(7 years, 9 months ago)
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Baroness Massey of Darwen
To ask Her Majesty’s Government what action they plan to take in the light of the Association for Young People’s Health briefing There for you which discusses the role of parents in supporting young people with mental health problems.
Baroness Massey of Darwen (Lab)
My Lords, I am delighted to have secured this debate on the very important and pressing issue of young people and mental health, and the importance of parental support. The report is called There for You—an apt title, as I shall discuss. I am grateful to the Association for Young People’s Health, of which I am a proud patron, for presenting the results of its recent survey so cogently.
I am very happy to see that the noble Lord, Lord O’Shaughnessy, is responding to the debate. I am aware of his interest in young people and we have often discussed their well-being in relation to character education and the links to personal, social and health education and life skills education. My noble friend Lord Patel also has a fine track record in supporting the development of initiatives in mental health. Many noble Lords speaking today have a variety of perspectives on this, so I look forward to a lively debate.
I will talk about some of the report’s background and proceed to repeat points made by parents. I will then seek the Minister’s acceptance of these points and his support. I recognise and appreciate that much has been done in recent years in recognition of young people’s mental health needs. I salute Norman Lamb MP for his tenacity and excellent work on this. The Prime Minister, of course, mentioned mental health last week.
I hosted the launch of this report. There, I talked to many parents who have the experience of supporting a son or daughter with mental health needs. They expressed agonies of feeling helpless, guilty, angry and sad at the lack of support. Many had sought private counselling as there was nothing available in the state system. The report estimates that 36% of parents are in this position. We must remember that young people are not just teenagers, but include children of primary school age and younger. These children may show disturbing behaviour—I do not mean just naughty behaviour, which is perfectly normal, but distress, which needs deciding upon and doing something about if it is not to become more serious.
Some of the parents had formed local parent groups. The question occurred to me: what if you cannot afford to get help? What if you do not have, for whatever reason, the initiative to set up a group? It seems that you just get left behind, feeling more and more distressed. I will give two moving quotations from the report. First, a parent said:
“It must be incredibly hard for a young person who’s in crisis themselves to then look at the one person they trust, who is sitting on the floor sobbing … thinking I have no idea what to do, and nobody’s helping me”.
Secondly, a young person said that,
“if they were to empower my mum … then I would feel more empowered too”.
These are real cries for help.
The report is part of a wider parenting project and reflects a survey of parents’ networks co-ordinated by Young Minds, which also does excellent work on the broad aspects of young people and mental health. A thousand parents were involved—not parents who had no voice at all, or those who are perhaps less engaged with their young person’s mental health problems, but it is a starting point for finding out what parents think. A fuller profile of the parents taking part is given in the short report.
The need for such research and action is clear. Half of all adult psychiatric disorders start by the age of 14. Only a quarter of young people referred to specialist services will be seen. Only 0.7% of the total NHS budget is spent on mental health services for the under-18s. Things are simply not changing fast enough, despite all the excellent recommendations and reports. I ask the Minister: how might this be improved? Self-help is good, but it is not sufficient. Parents and young people need a better deal. It is so much better to treat such problems early, rather than wait. Costs, as well as human misery, inevitably increase the longer there is lack of support.
Parents say that there is a problem of waiting times for treatment. They are often left alone to cope. They may have to take time off work, or go part-time or give up work. They struggle to find help or they may feel that they have something to offer but get sidelined. Many parents I talked to said that they needed more guidance on how to offer help to the young person in need. Dealing with a young person in crisis can leave a parent feeling helpless, guilty and under-confident. Parents and families—such problems affect the whole family—are desperate. Parents in the survey made suggestions about how things could be improved.
I will recount some of their ideas. The first is the development of parent support groups. Parents are dealing with the stresses of their children’s lives constantly. Of course, parenting has its joyful aspects, but come a crisis, parents and families often need help rather than having to cope on their own. Support groups are one way of helping. When I was chair of the National Treatment Agency for Substance Misuse some years ago—the noble Lord, Lord Patel, will remember that—support groups for users, parents, grandparents and families were prominent in aiding recovery and, frankly, keeping people sane. Some of those groups were supported by local authorities. Support could include practical advice, with a dedicated worker to provide support. Would that not be a way of helping parents with children and parents struggling with crises, especially mental health crises? Support could include practical advice on where to go next in finding a CAMHS worker, for example, or other consistent key workers. Consistency is really important here. Having someone with professional expertise alongside them would be a boon to parents.
Secondly, parent support workers attached to schools were suggested as another means of helping parents. Such a person might, for example, manage the interface between services such as CAMHS, the school and the home. I certainly advocate a role for schools here. I have long been convinced that much stress is created in schools by overtesting and overpressurising. That is what children say. There is still no requirement for schools to develop coherent programmes for delivering ways of coping, such as personal, social and health education, character education, life skills—whatever we call it, children need it.
Thirdly, parents stressed the need for and importance of early intervention—help before the breaking point. A triage-based service for all levels of mental health issues is important, not just when they become crises. Parents also suggested that out-of-hours support such as telephone helplines could be important. They thought that parents could help design services and delivery. Involving those dealing with problems is always a better way of getting things right—my words, not theirs.
In reflecting on the results of this extremely helpful and powerful survey, I do not underestimate factors such as socioeconomic status, poverty and family situations. But any child, from any stratum of society or any family, can develop mental health problems. We must recognise that, and act on developing the valuable role that parents can play as partners in such situations. There may be some costs involved, but nothing extraordinary. In pure cash terms, the savings would be enormous in the long run. In terms of distress, they would be even more enormous.
Will the Minister reassure us that the Government have their eye on this, and will he personally intervene to encourage initiatives to help parents and young people? I know that he knows it makes total sense.
Baroness Chisholm of Owlpen (Con)
My Lords, I thank the noble Baroness, Lady Massey, for initiating this debate. Mental health is coming out of the shadows and into the light. This generation will benefit from the greater awareness that their parents and grandparents were denied. It is a largely taboo subject for older generations, and because of this, physical health is talked about far more openly than mental health—for instance, we talk about children’s allergies but not their self-harming.
Conversations about mental health issues should be about hope and support, not shame and confusion. As parents, we recognise when a child is physically unwell, but mental health is far more complicated. Differentiating between normal problems experienced by children and the kind of behaviour that could be the first signs of a mental disorder is difficult, yet we know that early intervention is the first step towards effective treatment. As the noble Baroness, Lady Massey, said, half of all lifetime cases of mental illness begin by the age of 14. Parents have a vital role in contributing to support and solutions for successful outcomes. Those who develop good communication skills are more likely to pick up problems.
However, for parents to be able to give the support required, they in turn must be listened to and supported. Parents can feel sidelined. Building resilience in the family brings a better chance of helping a young person in the long term. Making parents part of the solution can help reduce the need for crisis intervention. They have a critical role to play in joint decision-making. It can be devastating and bewildering to realise that something is seriously wrong, and that can be after parents have been struggling for months. Their first port of call is usually the GP. Here they should find heightened awareness, information, advice and options available so that the right decisions can be made about supportive treatment, yet most GPs have very little mental health training. Is this going to change?
Schools have a vital role. Teachers are a large part of a young person’s life. Some 65% of primary school children were in contact with NHS mental services for the year ending June 2016. We must focus on prevention, and parents and schools are central to that. Studies have shown that school-based counselling services have a positive impact on learning. Will the Minister confirm that funding for this counselling will continue?
Oliver Goldsmith Primary School in Peckham is delivering a new programme, funded by the South London and Maudsley NHS Foundation Trust, called CUES-Ed. The programme teaches children to recognise the signs when things are not right, and behavioural techniques to help them to manage their mood. However, this is rare. What training are teachers getting in dealing with mental health problems among schoolchildren? The time has come for joined-up decision-making and care between healthcare professionals, parents and teachers. We must ensure that there is access to effective treatment, that services are tailored and responsive to their communities, that children get the help they need and that parents are included so they are part of the solution. Our children have the right to timely treatment, just as they would get with a physical health problem.
Baroness Lane-Fox of Soho (CB)
My Lords, I too thank the noble Baroness, Lady Massey, for her leadership on this issue.
There is no greater advocate for the change that the internet has enabled than me. I see its benefits on a daily basis and have worked my whole working life within the sector. However, even I do not believe that we have yet understood, and developed the frameworks to help our children deal with, both the benefits and the destruction of this incredible revolution.
There is so much to be positive about. I see my nephews playing multiplayer games and building incredible things, connected to children they have never met before across the world. I see my godchildren playing chess in complicated ways with players they have never seen before in countries all over the world. However, it is hard to ignore some of the data and studies that also show how this technology is affecting children in a negative way. The BBC says that 62% of children on its websites are looking for mental health-related data. I look at this issue from a different angle: the number of children who are using some of the networks that were never intended for them. I declare an interest as a director of Twitter. Although we do not have so many children on our network, Facebook says that 52% of eight year-olds sign up to Facebook, despite an age limit of 14. I am not against social networks—quite the opposite—but there are reasons why they are age-appropriate.
The positives of this amazing technology must be countered by an understanding from parents and teachers about what their children are really doing. I had a small absence from your Lordships’ House as I now have seven-month-old identical twin boys, and this issue is front and centre as they see me with my iPhone or my iPad—probably too much—and immediately their faces turn towards it. I find this world hard to navigate; how it must be if you are living in one of the 1 million families in this country who do not have basic digital skills, I dread to think, let alone if you are a teacher who may themselves be struggling with understanding this complex new world, yet you are responsible for a class of children who may be at varying degrees of usage and attention in the classroom.
I feel strongly that we must create new ways of thinking about this problem. It starts with schools but it must also be led by parents. I pay tribute to my noble friend Lady Kidron who has done a lot of work on children and their rights, but we need to go further. I am keen to understand how we could use more creative thinking and I urge the Minister to consider this. Some amazing people around the world are looking at the issue, and I cite Danah Boyd, who is based at Stanford, as a world-leading expert. I would love to see how parents can be given comfort and reassurance in these uncertain times so as to make sure that the benefits continue to outweigh some of the dangers.
The Lord Bishop of St Albans
My Lords, there are few more urgent issues in modern Britain than the state of mental health among our young people, and I thank the noble Baroness, Lady Massey, for tabling this important debate. Referrals to specialist mental health services have risen dramatically in recent years as increasing social pressures on our young people threaten the mental health of a generation. Issues around body image are one area of particular concern, fuelled in part by the rise of social media. I want to take this opportunity to pay tribute to my friend the right reverend Prelate the Bishop of Gloucester for her important work around body image and self-worth.
One statistic that has caused me concern, and which I have already mentioned in the House, is the rise in self-harm among young boys and girls. Some 20% of British 15 year-olds report some form of self-harm, while in the past five years hospital admissions associated with self-harm have gone up by nearly 93% among girls and 45% among boys. It is notable that of the parents who participated in the report mentioned in the Question put by the noble Baroness in tabling this debate, 59% said that their child self-harmed.
The charity selfharmUK, located in my diocese, does amazing work helping parents, youth workers and teachers understand and respond to the issues around self-harm. But for many who do not have access to such resources, parents in particular, knowing how to respond can be very difficult. It is all too easy to panic and thereby sometimes make the situation even worse. What seems to me to be absolutely essential is readily available support and training for parents, teachers and youth workers about how to help children who are struggling with self-harm and similar mental health conditions. I was very moved, as I am sure were other noble Lords, by the comments made in the past week by the broadcaster Mark Austin in the Times about his struggle to understand his daughter’s anorexia. Can the Minister therefore inform the House what steps, in addition to the welcome mental health training for teachers announced by the Prime Minister last month, Her Majesty’s Government will take to make sure that parents and youth workers are able to access proper resources and support when it comes to understanding mental health in young people?
Lord Farmer (Con)
My Lords, our young people live in a culture that seems to value them for their outward appearance, their achievements and eloquence on social media and, grotesquely, their sexual allure at an even more tender life stage. They are under a significant amount of pressure and need reliable, loving foundations to thrive. Parents have a primary and indispensable role to play in providing these, so I thank the noble Baroness, Lady Massey, for securing this important debate.
As a sponsor-governor of the Ark School in Camberwell, I know about a whole-school approach where anti-bullying policies are not just words on a page but part of a culture that prizes nurture, encouragement and mutual support, all of which are vital. Equally, on-site counselling and therapy when children are clearly struggling with specific issues is needed. However, my heart sinks when the solutions to young people’s mental health problems are deemed to begin at the school gate given that much support, and in many cases the underlying contributors to their difficulties, is to be found at home. While there is an important parenting dictum that says, “Don’t take all the credit, don’t take all the blame”, another aspect of our culture which erodes so many young people’s sense of well-being and good mental health is the pervasiveness of contingent commitment in adult relationships—the sense that, “I will be there for you only as long as my needs are being met”.
The noble Lord, Lord Giddens, who will contribute to the debate later, describes how this transition in the ethics of personal life flows from living in a society with a high divorce rate, yet the toll this takes on our children’s mental health means we must not treat current levels of instability in parental relationships as inevitable. In the past, many children had to face the world alone because of the death of one or more of their parents, but today’s high level of family breakdown can feel like a much more intentional wound. Professor Brad Wilcox’s new research shows that we have more children living in unstable families than anywhere else in the developed world. Researchers at the Institute of Psychiatry showed that experiencing family fracture and separation from a parent in childhood are risk factors for later serious mental health disorders. Finally, US research found that low-conflict separation can also cause great harm. Children blame themselves and assume that relationships are fundamentally unreliable. Strong, stable families lay the foundations for life. Family breakdown has implications for population-wide mental ill health—we ignore this at our children’s peril.
Will the Minister let us know what the Government are doing to strengthen and stabilise families? Does he agree that every government department has a role to play in tackling our big cultural problem of family breakdown?
Lord Cashman (Lab)
My Lords, I too wish to place on record my thanks to the noble Baroness, Lady Massey. I welcome the briefing There For You. It is eloquent, and the parents involved in the survey are hands-on, informed and know how to connect. But what about those who do not? What about those who are not connected and who, in fact, feel disconnected from where to seek help or advice? These are the groups that we need to target and, I would argue, prioritise—those who are unable to recognise or cope with the reality that their child may have a mental health problem. We need to remove the stigmas and barriers around discussion. In that respect, some of us need to come out and admit how all of us, to a greater or lesser degree, battle with mental health problems that our friends and colleagues so rarely understand or acknowledge as a health issue. We need to deal with the causes of mental health problems, both physiological and psychological.
In that regard, I wish to say a few words about young people who are overlooked and often fall through the safety nets we try to construct: lesbian, gay, bisexual, trans and intersex youths. The 2014 What about YOUth? survey of 15 year-olds presents deeply worrying facts that have, sadly, been overlooked by the Department of Health and the Department for Education. The research revealed that 31% of lesbian and gay 15 year- olds and 39% of bisexual 15 year-olds had low life satisfaction, compared with 12% of heterosexuals. Of those who had been bullied in the period under question, 74.5% were lesbian and gay and 81% were bisexual, compared with 53.4% who were heterosexual. These are 15 year-olds, crying out for help but help is not coming their way. These young people are crying out to be understood, especially among their own community and within their social structures. That is why we need comprehensive sex education that is mandatory, not something that schools or religious organisations can opt in or out of, so that people are not bullied or mistreated but are understood.
We need action plans to prevent the damage that is inflicted upon young children from a very early age. That harm affects us all. Parental support is not always there for LGBTI children because, for that to happen, the child would have to come out to their parents or teachers, and sometimes they are not ready or able to do so. If you put religious adherence in to this mix, the damage is toxic. Young people are shut out from families and religious communities and cast aside. There are some organisations doing great work in challenging circumstances, such as FFLAG, of which I am a patron. However, they are underresourced and always in demand. Schools Out is another, and is working hard to educate, particularly in this LGBT History Month. I urge the Minister to work cross-departmentally with these organisations and others to ensure that no child suffers.
Lord Hastings of Scarisbrick (CB)
My Lords, I, too, am deeply grateful to the noble Baroness, Lady Massey, for allowing us to debate this issue. I am very grateful to the noble Lord, Lord Farmer, for framing the very remarks I would have made myself so I shall admit to needing to refer to similar matters.
This debate has given me the opportunity to reflect on what it means to be the parent of an adopted child who came from a severely drug-disabled parent and therefore spent the early months of his life in an incubator without contact with adults and then developed significant distress disorders, which we live with now in his adult years. That led me to look at the detail of the research and to realise that mental disorder is often picked out as being about the distress that a young person or individual may feel, rather than necessarily being about a strict form of behaviour. Anxiety and distress lie behind the statistics from Young Minds, which I found very painful, of the high levels of male and female suicide—tragically, the girls are slightly beaten by the boys. That led me to reflect on how as parents we have responded to the needs of our youngest son.
In my son’s distress and confusion, and very often in his pursuit of answers, more than just parents have been necessary to assist him. As I looked at the report, I realised that there may well be a limitation on how we understand the role of parenting as defined as those who have a direct birth or adoptive responsibility. In our case, the wider community of parents—those from the church community, the local garden centre, the café and the Outward Bound community; those connected to the school; those who have been adoptive uncles and good friends in the wider area and those whom he can drop in on in the shops—those people do not fit the category of “parent” but they are parenting. They are providing a context of security, a relationship and a place of identity, and it is that network of identities that gives security to young men and women who long to find a place in which they can reveal their minds and hearts and release their distress. I hope that we will begin to move away from the liberal consensus that defines security only in relation to those by whom a child is cosseted for their protection to a more open approach to allow our communities, as would be the case in more traditional societies in other continents, to love a child in a community.
Baroness Redfern (Con)
My Lords, I thank the noble Baroness, Lady Massey, for securing this debate. I declare my interests as in the register.
Parents and carers play a huge part in supporting any young person, especially, as we have heard, one who is struggling with mental health difficulties. Parents have more personal, intimate knowledge than a professional would, and therefore can greatly support their child’s recovery. Maternal instinct can quickly pick up changes in a young person that the young person may not be aware of. Motivating a young person even to take their medication can be very challenging in many instances, as can supporting them in attendance of classes. Attendance at school or college offers greater independence in managing their mental health and providing continued support as they become an adult.
It is important for parents to be able to take time to care for themselves, too, and they need help, support and reassurance that they are doing the right thing. The question is: where would we be without our carers in the NHS system? Many parents and carers have no mental health qualifications. They are not mental health professionals. Sometimes it is hard for them to know when they, too, need extra support. In many cases they can feel isolated. That is where organisations such as Young Minds come into play, as well as other organisations such as parent support groups.
Time is of the essence for assessments and referral times. As we know, in many cases early intervention prevents a young person falling into crisis. This debate provides an opportunity to raise the profile of and highlight our young people’s mental health issues, keeping them to the fore. Mental health training for teachers and staff is to be welcomed but I would like to see a much more co-ordinated approach to training, developing strong links with schools, communities and mental health staff, and hope to see a reduction in rollout time.
I shall give two brief examples. The first is of a young person’s esteem using Snapchat. She took 15 images before she could make a choice. She self-harmed and wanted to change her body image so she enhanced the snap chosen, giving herself a tan, using soft focus, et cetera, giving a much better outward appearance until she felt better about herself. The second example is of a young person suffering from loneliness, sleeping intermittently, desperately wanting to answer a text quickly if sent very late at night, or even during the night, so as not to miss out or be left out the next time.
Finally, I feel that by debating issues of young people suffering mental health problems we are making sure that mental health problems are everyone’s problems. Much more needs to be done.
Lord Giddens (Lab)
My Lords, I shall make some remarks about anorexia and obesity in children and young people, subjects that I have spent a chunk of my academic career studying. Anorexia has the highest death rate of any psychiatric disorder. Childhood obesity, as we all know, has taken on the characteristics of a huge epidemic: 20% of children aged 10 and 11 are obese in England and Wales. They seem separate conditions, almost opposites, but they are very closely linked. Both should be categorised as in some part mental disorders and are becoming so. The link is obsession-compulsion in relation to food and the body. Bulimia is like a bridge between the two in the experience of some young people.
There is a kind of unbelievable historical reversal going on here. Being fat was a characteristic of rich people and affected a tiny proportion of people in history. Anorexia was not even diagnosed until the late 19th century and was only known in the activities of saints fasting for the glory of God. Then about 50 years ago we had an amazing generalisation, not just in this country but across the world, of these linked conditions. To me, the main driving force is the advent of supermarket culture from about the 1950s and 1960s. This was the time when one had to decide what to eat in relation to how to be and we found an invasion of the body by compulsions and addictions.
I became interested in anorexia one weekend when I picked up two colour supplements of the Sunday papers. One had a starving teenager in Africa and the other had a starving teenager in the United States in the midst of an abundance of food. I thought that these conditions must be totally different, and so they are. We can be sure that these do not have genetic origins and the family and the peer group are plainly important influences. The family has a double role, obviously, because it can be causative in mental disorders as well as therapeutic. The work of the AYPH, which we are discussing today, is valuable here and slots into wider academic research.
I have a couple of quick questions for the Minister. Are the plans to combat eating disorders announced in January 2016 still on track? What happened to the waiting time targets for teenagers with eating disorders? Finally, what progress has been made with the conclusions of the document Childhood Obesity: A Plan for Action, which also came out in 2016?
Baroness Fall (Con)
I thank the noble Baroness, Lady Massey of Darwen, for securing this important debate and for drawing our attention to the pivotal role that parents play in supporting young people with mental health problems. We bring our children into a complex and difficult world, in which the lines between private and public are blurred and which operates 24/7 in 360 degrees through the likes of Facebook and Instagram. Our children never get a day off. Of course, older generations have always gazed with incomprehension at their children, bemoaning the lost values of their youth, and we are no different. Nor are we unusual in wanting to do our best for them, not just because as parents it is our duty, but also because we have an obligation as a society to care for our young. They are, after all, our future.
I am deeply troubled by the serious rise in mental health issues among children and young people in Britain today and the often inadequate help they are receiving, which puts enormous strain on them and their families. A lightning review by the Children’s Commissioner in May last year stated that as many as one in 250 children were referred to what is known as CAMHS by professionals. Of those, 28% were not allocated a service at all and 58% went on a waiting list. These are children in desperate need of help, who are often being turned away or asked to wait a long time for treatments, left with no one else to turn to but their parents. Parents often try to do all they can to help, but they are not trained specialists and can feel alone and overwhelmed by the responsibility and at times frightened for the safety of their child.
The recent paper “There for you” says:
“The practical impact on parents can be extensive. In order to care for their young people, many have to take time off work, go part-time, take unpaid leave, or resign from jobs entirely”.
There seems to be a corrosive combination of factors at work: a rising demand for help; frozen health budgets; a system of tough thresholds, which means that many referrals are turned away altogether; and long, painful waits for those who are lucky enough to get referred. Too often, by the time help is at hand the situation has deteriorated and the child may face no other option than being admitted to hospital. That is a terrible outcome for everyone. Taking the child out of their social environment, away from their families and friends, can make recovery times far longer and more painful and puts enormous pressure on parents, given that many of these places and sought-after beds are in hospitals miles away.
We have a serious problem, but one that I hope we are finally waking up to. I commend the Government’s recent intervention in this area and look forward to hearing more when their Green Paper comes out later this year. I especially welcome their focus on training teachers in schools, although I hope that that is extended to primary schools, where mental health issues so often begin.
However, diagnosis is one thing; treatment is another. We will never get to the heart of this problem while there are still rigid thresholds, rejected referrals and unacceptable waiting lists. We must try to intervene earlier and more aggressively. I also wonder whether we should not be looking for more creative solutions, working together with schools and the voluntary sector—perhaps in setting up drop-in clinics where parents and children might seek support from outside the system.
I welcome the concerns echoed across the Committee today and ask that we keep our eye on the ball, for we cannot afford to let things go on as they are.
Baroness Tyler of Enfield (LD)
My Lords, I congratulate the noble Baroness, Lady Massey, on securing this vital debate. Parental and family relationships have a huge impact on children’s mental health. This debate is all the more timely, taking place during Children’s Mental Health Week. Recent research revealed that up to two-thirds of children aged 10 and 11 worry all the time, with concerns about family and friends topping the list of causes of anxiety. Figures released last week show that more than 50,000 young people turned to ChildLine last year because of a serious mental health problem. In the light of these very worrying figures, it is hard to overstate the importance of the role of parents in supporting children with mental health problems.
In the time available, I can make only two key points. First, parents are a vital support and often a lifeline to children with mental ill-health. Given that parents spend more time with their child than anyone else involved, they have a crucial role in advocating on behalf of and supporting their child through difficult times. However, as the results from the “There for you” survey show, too often parents feel unprepared and ill-equipped to support their child and consequently struggle to play the vital role that they would like to. Indeed, the YoungMinds parents’ helpline found that 41% of parents said that they felt excluded from their child’s treatment, with other parents saying that they felt confused and isolated. We have to acknowledge that for a variety of reasons, some already mentioned, some parents are simply unable to provide the support that their children need. Obviously, there is a particular issue for children in care. Another specific concern that I want to highlight is perinatal mental health. More than one in five mothers develop a mental health illness during pregnancy or in the first year after birth. The knock-on effect of a mother’s perinatal depression on the mental health of her child can be severe.
My second point is that, as the noble Lord, Lord Farmer, reminded us, the quality of parental relationships has a significant impact on children’s well-being. Children growing up with parents who have low parental conflict, whether together or separated, enjoy better physical and mental health, better emotional well-being and higher educational attainment. Conversely, research indicates that parents who engage in frequent, intense and poorly-resolved conflict put their children’s mental health and long-term life chances at risk. In a recent survey of more than 4,000 children, family relationship problems were reported by CAMHS clinicians as being the biggest presenting issue.
We must promote greater involvement of children and parents in children’s treatment and do all that we can to ensure that effective resources are available to parents. I pay tribute to the free confidential parent helpline run by YoungMinds and its Parents Say network, bringing together parents to form a vital support network. Policy solutions and interventions need to take account of the wider family relationship in which children live and are supported. I urge the Government to prioritise support for parental-couple relationships in wider government policy, to reduce one of the often unspoken root causes of children’s mental health problems.
Lord Patel of Bradford (Lab)
My Lords, I am grateful to my noble friend Lady Massey for giving us the opportunity to debate this important and pressing issue. She has great expertise in the care and welfare of children and young people, which is evident in all the contributions that she makes to the House. It has been an interesting debate and noble Lords have raised a number of important questions. I look forward to the Minister’s response; given the challenging environment, I do not envy him.
The Government pledged £1.25 billion for improving children’s mental health services and £250 million to improve CAMHS provision for each year of this Parliament. However, in spite of these commitments at a national level, those funds are not reaching children’s mental health services and disinvestment is taking place at local level. The Government would argue that there have been no reductions in funding; in essence, that is correct, as there have been no direct cuts from central government. However, we know that the NHS is underfunded and social care is in crisis. The cuts to CAMHS budgets are the result of reduced funding to the NHS and local authorities, which then make cuts to local services and staffing levels. The impact of all this, as so graphically highlighted by a number of noble Lords, is that children and young people and their parents are unable to access services when they most need them.
In January this year, the Government announced that they would be publishing a Green Paper on children and young people’s mental health. Will the Minister give us an indication of when this will be published? I understand that the Green Paper will contain new proposals for improving services across the system and increasing the focus on preventive activity across all delivery partners. I warmly welcome this, but with a note of caution.
I have four questions for the Minister. First, will he assure us that the proposals will be adequately funded? Secondly, as the Government will not interfere with local decision-making or ring-fence money, how can he assure us that any national funding is used as intended by the local commissioning groups? Thirdly, I welcome the focus on preventive activity across all delivery partners—education, health, social care and the voluntary sector—which I believe is a crucial part of the solution to developing a good quality of care, a point echoed by the noble Baroness, Lady Chisholm. Are the Government proposing to issue guidance that will direct these partners to develop new ways of delivering children and young people’s mental health services that are collaborative and integrated? They should look at innovation, given the point raised by the noble Baroness, Lady Lane-Fox, around technology—I think that the noble Baroness, Lady Fall, mentioned that, too.
Fourthly, any new proposals must involve service users. Will the Minister assure us, in the spirit of the report “There for you”, that the people who use services and their families are placed firmly at the centre of any plans in a meaningful, not tokenistic, way, in order to ensure that their voices are listened to, heard and acted on, especially those very vulnerable young people whom my noble friend Lord Cashman highlighted in his speech? It is vital that we build a sustainable future for children and young people’s mental health services. To do anything less risks failing an entire generation of children and young people.
The Parliamentary Under-Secretary of State, Department of Health (Lord O’Shaughnessy) (Con)
My Lords, I pay tribute to the noble Baroness, Lady Massey, both for bringing about this debate and for the work she has done over many years in promoting the issues of mental health and mental well-being. I am extremely grateful to all noble Lords for this well-informed and passionate debate, and will try to respond in my speech to as many questions as possible.
I also welcome the report from the Association for Young People’s Health, and thank the parents in the YoungMinds network for their courage and honesty in discussing the very difficult issues they face in raising children with mental health problems. Parents deal with so much, often under the radar, and they deserve our praise and admiration. As the noble Lord, Lord Hastings, said, the concept of being a parent, in the sense of parenting as an activity, goes much wider. As my noble friend Lady Redfern said, mental health problems are everyone’s problems.
We must be clear, as noble Lords have been very clear today, that there is a real and growing problem with mental illness among young people in this country. It is estimated that around one in 10 children and young people have a diagnosable mental health disorder. That is three children in every class, a fact worth reflecting on for a moment. A new report out today from the Varkey Foundation paints an alarming picture of young people’s mental well-being in this country as compared to other countries.
When I was growing up, self-harm was a problem, but on a very small scale. However, over the last 10 years the figure has increased by 68% and, as the right reverend Prelate the Bishop of St Albans, said, it now affects boys as well as girls. Around 8,000 children under the age of 10 have severe depression—another heart-rending statistic—and the number of 15 and 16 year-olds with depression nearly doubled between the 1980s and the 2000s.
As the noble Lord, Lord Giddens, said, eating disorders are some of the most dangerous mental illnesses, and their prevalence continues to rise. There are multiple, sometimes competing, explanations for why this might be so, which several noble Lords have discussed today, whether family breakdown, as my noble friend Lord Farmer mentioned, the increased use of drink and drugs, the appalling rate of mental illness among children in care, or the effects of consumerism, as the noble Lord, Lord Giddens, set out. This means that a broad-based approach is needed. There is, unfortunately, no silver bullet. But there is hope.
While the trends have largely been negative in terms of the prevalence of mental illness, a sea-change in attitudes is taking place. As the noble Lord, Lord Cashman, described so eloquently, this has particular impacts on certain groups, particularly on minorities, whether according to sexual preference or ethnic minorities. Through concerted efforts by medical professionals, parents, young people themselves, campaigners, politicians and even the Royal Family, we are at last confronting the stigma of mental illness. It is finally becoming acceptable to admit mental health problems without it connoting some kind of personal weakness, as my noble friend Lady Chisholm, pointed out.
Government policy has both led and evolved in response to this change. I am very proud to serve a Prime Minister who is deeply committed to ending “burning injustices”. What greater injustice could there be than to receive inferior healthcare because your needs are mental, not physical? The previous Conservative and Liberal Democrat Government legislated to create parity of esteem for mental and physical health in 2012, and since then the Government have introduced the first mental health waiting time targets and have begun to roll out a series of initiatives—supported by an additional £1.4 billion—to support those suffering from mental illness, including support for young people suffering from eating disorders and to support perinatal mental health, which the noble Baroness, Lady Tyler, highlighted as being so critical.
However, it is important to acknowledge that there is much more do to. There are concerns that funding is not getting through to the front line, as the noble Lord, Lord Patel, said—and as other Peers have said in other debates—and it must be admitted, as my noble friend Lady Fall pointed out, that the performance of child and adolescent mental health services is patchy. Care also needs to be delivered closer to home wherever possible, as my noble friend pointed out. The Government are aware of these criticisms and are working hard with NHS and local authority partners to address them.
The report we are discussing today revolves around the role of parents, and some of the quotes in it are, quite frankly, heart-breaking. They lay bare the helplessness and frustration that many parents feel. As some noble Lords may know, I have spent the last few years working in education and in schools we always talk about parents as being the “first educators”. That is relevant here because in health we can think of them as the “first carers”—the first line of both defence and action, as the noble Baroness, Lady Tyler, pointed out. Government policy must be geared to strengthening parents’ ability to provide the love and support that makes young people more resilient, and to arming them with the skills and knowledge needed to identify and respond to the signs of mental illness when it occurs. The noble Baroness, Lady Massey, asked for my personal support in making sure that there is increasing support for parents through government policy and I am happy to give it.
There are some good examples of government policies that are working in this area. The Department for Work and Pensions supports parenting classes aimed at reducing family conflict, which has been raised as an issue. The Department for Education supports the YoungMinds Parents’ Helpline and the MindEd website, which provide parents with guidance on a range of parenting issues related to mental health. There is also the Family Test, which was introduced by the previous Government and which my noble friend Lord Farmer was instrumental in bringing about.
The NHS England Five Year Forward View for mental health has put mental illness at the forefront of NHS reforms. The noble Lords, Lord Cashman and Lord Giddens, asked about waiting time targets for eating disorders; these will be in place from April 2017. There is more funding, but there are challenges, as we know, in getting it through to the front line. I will respond to the question of the noble Lord, Lord Patel, later.
I think we have also launched today the next stage of piloting the single point of contact, which will benefit children in 1,200 more schools. The voluntary sector is doing pioneering work in this area, whether through Place2Be’s counselling services or through the proposals for a new national parenting trust emerging from the Legatum Institute, where I used to be a senior fellow, and which will provide parent support groups to help parents in a very challenging time of life.
I am delighted that the Government have committed to creating a joint Department for Education and Department of Health Green Paper on children and young people’s mental health. The aim is to publish it this year. I am also clear that this will succeed only if it boosts parents’ ability to support their children to deal successfully with mental illness. It is essential to involve parents in that policy-making. Mental health is being transformed in this country through local transformation plans which have parents and young people themselves taking part in the design of policies.
I take the opportunity to respond to some of the specific questions noble Lords have raised. My noble friend Lady Chisholm asked about mental health training for GPs. That is something NHS England is working on actively with the Royal College of General Practitioners. She will also be aware, I hope, of the Prime Minister’s really important and signal announcement, which outlined that there would be mental health training for mental health first aid in secondary schools. However, I very much take the point of the noble Baroness, Lady Lane-Fox, who talked about that going into primary schools too.
The noble Baroness, Lady Lane-Fox, also talked about the impact of social media and social networks. My oldest child is nearly nine years old and I am frankly terrified by the prospect of her joining social media. There is a kind of fascination with devices and everything that goes beyond it. You try to explain to them that there may be more bad out there than good, but they are desperate to be part of it.
The Prime Minister announced initiatives on digital mental health services, but clearly there is much more that we can do through the Green Paper and she was quite right to point out that businesses need to take responsibility, too, whether that means the social media businesses themselves—I can imagine that she is a forceful advocate for that on the board of Twitter—or other businesses. The Prime Minister has asked the noble Lord, Lord Stevenson, and Paul Farmer from Mind to carry out a review on mental health in the workplace.
The right reverend Prelate the Bishop of St Albans asked about support for parents. Some 90% of the local transformation plans that I have mentioned have parenting and early years programmes. Clearly, for this to be an effective strategy, it must involve getting to parents and families early, before problems arise, so that parents and young people, as they get older, have the skills they need to spot and deal with mental illnesses as they arrive.
My noble friend Lord Farmer asked what else the Government are doing to support families. There is a troubled families programme and, since 2010, there has also been the healthy child programme, which provides health visitor support in the home. As well as that, there is the Family Nurse Partnership, which provides targeted support for young mothers who are vulnerable.
The noble Lord, Lord Cashman, highlighted the issue of LGBTI people suffering from worse mental health. I admit that is something I was not aware of prior to this debate. I am grateful to him for raising it. I understand that in general there is a problem in mental health, in both prevalence and treatment, when it comes to equalities issues, which fall under my brief. That is something I will certainly look into. It is critical that we reflect that in policy.
The noble Lord also raised mandatory sex and relationships education and PSHE. That is a debate I engaged with when I was on the Back Benches. I do not want to reprise the whole argument now, not least because I am in a rather different role, but the issue is one of quality, not necessarily making something compulsory if it is not very good. We need to focus on making it good, then the argument to make it compulsory may be easier to make.
I hope I have answered the questions asked by the noble Lord, Lord Giddens, on waiting times targets. I apologise: it was my noble friend Lady Fall who made the point about this applying to primary schools. She also asked about drop-in centres. I hope she will have noticed that in the Prime Minister’s announcement on mental health there was rather an interesting and innovative idea about supporting crisis cafés and drop-in centres, which are precisely the kind of informal setting that it might be easier for a young person to access to get the support they need.
There is so much more that could be said on this subject. I hope I have given noble Lords confidence that the Government are taking this seriously. We have this wonderful opportunity of a Green Paper. We have to develop it. I do not know what a pre Green Paper is called, but we are in that phase. It feels to me that there is a large and important bucket that can be filled with brilliant ideas. I have some more ideas for how we might do that, but I hope this is the first of many debates on this issue. I am absolutely open to all Peers to discuss ideas they may have to make that a real milestone in mental health services, mental health treatment and building resilience in this country. I look forward to working with noble Lords to make sure parents play a central role in that strategy.