Mental Health Services: Children and Adolescents

(Limited Text - Ministerial Extracts only)

Monday 17th July 2017 Lords Chamber

[Baroness Lawrence of Clarendon]

To ask Her Majesty’s Government when they intend to bring forward proposals to reform Child and Adolescent Mental Health Services as outlined in their 2017 manifesto.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)]

My Lords, the Government are committed to delivering their manifesto pledge to reform child and adolescent mental health services so that children and young people with serious conditions are seen in a timely manner and no child has to leave their local area and family to receive normal treatment. We will set out proposals in the Green Paper for children and young people’s mental health later this year.

[Baroness Lawrence of Clarendon (Lab)]

My Lords, I thank the Minister for his Answer. In a report published on 5 November 2014, the Health Select Committee came up with a series of deep-rooted complications in the provision of child and adolescent mental health services. With 75% of mental health problems starting before the age of 18 but only 8% of mental health funding currently spent on children and adolescents, questions must again be raised. Will the Minister consider ring-fencing funding for young people with mental health problems and ensure that it reaches front-line services, so they do not have to wait for another report to be published?

[Lord O'Shaughnessy]

I thank the noble Baroness for highlighting this very important issue. She will know that ring-fencing funding for mental health comes up a lot. There has been increased funding for mental health, but there is more than one reason why ring-fencing is not used for clinical commissioning groups, including honouring the principle of clinical autonomy, and we do not ring-fence around particular disease areas. I should point out that CCGs are being monitored now to ensure that they are increasing spending on mental health, year on year, in line with the increases in funding they are receiving, which is £1.4 billion over the coming years. The noble Baroness is of course quite right in what she said about the specific issue of children under the age of 18. That is why, among other things, we have committed to introducing mental health first aid in all secondary schools.

[Baroness Meacher (CB)]

The Minister will be aware that the threshold for children and adolescents who have severe mental health problems is extraordinarily high and that they may have to wait months before getting any treatment, whereas children with similar levels of physical ill health will be treated within perhaps a day or days. Does he accept that we are still an incredibly long way from equality between mental and physical healthcare, and what does he plan to do about it?

[Lord O'Shaughnessy]

I accept the point that the noble Baroness makes. Unfortunately, we are starting from a low base, over many years, in mental health provision, and that is what we are trying to rectify. She will know that the Prime Minister is deeply committed to this agenda. Let me point to a couple of issues. First, there is the introduction of the first waiting time standards—and indeed there are positive early data on meeting those stretching standards—as well as an increase in the number of beds available for those suffering from the most severe episodes of mental illness.

[Lord Deben (Con)]

My Lords, this is an area which has been not only underfunded but not cared about for a long time, and we have got to get it right. Someone has to stand up for these people because in their own home circumstances they do not have the kinds of opportunities and support that many others do. Will the Minister commit himself personally to make this worth fighting for? This issue is perhaps in the front-line of human rights in Britain.

[Lord O'Shaughnessy]

I completely agree with my noble friend and I commit myself personally to this issue. He may know that I have opened up primary free schools which focus on improving mental health and well-being, so I feel this personally. He mentioned children coming from chaotic homes, which is true in some instances. However, it is not always true. Mental illness can strike anyone, and all families and schools need to be prepared for it. Another commitment in the manifesto, about which there will be more detail in the Green Paper, is the introduction of a single point of contact in schools so that there is a champion, if you like, for any child who needs to access mental health services that go beyond the school gate.

[The Lord Bishop of Newcastle]

My Lords, I declare an interest as a member of the Children’s Commissioner’s advisory board for Growing up North. Recently, the Church in Newcastle and Durham brought together delegates from more than 100 schools in the north-east to share their serious concerns for the mental health of children in our schools. Will the Minister say what is being done to support schools in dealing with this increasingly difficult problem and what plans there are for in-school counselling?

[Lord O'Shaughnessy]

I thank the right reverend Prelate for raising this issue. I have mentioned mental health training and single point of contact. There are also curriculum changes. There will certainly be a number of policies within the Green Paper that will address the points she has raised.

[Lord Rennard (LD)]

The Government in Scotland are considering providing mental health counsellors in every secondary school. Does the Minister accept that all schools should have dedicated members of staff able to do more than just provide mental health first aid, and that there should be a trained mental health and well-being lead in every school, college and university?

[Lord O'Shaughnessy]

That is what we are moving towards with the mental health first aid training for teachers in all schools. The noble Lord will recognise that schools come in all different shapes and sizes and that it is easier to do that initially in secondary schools, which are bigger than, for example, rural primary schools which might only have a staff of 10. It is critical to make sure that there is at least one member of staff who is highly trained in spotting and dealing with the initial signs of mental health problems and signposting them to the relevant authority—local health authority or whatever it is—for further care.

[Baroness Wheeler (Lab)]

My Lords, the recent survey by the Children and Young People’s Mental Health Coalition has shown that the problems young people are now presenting with have become even more severe. Can the Minister reassure the House that funding earmarked for local CAMHS transformation plans will reach local services this year? How are the Government making sure that this happens and preventing funds from being diverted to other desperately stretched services?

[Lord O'Shaughnessy]

The transition from CAMHS is now one of the mandatory national indicators in what is called the Commissioning for Quality and Innovation scheme which provides incentives for performance, so I can reassure the noble Baroness on that. She is also quite right to highlight the issue of severity. That is why, under the plans that we have set out for CAMHS, by 2021 the service will be able to see 70,000 additional children per year for evidence-based treatment.

[The Countess of Mar (CB)]

My Lords, I declare my interest as the chairman of Forward-ME and a patron of the Young ME Sufferers Trust. Many young people with ME are believed to have a mental illness, and despite what the noble Lord said two weeks ago and what other Ministers have said—that ME is not a mental condition—how do we persuade professionals that these children would probably be much better off if they were left to allow their bodies to heal themselves rather than having cognitive behaviour therapy and graded exercise imposed upon them?

[Lord O'Shaughnessy]

I know that the noble Countess feels passionately about this issue, but she will know that it is only right for me to say that we need to be guided by evidence that is collected in clinical reviews. A review is being carried out by NICE at the moment and we shall wait to see the results of that before deciding what needs to happen as a consequence in terms of the kinds of treatments that are appropriate for those suffering from ME.

[Lord Foulkes of Cumnock (Lab)]

My Lords, the Minister has answered both this Question and indeed the previous one in his usual effective manner. However, I wonder if he could tell us on behalf of which half of the Cabinet he is speaking.

--- Later in debate ---

[Lord O'Shaughnessy]

Both halves.

[Lord Ramsbotham (CB)]

My Lords, can I press the Minister on the Green Paper? It is apparent that something must be produced as a matter of urgency. The much-respected Centre for Mental Health has for a long time been reporting on the inconsistency of the delivery of children’s services across the country. What is more, too many CAMHS are offputtingly clinical, formal and remote and do not relate well to children. This is something that we really must get on with, so the Green Paper is required as soon as possible.

[Lord O'Shaughnessy]

I agree completely with the noble Lord. As I have said, the Green Paper will be ready later this year. I am afraid that I cannot give him any more detail than that at this point.