve.
On the co-ordination between the health service and schools, my noble friend Lord Jackson of Peterborough asked, specifically in relation to Tourette’s syndrome, whether there is co-ordination between the two departments. We are more broadly taking a joint approach to workforce planning and reforms to the special educational needs and AP systems. There is an implementation board, chaired jointly by Education Ministers and Health Ministers.
Returning to our schools, our aim is for schools to be a place where positive well-being is promoted and mental health difficulties are picked up on early, with referral to specialist services as needed—an aim that is being pushed forward through our programme of grants for senior mental health leads in schools and colleges and the continuing rollout of mental health support teams. My noble friend Lady Berridge asked about the take-up of grants for senior leaders in different areas, including whether schools with particularly high levels of disadvantage had lower take-up. I do not have that specific data for her, but we know that lower take-up has been seen in London, the east Midlands and the east of England, so we are working hard there to encourage higher take-up.
The Government’s focus, as many noble Lords have advocated, is to support schools to develop a whole-school approach. That wider approach to well-being works alongside more specialist support, which is why we agree with the spirit of the Bill, if not its specificity. That is why we have a comprehensive plan to roll out mental health support teams, including access to education and mental health practitioners, who deliver interventions and support schools to develop their whole-school approach.
The noble Lord, Lord Storey, asked whether there was more focus on mental health in the initial teacher training and early career framework. The very recently updated framework, published in the past few weeks, has a much greater integration of special educational needs and disabilities, including mental health within that. We expect these teams to cover at least 50% of pupils by April 2025.
We come to the issue of funding, which a number of noble Lords, including the noble Lord, Lord Hunt of Kings Heath, mentioned. He will understand very well that it takes time to train mental health professionals. Although I absolutely acknowledge and share the urgency that noble Lords have expressed this afternoon, it is important that we learn from early intervention to make sure that the support team model is as effective as possible—but we are also trying to co-ordinate and take a responsible approach to rollout, working with NHS England to make sure that we do not draw professionals away from the wider mental health workforce, which clearly would not be desirable.
We are also building on the learning from the independent evaluation of the Green Paper programme and data and intelligence from the ground, which will help to shape future delivery. One of the strengths of the mental health support teams is that they are an NHS service focused on supporting schools and pupils in a responsive way. That need for it to feel human, as I think my noble friend Lady Wyld phrased it—the noble Lord, Lord Hunt of Kings Heath, also referred to the difficulty that people sometimes have in navigating these systems—is absolutely critical. They are specifically trained to do that, and to build those links between sectors.
It is also true that even a significant number of additional staff in mental health support teams cannot provide all the help that pupils need, which is why the range of pastoral support and early interventions that schools already provide, including drawing on counsellors and educational psychologists, is so important. We have been working with the mental health support teams to make sure that they support that provision and do not displace it. But we are concerned that, by specifying just two types of professional support, the Bill is likely to constrain the range of support options that pupils can benefit from, which I know is not the noble Baroness’s intention.
We have also committed to offering all state schools and colleges a grant to train a senior mental health lead by 2025, enabling them to introduce effective whole-school approaches. More than 15,000 settings and the great majority of secondary schools have claimed a grant so far. This training and associated support equip schools to offer the right support from the full range of sources, making the best use of their funding.
Lord Watson of Invergowrie (Lab)
I do not know whether I picked this up correctly, but I think the Minister said that all schools would have access to mental health support teams by 2025. I thought the figure the Government were aiming for was 50%. Have I got that wrong?
Baroness Barran (Con)
There are two different elements, and I apologise to the noble Lord if I was not absolutely clear. He is quite right that with the mental health support teams we aim to cover 50% of schools by April 2025. What I was referring to just now was the senior mental health lead training, so that there will be a senior mental health lead in every school, supporting staff in their response and giving them confidence to respond to children, which we know is so vital.
My noble friend Lady Berridge referred to children in secure mental health institutions. I will write to her. We are reviewing and redesigning provision to support the move to more community-based provision closer to home—a concern that my noble friend rightly raised. I am not aware of whether there is updated data on this but if there is, I will share it with my noble friend and put a copy in the House Library.
In conclusion, we believe that, to continue to support children and young people, rather than having a new set of requirements in schools, we should continue with the rigorous implementation of the evidence-based approach exemplified by the mental health support teams and the senior mental health leads. For that reason, we cannot support the noble Baroness’s Bill.
Baroness Tyler of Enfield (LD)
My Lords, I thank the Minister for her thoughtful response. It is true that we share broadly the same aspirations and, as she said, there is plenty in the spirit of the Bill that we can all agree on. I thank all noble Lords who contributed to this excellent debate. I know we often say, “It’s been an excellent debate”, but this really has been, and I have learned so much from it. It has really added to my understanding.
I particularly thank the noble Baroness, Lady Berridge, for pointing out the position of children detained under the Mental Health Act and in secure units. That was an extremely important point. I thank the noble Lord, Lord Watson, for his support and for emphasising that children need to go into schools ready to learn. At the moment, too many do not. I thank him for his support and for saying that the Bill would ramp up the provision needed.
I am particularly indebted to my noble friend Lord Russell, who, as other noble Lords said, so movingly referred to his personal experience. He highlighted the plight of parents who cannot afford to pay for the provision that they know their children and young people need. It is heart-rending, frankly, to think of that. He vividly described the missing middle that I have been talking about in the Bill. I just wish I had thought of that analogy myself.
I thank the noble Lord, Lord Jackson, for his insightful contribution and for raising the issue, which I had not thought of before, of children with Tourette’s, and how that is another example of children falling through the gaps in provision. The right reverend Prelate the Bishop of Winchester made a powerful and wide-ranging intervention; I was grateful to him for drawing the links with poverty and disadvantage.
It has been my pleasure to work closely with the noble Baroness, Lady Wyld. I am so grateful for her support for the principle of the Bill and for reminding us about the importance of family hubs. As she said, there must be hope, and I hope that the Bill can in some way add to that hope.
I thank my noble friend Lord Storey for his historical perspective on the development of mental health provision in both the NHS and schools. I thank him for his focus on teaching and non-teaching staff, which was a really important point.
I was grateful to the noble Lord, Lord Hunt, for his general support and welcome, and particularly for the way he highlighted the problem of navigating the system, which so many people and parents find so difficult.
Putting that all together, I have been heartened by the cross-party support for the spirit of the Bill. There is a strong understanding that at the moment too many young people are in that missing middle and falling through the gaps in provision. I am firmly of the view that mental health support teams, which do an excellent job, must contain professionals who are properly qualified to help young people who have moderate to more complex needs so that they do not fall through the gaps because they still do not meet the threshold for CAMHS.
I thank everyone for their contributions. It is heartening to have so much support on the principle. There is perhaps slightly less agreement on the precise way of securing it, but the consensus on the importance of this issue has been exemplary. That is why I hope we can carry on these discussions. I would welcome any amendments to the Bill to explore the practicalities that people have pointed out might not be quite right at the moment. I hope we can find a way that will allow us to take this debate forward and find a way forward. We all wait with bated breath for next week’s Budget—let us see what happens there—but I hope to continue engaging with the Minister on this important issue.
Schools (Mental Health Professionals) Bill [HL]
Tuesday 14th May 2024
(7 months, 1 week ago)
Lords ChamberRead Full debate Schools (Mental Health Professionals) Bill [HL] 2023-24 Read Hansard Text Watch Debate
Baroness Tyler of Enfield
That the order of commitment be discharged.
Baroness Tyler of Enfield (LD)
My Lords, I understand that no amendments have been set down to this Bill and that no noble Lord has indicated a wish to move a manuscript amendment or to speak in Committee. Unless, therefore, any noble Lord objects, I beg to move that the order of commitment be discharged.