(5 years, 7 months ago)
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Baroness Royall of Blaisdon
That this House takes note of the mental health of children and young adults in the United Kingdom.
Baroness Royall of Blaisdon (Lab)
My Lords, I am delighted that today we are focusing on the mental health of children and young people. I declare an interest as principal of Somerville College, Oxford, and I am particularly pleased that the Minister replying to this debate is the noble Baroness, Lady Blackwood of North Oxford, a Somervillian.
Like everyone working in higher education in universities and colleges, I am acutely aware of and deeply disturbed by the ever-increasing number of students with mental health problems. I was glad to hear the commitment made by the Prime Minister at Prime Minister’s Questions yesterday that the Secretaries of State for Health and for Education will work together to provide a specific fund for universities to develop new and innovative ways to help students with mental health pressures. I trust that whoever is the next Prime Minister will pursue this further.
In 2012, it was in response to pressure from this House, and specifically from these Benches, that the coalition Government committed to parity of esteem between physical and mental health services but, to date, the warm words have little substance. If there were real parity of esteem for children and young people, and if there were early intervention with proper diagnosis and treatment, so much misery could be averted and so much money could be saved in the NHS and other services. For example, in Oxfordshire 40% of police time is devoted to mental health issues.
The statistics are stark. One in four of us will suffer from a mental health problem during our life. The reasons are complex but we know that many of the difficulties begin in childhood and adolescence. Fifty per cent of the problems are established by the age of 14 and 75% by the age of 24, yet only 25% of children in need of treatment receive it and, of those, only 31% referred to child and adolescent mental health services—CAMHS—last year received treatment within that year. CAMHS continues to be what Luciana Berger has described as,
“a Cinderella service within a Cinderella service”.
The House of Commons Education Committee and Health and Social Care Committee published a joint report on the Government’s Green Paper, Transforming Children and Young People’s Mental Health Provision. It was entitled Failing a Generation, and that encapsulates the state of our mental health services for young people.
Stigma continues to be a big challenge and still too many children and young people suffer in silence, sometimes because they fear stigma and sometimes because those who love them do not notice the signs. As someone who has frequently talked the talk on mental health, I have to say that I have not always walked the walk. I am ashamed to say that I failed to notice my daughter’s mental health problems when she was a teenager. She courageously sought help but later suffered the most appalling consequences of postnatal depression, some of which I believe could perhaps have been avoided. She will probably have mental health problems throughout her life but these have been contained and she is now working for a brilliant charity, Artlift, which provides arts on prescription.
Many young people today have a good understanding of mental health issues but, sadly, in many areas the welcome rise in awareness has not been matched by service improvement. Rather, greater demand is matched by fewer staff and overstretched services, while some of the causes of mental illness are ignored. Mental health is no respecter of gender, race or class, but, as ever, it is the disadvantaged who are disproportionately affected. Just last week we welcomed the Timpson report into school exclusions. It demonstrated that a huge proportion of those excluded have special educational needs and many of those will have mental health issues. Children who end up in custody are three times more likely to have mental health problems than those who do not.
In universities, there is a well-documented, exponential rise in the number of students with mental health problems. At Oxford, for example, over the past five years there has been a fivefold increase in individuals reporting long-term mental health conditions. Of course, some people who, rightly, seek advice do so due to low levels of well-being or stress, anxiety and even loneliness rather than mental illness, but we have to ensure that these issues are addressed before they escalate in some way. The university is currently consulting on a new student well-being and mental health strategy with the full participation of students and the whole university, from the vice-chancellor downwards. There is a real determination to ensure that every part of the university is committed to implementing the necessary policy changes and practices so that the needs of all students are met. At Somerville, specifically, we have what I believe to be a good system. It includes peer supporters, a part-time counsellor, a nurse, junior deans and a full-time welfare support officer, but we can always do better. We also have a development programme which helps to build resilience and addresses issues such as time management, which can be the cause of huge anxiety in the run-up to exams.
The statistics are clear but the reasons for the increase in numbers are complex. Students are sometimes referred to as “snowflakes”—delicate individuals who melt when the temperature rises. That is absolutely not the case, but it is the case that the challenges they face are increasing.
Many people arrive at university with established mental health problems, some of which have been diagnosed, but not all. Those who are already in the system may well have had a painful transition from CAMHS to adult mental health services. I know that there is great awareness in government as well as Parliament about this problem, which causes great pain and stress, but to date the need to address it in a comprehensive way has not been met and the 10-year plan lacks the necessary centralised system. The consequence is that young people, at a time of great vulnerability, fall through the net.
The transition from home to university is also a major life change and can be overwhelming. Research is being undertaken to ensure a better understanding of the health and mental health needs of first-year students, which might lead to system change. Yes, transition to university has always been challenging, but it is now more difficult than it might have been before. For some, there is a knock-on effect of a parental divorce. Parents stay together while the children are at home, then, once A-levels or the international baccalaureate are over, they announce their separation. The children, on top of other emotions, have a sense of guilt at having been responsible for keeping their parents together in an unhappy marriage.
LGBT young people experience disproportionately high rates of poor mental health. The freedom of leaving home is a time when some LGBT young people come out—a wonderful and liberating step for them, but one that can be extremely difficult emotionally and can have an impact on their mental health.
There is the stress of the unprecedented financial burden from student loans and increased tuition fees, which adds to the pressure of having to succeed. Some question this pressure, but it is undoubtedly a reality. A new poll today found that more than half of 20-somethings said that finances had taken a toll on their mental well-being. It is felt at university that to get a good job you have to get a good degree, and the pressure of succeeding sometimes throws the work/life balance out of kilter. A man who graduated in the 1950s recently commented to me that when he was at university the libraries closed at 6 pm, but many are now open and populated 24/7.
Then there is social media. The recent social media summit is welcome, but we now need to see action and results. Social media is an advance in many ways, but it is also a torment for many young people who cannot escape their foes—the people who bully them or demean them, who wreck their self-confidence and make their lives a misery. The impact of, for example, Instagram and Snapchat on self-esteem is enormous, because of the way in which they feed obsession about the way that we look and dress, our weight and our physical attributes. It is no wonder that more and more young women, and some young men, have eating disorders when they believe that their self-worth rests on the way that they look, and to be other than a size 6 is not acceptable.
I am delighted that the theme of this year’s Mental Health Awareness Week is body image. I meet many brilliant young people whose lives are blighted by eating disorders or an obsession with hours in the gym. When they are diagnosed it then takes months, perhaps years, to get into a system that is desperately overstretched and underresourced. This devastating disease strikes rich and poor alike, the difference being that if you are wealthy you can usually access treatment more swiftly, as in the case with all mental health problems.
However, money is not always the solution. We should talk about and take responsibility for our well-being, but it is absolutely clear that, despite the Government’s words and some actions, our mental health services are desperate for more investment. I am sure that the Minister will point to increased spending on CAMHS provision, but this barely scratches the surface when you consider the resources that have been taken out of the system. I would be grateful for an assurance from the Minister that the additional money going into CAMHS is reaching front-line services, and an explanation of why we are lagging so far behind other EU countries. I wonder whether she is aware of a recent report showing that we are 21st in the EU for the number of CAMHS psychiatrists, with just 4.5 psychiatrists per 100,000 young people. The top-ranking country, Finland, provides eight times as many psychiatrists for its young people.
Mental health trusts have less money to spend on patient care in real terms than they did in 2012, according to the Royal College of Psychiatrists. The IPPR has found that mental health budgets must rise by more than £4 billion by 2023-24 to achieve parity of esteem with physical health. Last month the Secretary of State announced that budgets would rise, but by only half this amount. So I ask the Minister: how do the Government intend to achieve parity of esteem?
Mental health services need proper staffing, but there are 2,000 mental health staff leaving their posts in the NHS every month, and Brexit is exacerbating the problem. There is a particular issue on in-patient wards, where many agency and bank staff are being used and specialist CAMHS practitioners are at a premium. There has been speculation that this is because of the high workload, poor work conditions and poor pay of CAMHS staff. With regard to staff, the government response to transforming children and young people’s mental health provision fails to mention social workers and the positive role that they play in improving children and young people’s mental health.
The statistics are dry, but their impact on individual lives is mighty. Young people’s lives are disintegrating because they are having to wait for diagnosis and treatment. This in turn has an impact on families, friends, schools, colleges, universities and the workplace, not to mention the economy. It also has a profound effect on charities—wonderful organisations without which the whole system would crumble. The number of charities and volunteers on whom we rely is vast, and there will always be a place for them. However, they should not be expected to fulfil tasks and obligations that are rightfully the duty of the state—a state that at the moment is abdicating its responsibilities in this and so many other areas.
In addition to more people presenting to services, their needs are increasingly complex. Across the country we have seen local authorities having to reduce their expenditure. As a result, youth services, libraries and community outreach workers have been stripped to the bone. These services traditionally provided a safety net for young people, allowing professionals to spot signs of mental ill health early, as well as giving young people a chance to build resilience skills and coping mechanisms. As more young people struggle to get help early on, more of them are approaching CAMHS at a more acute stage of their illness. Of course, some people do not at first want to address their problems face to face, either with friends or professionals, and the new mental health text messaging service launched by the young Royals is an important means of finding help, as is the invaluable, well-established initiative, Childline, founded by Dame Esther Rantzen, another Somervillian.
It is encouraging to see that the Government clearly acknowledge the significance of early years mental health provision. Poverty, neglect and exam pressure all have a role to play in children’s mental health. A YoungMinds survey showed that more than 90% of teachers have seen a rise in students with mental health problems in the last five years. I would be grateful for an update from the Minister on the rollout of the Youth Mental Health First Aid in Schools programme. What percentage of schools are now part of this programme, under which trained staff become champions for improved mental health and well-being outcomes in schools?
I pay tribute to Poppy Jaman, one of the founders of Mental Health First Aid, who led and grew the movement. Two years ago, Poppy suggested that a “wave of change” was coming in mental health, and she is still of that view, although she is concerned about funding. I trust Poppy and she makes me slightly optimistic. Change is coming, but it is coming too slowly.
In their Green Paper, the Government had good proposals, but they are rolling out their plans for only a fifth to a quarter of the country by 2022-23. This lacks not only ambition but a real understanding of the devastation that poor mental health will have on the hundreds of thousands of children and young people who will not benefit from the strategy because its implementation will come too late.
As in every other area of healthcare, innovation must be one of the keys to transforming the provision of mental health care. I know that in our universities, including Oxford, the most extraordinary research is being undertaken. So I end by asking the Minister for her assurance that there is a real joined-up approach between the NHS and our universities. I hope that she will come to Oxford in the near future to discuss innovation, especially in relation to diagnosing, treating and safeguarding the mental health of our children and young people.
Lord Storey (LD)
My Lords, I thank the noble Baroness, Lady Royall, for this debate and for her opening speech, which was fantastic.
As the Royal College of Psychiatrists says:
“A mental health crisis in our children is developing”.
So let me ask the Minister straight off: why then are we seeing a 3.7% fall in the number of child and adolescent mental health services providers in our schools?
The Government have responded to the mental health crisis in much the same way that most Governments react to problems or crises. The NHS Long Term Plan, which includes children’s mental health, is excellent. The Government have set targets in their Five Year Forward View for Mental Health. The Green Paper proposes to bring schools and NHS services closer together. Mental health support teams have been set up and pilot schemes rolled out. Champions have been appointed. Targets have been set. That is all very laudable, but we need action for all children and young people.
As we have heard, one in eight children and young people aged between five and 19 has a mental health disorder in England, and 400,000 children and young people are not getting any professional help or support at all. We can establish mental health champions in schools, train staff to be able to identify mental health issues and embed mental health in teacher training programmes, and it is vital that we do so, but if the resources are not there it is all for naught. It is like pulling a lever and it does not connect with anything. Nothing happens. If a child or young person is diagnosed with a mental health problem, we must have the resources to respond and to support them immediately.
The NHS Long Term Plan says:
“Mental health support for children and young people will be embedded in schools and colleges”.
The Government claim a success in that,
“We are delivering on our commitments to expand mental health services for children and young people”,
as set out in the Five Year Forward View for Mental Health. That may be true, if success is defined as 30% of those with mental health conditions being able to benefit from treatment and support, which is still less than one-third of those who need treatment. Could noble Lords imagine the headlines and the outcry if only 30% of people with serious heart conditions were being treated?
I go back to the NHS plan. The NHS will be funding new mental health support teams working in schools and colleges, which is welcome, but not until 2023—nearly five years from now. Only one-quarter, at most, of schools and colleges will have such a team. There is no indication of when, if ever, there will be a team in every school and college. Will the Government be encouraging schools to add a section to their school prospectus and website along the lines of, “Our academy is the only one in this area to have a Mental Health Support Team. If your son or daughter has a mental health problem, or you think that he or she may develop a mental health problem in the next five years, make this academy your choice”? While this idea is obviously ridiculous, what will the 75% of schools without a mental health support team be able to tell parents when a student needs support? I look forward to the Minister’s reply.
The lack of robust data about the mental health of children and young people is a matter that should shame the Government and, indeed, all of us. The teenagers who were part of the last exercise in, I think, 2004 are now in their 30s. The Department of Health claimed repeatedly that there was not enough money to undertake a full-scale assessment, and undoubtedly money was tight. Another explanation of failure to collect robust data is that the Government were content for the true picture to remain a “known unknown”, because knowing the extent of the challenge would have proved uncomfortable and expensive.
The past decade has seen a whole range of new pressures on children and young people—we have heard some of them from the noble Baroness, Lady Royall—many of which contribute to more of them suffering from mental health issues. The internet, which admittedly has opened up the world to children and young people, also has a dark side. The ubiquity of social media can lead to children being bullied by their friends or groomed by predators. Social media also promotes an image of perfection to which no ordinary person can aspire. Those who have a poor image of themselves can easily find “help” in self-harming and encouragement to starve themselves. All of this, of course, is available 24/7 since the internet never closes, even on bank holidays.
I would like to move from the macro picture to the micro picture. We have all read what reality is like for many mentally ill children and young people, with suicide a too common occurrence. I cannot imagine what it is like to have a son or daughter with a developing mental illness, for whom support only becomes available when a crisis occurs, and only then if you are a danger to yourself or others. For those acutely ill and needing in-patient treatment, a bed is often only available hundreds of miles away, which can make it almost impossible for family and friends to be in contact at the very time when these contacts are most needed.
Training school staff to spot the early signs of mental illness—and the new programme to train all sports coaches—is welcome. However, if there is not the support needed to follow up the issues identified, it will lead to even higher levels of frustration by those teachers and other professionals who work on the front line.
The need to provide better support services is universally acknowledged. Noble Lords will probably have seen from the Treasury minutes in the briefing pack that every single recommendation in the Public Accounts Committee report on the mental health of children and young people was accepted by the Government. Let us hope that the actions really will speak louder than the words.
In concluding, I would like to say a little about what should be done to try to promote well-being and good mental health among children and young people. In February, the Secretary of State for Education and the Secretary of State for Health announced,
“one of the largest trials in the world to boost the evidence about what works to support mental health and well-being”.
This is a welcome development in prevention, and will be much more effective than even the most effective cures. However, what we really need is a study that looks at the multitude of pressures which contribute to mental illness and young people. This study could then make radical recommendations for strategies to minimise those pressures. We have heard about pressures of young people at universities and colleges, but there are pressures right—
Baroness Goldie (Con)
My Lords, we are tight for time. I would be grateful if your Lordships could keep an eye on the clock. Is the noble Lord about to conclude? The allocated time is six minutes.
Lord Storey
I have misjudged my time; I apologise profusely. I do not know where I got 10 minutes from, I must have been looking at the next debate. I will conclude now—my apologies.
Lord Giddens (Lab)
In that case, my Lords, I will start.
Let me begin by congratulating my noble friend Lady Royall on having secured this debate and on introducing it so ably. I am a bit far up the list for this, but my subject is a deeply perturbing one. I want to offer some comments on suicide and suicidal behaviour in relation to the mental health of children and young people.
Is there anything more tragic? It is not just a case of lives lost; it is a case of lives foregone. We cannot respond as a society unless we grasp the dynamics of suicide more generally. Understanding suicide poses unique problems, because by definition you cannot ask the individual why she or he acted as they did. Motives have to be inferred after the event, and this is often extremely problematic. For this reason, official suicide statistics, although they influence much public policy, are always pretty suspect. Can the Minister comment on this, given that suicide rates figure very largely in the national suicide prevention strategy, which I otherwise strongly support?
I spent a good deal of my academic career studying suicide and related behaviours. In my view, we need much more in-depth and sophisticated measures than suicide statistics if we are going to monitor the success or otherwise of prevention strategies. Some aspects of suicidal behaviour are absolutely counterintuitive. People will travel hundreds, even thousands, of miles to throw themselves off the Golden Gate Bridge in California, or in this country, Beachy Head. These include substantial proportions of young people. The youngest who has jumped from the Golden Gate Bridge was only five years old—albeit egged on by her father. Many have been teenagers and young adults, as at Beachy Head.
The Golden Gate Bridge provides the closest we have been able to get to talking to people who have committed suicide, which is otherwise a complete paradox. Throwing yourself off that bridge has a 98% fatality rate. Some of the tiny minority who survived, however, have been interviewed. They all said—this is pretty gripping—that as soon as they started falling, they regretted what they had done. One said, “The second my hand left the bar, I said, ‘I don’t want to die. What am I going to do?’ So I said, ‘Maybe if I get feet first, I’ll live’”. And in fact, this person did, but statistically it is virtually impossible to achieve. Your Lordships may ask what proportion of other suicides this would apply to, if there was data for this doubly tragic act—triply tragic in the case of children and young people.
The research also studied people who tried to jump off the Golden Gate Bridge but at the last minute were prevented from doing so by the police. Amazingly, the results showed that only 6% went on kill themselves. The rest—all 94% of them—lived out their normal lifespan. In other words, and importantly for the relationship to mental health, it is not the case that they remained suicidal personalities. In fact, that very notion is suspect.
The biggest reduction in suicides that has ever occurred in this country did not come from therapy or mental health treatment; it came when natural gas replaced coal-fired gas. Putting your head in the oven had accounted for almost 50% of suicides before that point, but then we saw a steep reduction in the suicide rate, which I am sure was real. The implications of this have to be clearly thought through. Suicide is very different from many of the things that people write about it and much more problematic in its motivation. This has to be recognised.
The suicide prevention strategy that has been rolled out at national level is a very worthwhile initiative. It is also good that substantial public funding has been allocated to organisations such as the Samaritans and the Zero Suicide Alliance. However, does the Minister think that the strategy embodies the most avant-garde thinking about suicide, in the light of research such as I have mentioned? I am not at all sure that this is the case.
In conclusion, perhaps she would like to comment on the following points. First, I know that this debate is about mental health, but it is time to move away from the mental health model of suicidal behaviour towards a more sophisticated perspective, recognising the symbolic richness of that action. Secondly, suicide, attempted and actual, is often as much a form of self-assertion as it is of despair. Thirdly, as the Harvard School of Public Health puts it:
“Intent isn’t all that determines whether an attempter lives or dies”.
The way in which it is done is often symbolically crucial, as your Lordships can see from the case of the Golden Gate Bridge. It is not often that someone says to themselves, “I just want to die and I don’t care how that happens”. More often than not, there is a deeply symbolic and rich emotional content to it.
I hope the Minister will recognise that understanding these complexities is key to the prevention strategy which the Government have quite rightly introduced.
The Earl of Listowel (CB)
My Lords, I also very much welcome this debate and thank the noble Baroness, Lady Royall, for bringing it. I declare an interest as a trustee of a mental health service for adolescents in north London, the Brent Centre for Young People, which began 50 years ago. It focuses on adolescents with suicidal thoughts and tries to address their needs. I am also a trustee of the Child and Family Practice Charitable Foundation, which concentrates on interventions to support post-traumatic stress disorders in young people. I am also a patron of a charity called Best Beginnings, which has been going for maybe 10 years and has developed a video, a drama re-enactment of a mother’s experience of postnatal depression. It is harrowing, but a helpful tool to health providers and others trying to understand postnatal depression. What stands out in that film is the isolation the poor young woman experienced, and the lack of assistance and understanding from the health service.
I will say a bit more about Baby Buddy and perinatal mental health. I commend the Government for their important and significant investment in perinatal mental health. Reports have clearly shown that, by failing to address the mental health needs of mothers, we can readily harm the life chances of their children. It can have a huge impact. I am immensely proud to be a patron of Best Beginnings. In the last six or seven years, it has developed an app called Baby Buddy. This was developed with the royal colleges with the relevant experience—the Royal College of Midwives, and the Royal College of Obstetricians and Gynaecologists. I am drawn most to its videos. The chief executive of the charity is a former BBC film producer, and there is a video of a mother breastfeeding her infant, showing mothers how to breastfeed, and of a father communicating with a young child, helping fathers to communicate with their children. I am proud that the evidence shows that this Baby Buddy app has increased initiation of breastfeeding by 9%, which is a significant improvement and above many other interventions. I mention this in the context of this debate because it is important that infants form secure attachments to their parents.
I will concentrate on the culture that children and young people grow up in and a few other principles lying behind the good mental health and emotional well-being of children and young people. I quote Sir William Utting, a respected social worker and perhaps the chief social work inspector of his time. He produced two reports in the late 1990s on the abuse of children in children’s homes. In his second report, People Like Us, published in 1997, he began by saying that the “best safeguard” for children is an “environment of overall excellence”. The culture in which our children grow up is very important. Perhaps we cannot always be excellent, but we can at least try to be good enough.
The city of Leeds has developed a strategy based on the United Nations Convention on the Rights of the Child. Everything it does, across the whole city, is founded on those principles. It has had outstanding results from inspections of child protection by Ofsted. It has recently been successful in reducing childhood obesity in young people. Again, this is put down to the culture it has created of concern for children’s welfare.
The Minister spoke helpfully about the excellent work the Government have done with social workers in the last 10 years. I would like to talk about the importance of expertise and experience. Timothy Loughton did not have a background in child protection, but took every pains to work with social workers, listen to young people in care and develop a thorough understanding of this work. Working with the noble and learned Baroness, Lady Butler-Sloss, he produced a report called No More Blame Game, championing the status of social workers. Subsequent to Timothy Loughton we had Edward Timpson as Children’s Minister. His family had a background of fostering, he had adopted siblings and he was a practitioner in the family law courts. He had a deep understanding of the issues around supporting children and young people, particularly those who are vulnerable. From that, we have seen many good policies emerge; for instance, the appointment of chief social workers for children and families and other areas.
In terms of the culture, politicians have an important role to play. I have always been of the view that if one is going to talk about the welfare of children, one has to have worked with them to some degree. I am fortunate to have had that experience. Being a parent can be a helpful introduction, but one needs to work with children and young people, understand their vulnerabilities and difficulties, and understand that growing up is complex—we underestimate that as a culture. I see that I need to end here.
I welcome having expert practitioners at the forefront of policy as our chief social workers. Politicians need to be humble before that experience. They perhaps need to see themselves as communicators to the public of what is important, based on what they learn from those who have long experience as nurses or clinicians. That will help create a culture in which our children do much better. I look forward to the Minister’s response and apologise for speaking for so long.
Baroness McIntosh of Hudnall (Lab)
My Lords, at the end of King Lear, where, frankly, the stage is littered with bodies and not much to cheer one up has occurred, the Duke of Albany speaks to the few people who are left standing. He enjoins them thus:
“Speak what we feel, not what we ought to say”.
At this point, I feel that that is all I can do, because, unlike my noble friend Lady Royall who introduced this debate so extraordinarily well, and many others who are speaking, I cannot claim any expertise, whether clinical or in the work I have done in the field of child and adolescent mental health. However, I have some direct personal experience. Many people in my family, including me—I regret having to say it—have suffered from difficulties with their mental health. That includes children and one young child at the moment.
When I put my name down to speak in this debate, I knew that I wanted to speak but I was not sure how I was going to say what I wanted to say. I am still not entirely sure, so if what comes out lacks coherence or is sometimes intemperate, I apologise to the House and in particular to the Minister who has to answer this debate.
Two things have happened in the past 12 hours which have changed the way in which I thought about this subject. One was a television programme, and one was something that happened to a member of my family, a young child. The television programme was shown last night—I do not know whether anybody else saw it—and in it Nadiya Hussain talked about her own anxiety problems. The one thing that emerged from that for me more clearly than anything was that young people whose mental health problems are not diagnosed grow up into adults with mental health problems. That has already been mentioned by others, but we should never forget it. That is the risk we run: if we do not look at children’s mental health early enough, they will grow up into adults who find it much more difficult to deal with the residual problems they have.
This week is Mental Health Awareness Week—many of us are sporting the badges. It may be less widely known in this House that it is also SATs week; if nobody understands what that is, they should look it up. Putting the two together, the few things I want to say are about schools—schools as healthy or, in some cases, unhealthy communities. I want to make it clear that, as I say it, I intend no disrespect whatever to teachers or their students, all of whom in their different ways are trying their best to do a good job in difficult normal circumstances. I say that because I believe it but also because I have quite a lot of teachers in my family, so they would be very cross with me if I did not say it.
Good education must always strike a balance between discipline and freedom; core skills and creative range; learning to be part of a group and learning to be ourselves. Government policy over the past decade has done very little to help schools be healthy communities in that way. It has steadily narrowed the curriculum, reducing choice and imaginative aspiration, and focusing far too much on testing, which is why the SATS point is important. It has downgraded and undervalued arts subjects. I know that this is an old hobby-horse of mine, but I do not mind riding it out again when evidence shows the benefits of these subjects, including to mental health. More than anything else, government policy over the past decade has drained the joy out of education. If you cannot be joyful as a child, it is very hard to be mentally healthy.
I know that the Minister will say, with some good reason, that this is not her area of responsibility, but I ask her to consider that it is the responsibility of the Government as a whole to understand that young people spend a huge amount of their lives in school. Schools are communities, within which adults and young people need to find a way of co-existing such that the education the young people receive is good, enduring, healthy and sustainable. They cannot easily get that from adults who are themselves stressed, overworked and anxious. It is my belief and experience that many teachers in the system at the moment are in exactly that condition.
One way we can prevent our young people from becoming problems and needing mental health interventions is to try to ensure that their experience at school is nurturing, creative, safe and inspiring. That is what schools ought to be. I wish more of them were and I hope that the Minister will understand why I am putting this to her today.
Lord Farmer (Con)
My Lords, I too congratulate the noble Baroness, Lady Royall, on securing this important debate. I will focus on the indispensability of family support, and particularly support for parents’ relationships with each other, if we are to address major contributing factors to children’s and young people’s poor mental health. Prevention should, whenever possible, be at the heart of any mental health strategy, whether from local or national government or from the NHS. Family relationship difficulties are also provoked by mental health problems in a child or young person. Whichever comes first, the family system, not just the person with the diagnosis, needs attention.
In a letter to the Times this week, I said that,
“The breakdown of family relationships creates a plethora of social policy challenges”.
Measures to strengthen families should be on the business plans of every department of government, as families which function well are major assets to their aims and objectives. This is particularly the case here. The NHS survey Mental Health of Children and Young People in England, 2017 found that family functioning was clearly correlated with mental health problems. Almost two-fifths of children from families functioning in the least healthy ways had a mental disorder, compared to one-12th of children in the families functioning most well. Robust surveys of mental health clinicians corroborate this. Family relationship problems were cited as the biggest presenting issue by mental health clinicians in a recent study of over 43,000 children in services.
Distressed children would agree. I commissioned research from a team led by Dr Samantha Callan, my parliamentary adviser, to inform the work of the Department for Education and the Department of Health and Social Care in developing the Green Paper on CAMHS. This included a focus group with young people with mental health problems who had experienced parental relationship breakdown. They highlighted that people in general are “not at all” aware of the effects of family breakdown on children and young people. They described teachers’ and other adults’ expectations that exposure to conflict or parental separation two or more years earlier would no longer impact them. This made it very hard to express ongoing pain from the lingering effects, including the difficulties in keeping in contact with the non-resident parent.
One participant said: “I see girls who don’t see their dads who try to get the attention and the affection from someone much older than them. It can have a bad long-term impact on you if you end up in bad relationships”. Another described their severe problems with anger management, linked to their father leaving unexpectedly more than a decade ago. Other negative effects were attributed to one parent not having recovered from the relationship breakdown. Conflict might have ceased, but children might still be coping with their parents’ depression, bitterness or other long-term ramifications of the split, which went unsupported. One said, “I have absolutely no complaints about the care I have received, but my mum didn’t get any help at all. I might not be sitting here if she had had the same level of support”.
The importance of good interparental relationships was recognised in the 2017 Green Paper, which said:
“Children who are exposed to persistent and unresolved parental conflict are at a greater risk of early emotional and behavioural problems, anti-social behaviour as an adolescent and later mental health problems as they transition into adulthood”.
To unpack the concept of persistent and unresolved conflict, this need not mean a violent home environment but one daily characterised by overt, hostile exchanges or cold, contemptuous indifference.
Apart from citing the DWP’s reducing parental conflict programme, the Government’s response to the Green Paper consultation made no proposals to support families and interparental relationships. Similarly, the NHS Long Term Plan merely acknowledges that a,
“stable and loving family life”
significantly influences young people’s health and life chances. Health services might argue that relationship and family support are someone else’s responsibility, but this ignores the fact that, in a phrase coined by researchers from UCL, good relationships are a health asset. Indeed, I cannot resist saying here that “The key to happiness”, according to today’s headlines from the Office for National Statistics, is to “Eat, drink — and be married”. Moreover, health budgets dwarf government funds earmarked for relationship support, so can my noble friend outline what the DHSC is doing to support family relationships?
I have a couple of recommendations. First, NHS organisations could invest directly in the provision of relationship support. Hackney child and adolescent mental health service employs a specialist to work directly with the couple while another member of the multidisciplinary team treats their child or young person who has been referred. The research found that this is rare, so to help build confidence that embedding couple counsellors in CAMHS teams is good use of scarce mental health funding, the DHSC should fund pilots of this model.
Secondly, early help for families is imperative to address the roots of mental illness and prevent children and young people developing such problems. Local councils, from Newcastle to the Isle of Wight, are making progress in repurposing children’s centres as “family hubs”, so that their expert early years services are preserved alongside services offering help for parents of children aged nought to 19. Health services and education, now both on the front line of help for children with mental health difficulties, are free and available to all, yet we cannot ignore any longer the uncomfortable truth that, without similarly accessible support for family relationships, they will fail to turn back the tide of mental illness in this and future generations.
Baroness Morris of Yardley (Lab)
My Lords, I too congratulate my noble friend Lady Royall on the way she introduced this debate and on giving us the opportunity to speak on such an important issue. I accept all the points made about the lack of resources in the National Health Service, the queuing for CAMHS and the need to invest there. Having said that, I do not want to talk about that aspect of well-being and how we can support young people. If our approach is that we always use an external health model to deal with this issue, we will never actually solve the problem: if we are always treating the crisis, there will always be a crisis. Whatever Government are in power, CAMHS and other mental health services through the NHS will always be rationed to some extent. At the moment, we are seeing teachers in schools spending their time queueing to get their children into the acute services of CAMHS and the health service.
I want to put forward as an example an approach to go alongside that but not replace it, because I know that for some children that level of expert clinical support will be needed. Essentially, we need public health working through schools. As a parallel, in dealing with obesity we deal with the causes of obesity; we have dentists, but we deal with the causes of children having bad teeth.
My noble friend Lady McIntosh made an incredibly powerful and effective speech. But even if we had the sort of curriculum in schools that she would like—and I wish that too—there would still be a need to make school a place where the well-being and mental health of young people are supported. That is the job of adults, whether parents, family, community or teachers. It is for us to create an environment where more young people develop the skills and knowledge to have better mental health and well-being throughout their lives.
I chair the Birmingham Education Partnership; in saying that I declare my interest in the register. Four years ago, we were approached by the clinical commissioning group in Birmingham. It wanted to do this sort of work and knew it did not have the access to the city’s children that we did through the schools system. BEP provided funding to work with schools on a public health model. With its resources, we have appointed a team led by a psychotherapist—a brilliant woman called Anna Robinson—and made up of a family therapist, a head teacher and a learning mentor. So far, the team has worked in 53 secondary schools in Birmingham, appointing a designated senior lead in each school. The job is quite simply this: to help those teachers identify vulnerable children as they come into school from primary; to develop training packages for teachers and all adults who work in the school; to work with external partners, as managed by our group, such as the excellent YoungMinds, the public health authorities and clinical commissioning groups; and, now and again, to bring together the leads from all the schools so that there is a community of interest and support for this work. We are working with 53 schools, and when we finish our fifth year of funded work we think we will be working with all 80 secondary schools in the city. We are now turning our mind to working with primary.
The examples that the noble Lord, Lord Storey, talked about, of some schools having support and not others, are what I experienced and are usual. As an ex-Education Minister, I know that the most difficult thing is not to find what works but to get it into every school. The real challenge is rolling out good practice. I am cautiously excited, if that is not a contradiction in terms, to have got this model into 80 schools in Birmingham in five years and to be all ready to move to the primary schools. I wanted to bring that to the attention of this debate as something I hope we can take forward.
I know that, after we started, the Government came forward with their Green Paper, the first aid kit and measures to work with schools. I applaud that and am grateful for it, but the worry of our team in BEP is that elements of this still use the NHS-based model. If I get over one fact in this debate, it is that that by itself will not work. It has to be a model that is wrapped round, runs through and envelops the life that children have in schools, so that attention to mental health is part of how we do our job and not something that we have to refer children to.
I will finish by giving four or five points that BEP has learned and wants to bring to the attention of this debate—I am merely chair of the organisation and pay tribute to the team. First, quick wins are possible and there is nothing wrong with them, but sustained work needs time and consistency. The fact that we are going into our fifth year of this project is an important message in itself. Secondly, these lead teachers need to be confident and well trained, and have good subject knowledge and the confidence to train others. They therefore need training on an ongoing basis that will bring them together and enable them to do their job. Thirdly, schools need to be supported by an integrated team with other skills and other professionals.
I will make two points to finish about things that are not around yet but which will come. Schools need to know who to go to in order to buy or get good quality support. This will become a market. There are lots of organisations—some good and some not so good—selling or giving services. We will get to the point where we as politicians can list the organisations and resources which schools can access to support this work, but we do not give teachers the information they need to make wise decisions about what they buy or access.
Lastly, our team made a point which made me smile: you have to work within the school year. The National Health Service does not work in line with the school year. If we are to bring professionals together to create in our schools an environment where children are given the skills and knowledge to create as good mental health and well-being as possible, we have to work around the rhythms of what they do.
As I say, I am not putting this forward as something that is guaranteed to be a success, but I am confident that it is a more than valuable and important contribution to the debate, which I am delighted we are now having.
Lord Addington (LD)
My Lords, the fairest question we can ask any Minister in this debate is, “What are you doing to lead the action that is required here?” No one department can deal with this. When you talk about young people, clearly you will be talking about education—there has already been a great deal of emphasis on that. However, if you look across at the things that are working, take a leaf out of your own sports policy. Exercise is reckoned to be incredibly good for most people with mental health problems. Taking part in a sports team is a good way to prevent mental health problems, as you get a positive attitude and company, and the endorphins and stress release of sport help.
What are we doing to encourage that? What is the Department for Education—which, let us face it, is one of the few departments which is not quite as tightly squeezed as the rest of government at the moment—doing to lead this? That is the question that it is fair to ask the Minister; I am afraid that it comes with the job. What are you doing to help make sure that we get things right? If you do not, the Department for Education and everyone else will merely shuffle the problems on to you. What does not come to the Department of Health and Social Care will go into the criminal justice system. Where people fail to function in society is where it ends. On every occasion, when there is somebody who cannot function in respect of mental health or anything else—you name it—that is where you pick it up. You are the catch-all for what goes wrong.
Can the Minister gave us some idea of what encouragement the department is giving to make sure that in the field of education the Department of Health is saying to the Department for Education, “Will you make sure that people are educated in such a way that they can thrive?” I refer to the groups that were mentioned in the good and comprehensive opening remarks from the noble Baroness, Lady Royall: those with special educational needs. I remind the House once again of my interests in this field.
The All-Party Group for Dyslexia and Specific Learning Difficulties, led by Sharon Hodgson, flanked by myself and Henry Smith MP, has just produced a document in which we looked at the personal costs to dyslexics as a group and the amount of stress experienced by an individual and their parents if they are dyslexic and their needs are not being met as they go through the educational system. Stress is a great trigger mechanism for mental health problems—I think that is agreed. What are we doing to make sure that the Department of Health and Social Care says to the Department for Education, “You’re shovelling your problem on to us”? These trigger mechanisms are in place, but because of recent education reforms people are saying to dyslexics, my group—which is not the only one that is suffering—“You must get English”, and are putting an emphasis on taking more spelling tests, which is probably the world’s worst thing to do to a dyslexic. If you have a bad short-term memory and bad language processing, it does not matter how many times you do a spelling test—you will still forget. I know, because I have done it. What are we doing to say, “Stop doing these things that aggravate this very large group”—roughly 10% of the population?
As I said, they are not the only group. The National Autistic Society reckons that 70% of those with autism have mental health problems in the school system because of this pressure. It is not those with the most obvious problems—the low-functioning autistic or very severe dyslexic—but those who probably could just function in the system whom we must worry about. They are the people who will be overlooked and who will not get help automatically. I always use the example that if you have a car at the side of the road with smoke coming out of the bonnet and somebody shrieking, people will stop and help. If you are stuck in third gear, you are a pain.
What are the Government doing to lead this activity? Those are only two small examples covering two areas. How are they bringing this together? If the department does not do that, we will have high, pious words. Everyone will say, “Oh, it is terribly difficult”. Most of the reaction in the education system will be, “If we wait a few years, it will be another bit of the education system’s problem. Then it will be the Department for Work and Pensions’ problem—and then it will be a problem for the criminal justice system and then for the Department of Health”. That is what happens. We need co-ordination, and the Minister’s department must lead it.
Lord Bradley (Lab)
My Lords, I, too, congratulate my noble friend Lady Royall on her excellent opening speech to this very important debate. I also declare my interests in health and education as recorded in the register.
I will take a few moments of my time to sincerely thank both Houses of Parliament, including the Ministers—the noble Baroness, Lady Blackwood, and the noble Baroness, Lady Goldie, who has just left the Chamber—and my noble friend Lady Thornton, on behalf of my sister Janet, Gavin, Miles and both of our families for the very kind messages of sympathy following the deaths of my sister, Dr Sally Bradley, and her husband, Bill Harrop, in the Sri Lankan bombings. They were a great comfort to us all. Thank you.
Turning to the subject of the debate, I will first make a brief comment about the funding of mental health services. In a Written Answer, the Minister advised me that the cumulative increase in NHS England’s revenue funding would be £6.2 billion in 2019-20, rising to £25.4 billion in 2022-23. The NHS Long Term Plan indicates that at least £2.3 billion more will be spent on mental health care. Assuming we receive that £2.3 billion, it means that over the period, the percentage spend on mental health will actually reduce from 37% in 2019-20 to 9% in 2022-23. We also know that the proportion of that spend on children and adolescent mental health services is only about 15% of the total. If we are really to tackle the gaps in mental health services for children, a significant further shift in resource allocation from physical to mental health must be made to achieve the ambition of parity of esteem. I should be very grateful for the Minister’s views on that point.
Secondly, I will say a brief word on the workforce. The long-term plan states that,
“we will continue to increase the NHS workforce, training and recruiting more professionals—including thousands more clinical placements for undergraduate nurses”.
There is a real crisis in our current mental health workforce, given the age profile of those extremely dedicated staff and the number who will retire in the next few years. It was disappointing that the workforce plan was not published at the same time as the long-term plan. Obviously, we welcome the work that the noble Baroness, Lady Harding, is undertaking on behalf of the Government, but can the Minister confirm today when the final report will be published and what engagement the noble Baroness has had with universities undertaking high-quality nurse training, such as the University of Salford in Greater Manchester, where I am honoured to be the pro-chancellor? Without a clear, robust workforce plan, whatever the increase in funding, timely access to essential support for the spectrum of mental health needs—the key issue—will not be achieved.
Turning to mental health and well-being in the education system, I will raise two issues. First, many representations—including my own—have been made through YoungMinds and the Children and Young People’s Mental Health Coalition to Ofsted as it reviews its inspection framework to ensure that it assesses and recognises the effectiveness of schools and academies in supporting children and young people’s well-being. I hope the Minister will ensure that it becomes part of the Ofsted framework to ensure that early intervention in schools is comprehensive and consistent across the country.
Secondly, it is clear from the speeches we have already heard that mental health issues in higher education are a crucial challenge that universities need to address. Over the past five years, 94% of universities have experienced a sharp increase in the number of people trying to access support services. I therefore commend to the Minister an initiative in Greater Manchester that established a task force, following a workshop bringing together all the universities in Greater Manchester, the Greater Manchester Health and Social Care Partnership, the Mayor of Greater Manchester, mental health experts and clinicians. The task force designed an integrated single pathway and hub for all 100,000 students in Greater Manchester and included a central physical treatment hub in the area of greatest student density—on Oxford Road, near the centre of Manchester—and two further hubs in Salford and Bolton, as well as a clear pathway to enable students to be referred through existing support channels, digital consultation sessions, digital communication with students and many other initiatives. This is a two-year pilot going live at the start of the new academic year in September and co-funded by the universities and the NHS. I hope the Minister will visit Greater Manchester to review this project, with a view to it being rolled out as a model across the country.
Finally, I will make a brief comment on mental health, learning disabilities and the criminal justice system. Over the past few years, since my report was published in 2009, a core all-age liaison and diversion service has been rolled out across the country to support people who hit against or find themselves in the criminal justice system. It is anticipated that the scheme will reach 100% geographical coverage over the next year. The next stage, for the next 10 years, is to address particular health issues. I raise one today—autism—in recognition of how many people with that condition may find themselves a witness, victim or suspect in the criminal justice system. We must improve access to training for all staff working in the criminal justice system—whether in police stations, courts, probation services or prisons—on autism and other key vulnerabilities, and deliver on the commitment in the NHS Long Term Plan to,
“invest in additional support for the most vulnerable children and young people in, or at risk of being in, contact with the youth justice system”.
I hope the Minister will help drive this forward.
Lord Bragg (Lab)
My Lords, I too thank the noble Baroness, Lady Royall, and congratulate her on introducing such an important subject at a particularly apposite time. Her comprehensive speech was compelling. I declare an interest: from 1996 to 2011 I was president of Mind, the leading mental health charity in the UK. In 2011 I handed over to Stephen Fry, but I have continued to work for Mind and its CEO, Paul Farmer.
Although it could not be called an interest, it is also relevant to say that I am rather in the position of my noble friend Lady McIntosh. I had a severe breakdown in my early teens. This lasted about a year and a half and had many unhappy consequences at school, at home and in the town. I raise this to observe that at that time, 1953-54, there was no one I could say a word to about what was happening, neither at home nor at school. There was nothing I could read, and I never dreamed of going to the doctor about such an inexplicable event that I could not articulate. Even now it is impossible to describe. It seems to have been an inescapable condition and the only thing I could do at the time was to hide it. Isolated and imprisoned like so many young people are today, it was a desert.
I can draw the following from that for this debate. First, mental health issues are still largely invisible, which over centuries has resulted in them being dismissed as the devil’s work, mere make-believe, obstinate laziness or the sufferer’s own fault. It has also persistently carried stigma, with the word “mental”, by a vicious irony, being applied to someone whose unimaginable affliction was mentally generated. You can see a fractured arm and sympathise; a fractured mind eludes sight and sympathy.
The example of my childhood, which could have been multiplied 10,000 times or more by people of my age at that time, was likely to have been considered a mark of shame, beyond reach. Sufferers were taunted or ostracised. Remember, this was soon after World War II, when tens of thousands of victims of traumatic stress in this country were totally ignored.
The main point I wish to make in my contribution is to argue how very much has changed for the better since that time. It is perhaps against the flow of this debate but it is important to air it. I am aware of how far there is to go and, thanks to Mind, I have a litany of sad statistics. One in 10, or nearly 850,000, children and young people aged five to 16 are diagnosed with mental health problems and this is increasing. These statistics have been set out by other people. However, the progress over the past 50 years—especially the past dozen or so years—is important to show that these problems are being resolutely tackled at last.
Another personal example I will now give may seem to be on the margins of usefulness but I think it matters. So, if your Lordships will excuse me once again, I will use personal experience. About 20 years ago, when I helped run the Mind annual book award for the best book of the year concerning mental distress, I tried to find a sponsor. Mind’s money came almost wholly from its effective shops throughout Britain. A sponsorship of £5,000 would have been a help. I approached a number of organisations and well-known patrons and, to use a phrase, none of them wanted to know. They did not want the association. The ancient taboo that mentally ill people were destabilising was still rigidly in place. Perhaps they feared contamination by association.
How greatly for the better times have changed. The younger members of the Royal Family, for instance, have just come onside emphatically and openly and with a substantial contribution from their own funds—unthinkable before—and have aligned themselves with the cause we are discussing today. This is a tremendous boost. The great and the good—I say this with gratitude and not irony—have over the past dozen years moved into this area with substantial impact. Tonight, for instance, with Stephen Clarke, the CEO of WHSmith, I will be talking to more than 100 people at the house of the noble Lord, Lord Fink, in London, who will be there because of their interest in helping Mind’s efforts for young people. It is a high-level involvement on their part and it is important for us. Their contributions will be invaluable and fill many a gap in the present struggling system for mental health for the young.
Something in our society has shifted. In this as in some other areas we have become kinder. Perhaps generous people looking for a cause to support have found —who knows, perhaps on their own doorsteps?—that this problem affects the most vulnerable and needs all the help that powerful patronage can bring. They are acting pro bono publico and Mind is grateful to them.
As we have heard, the subject is now referred to much more openly on the television and certain newspapers have come out in support and have, above all, made the issue visible. The formerly unmentionable has now become a problem that can be addressed and, I hope, set on the road to benefit many young people who, at the moment in our country, are locked in a state of mind from which they despair ever to be released. It is part of the good that is happening here as more and more we are uncovering minorities who have been scorned or neglected and trying to bring them home into the larger community that is our country. We are as good as we treat the weakest people among us, and that needs to be singled out for praise.
As I said, I know there is a long way to go but we are now on the road. For instance, Anne Longfield, the Children’s Commissioner, points to the vast number of reports we have had on children’s mental health recently. That is a mark of the some way in which we have gone.
We learn in this debate how far there is to go. Although we are failing, we are trying, and that is important. We are trying better. If we can make as much progress in the next 20 years as we have made in the past 20 years, we could be well on the way to removing the stigma, the centuries-old, deep prejudice, and alleviating the torments attending so many young people. We need to harness the strength of hope for our young people who need help so much, who need to be reached and restored to the full possibilities of the lives they deserve.
Lord Hastings of Scarisbrick (CB)
My Lords, I, too, am deeply grateful to my friend, the noble Baroness, Lady Royall, for allowing us to have this important debate in which many personal experiences have been shared. I start by referring to a conversation that happened yesterday. The noble Lord, Lord Giddens, is no longer in his place, but he brought us towards understanding the pain and pressure of suicide. Yesterday afternoon I met a young man who graduated from Manchester University with a first-class degree in politics and economics. He spent the week immediately after Easter with nine others in Tenerife. They were working with an established church which every year seeks to cater for the thousands of young British men and women who go to Tenerife to have a drink-filled funfest over seven days. In the course of that week, three guys and one girl aged 17 to 20 committed suicide. They were meant to be relishing the freedom of economy and opportunity. They all had exceptional grades from school but none of them were happy enough to survive a week away.
Much has been said in this debate about the importance of families and the vital need for communities around our young people. I recently looked at two Gallup surveys. One was on global purpose and asked hundreds of thousands of people around the world, including in the UK, what they felt about the value of their lives. The other, which has just been published, is based on the world happiness report. The statistics from the Gallup survey on purpose reveal that just over 80% of people in the world, mainly adults, say they do not know what their purpose in life is. In Europe, 22% of people say they know what their life is about and why they exist. In other words, there is a severe deficit of purpose among adults. This will translate on to the next generation. When it comes to happiness, interestingly, communities and countries with the highest levels of happiness are in the south. Patagonia is the happiest place in the world. Latin American countries, Africa and parts of Asia show higher levels of happiness than North America and Europe. What is this telling us? It is telling us that people feel that the complexity of our well-heeled lives in the western, richer world is not giving us the community of well-being that allows that essence of strong families, good relationships and strong coherence that is more easily experienced in poorer communities. That raises the real question: what is wealth and what is it for?
A report was published a few months ago by the Legatum Institute: The Maker Generation: Post-Millennials and the Future they are Fashioning. The noble Baroness, Lady Stroud, is chief executive of the Legatum Institute. The report refers to the good news and, as the noble Lord, Lord Bragg, has just indicated, there is good news. There has been a 71% fall in the number of young people sentenced for criminal offences in the past decade; teenage pregnancies are down; the use of drugs among 11 to 15 year-olds has halved in the past decade; and underage drinking is declining. That is the good news. However, Legatum says:
“Britain has developed an adolescent mental health crisis”.
All the statistics that we have heard about and referred to clearly indicate that that is the reality. Its report is based entirely on government analysis and says:
“The proportion of children living in lone parent families has tripled, to 25%. A recent study found that only just over 50% of 16 year olds are living with both their biological parents. The change in family life, and for some the absence of a father in particular, means that many new parents have not had the role models previous generations relied upon to teach and guide them”.
It goes on to talk about the absence of cohesiveness in neighbourhoods, which drives severe well-being and mental health pressures in addition to the many other factors that have been referred to in the absence of services.
Therefore, we live in a more conflict-based society, and in the last week ITV has been coming to terms with what that means. The complexity of society brings huge pressures. Our communities are less secure, relationships and long-term commitments are less coherent, and our sense of endless risk divides people. Excessive over-concern about risk separates communities, but that is not the case in the happiest nations in the world. We need a review of our risk reality, and we also need to look at a different form of citizenship that encourages active community, which brings well-being.
Lord Layard (Lab)
My Lords, in her excellent speech my noble friend Lady Royall described the dismal state of access to treatment for young people with mental health problems—a point repeated by almost every speaker. The question is how to deal with it. I think that the way forward is quite clear, because the situation for children now is almost exactly the same as it was for adults in 2008. However, since then, the situation for adults has been improved radically through the programme for improving access to psychological therapy, otherwise known as IAPT. This includes a large programme for training therapists, plus new services rolled out across the country to deal with all but the most serious cases, who continue to use regular mental health services.
What we need to do for children now is exactly what has already been done for adults, and that is the approach that the Government agreed to in the Green Paper. That was an excellent document. It proposed creating a nationwide system of mental health support teams to do for children what IAPT has been doing for adults. The teams will take all those cases that fall below the very high CAMHS threshold, and typically they will do that in the friendly setting of a school. Therefore, this is a moment of great hope and I congratulate all those in the Department of Health and Social Care and in NHS England who have brought us to this point. However, I also want to raise three key issues in respect of which I think the programme could be significantly strengthened.
The first is training. At present, the training is mainly for handling only mild to moderate problems. However, unless the service can also handle moderate to severe cases, it will end up passing many children who start off in it upwards to CAMHS and the blockage in CAMHS will continue, just as happens now. Therefore, in these new support services we need a stream of “high-intensity” therapists, as they are known, working with young people in the same way as they work with adults in IAPT.
The other issue is conduct disorder, which is not adequately covered in the training of the support teams. It is as serious a problem as anxiety and depression. We have already trained 4,000 practitioners to deliver the group training of parents of children with conduct disorder but very few of them are being used. We should be using them.
The second issue that I want to raise is the management of the service. When adult IAPT started, it was helped enormously by an expert reference group, which included leading psychological therapists, who brought their experience to bear on the design of the service and, conversely, carried back to the profession their own excitement about what was happening. However, we do not have any such group for children, and many leading figures in the profession feel excluded from the process. That is a real pity, and I hope that the Minister can assure us that such a group will be created. I hope that she can also assure us that the more ambitious training scheme that I have mentioned can be put in motion.
The third issue is scale. The Government have allocated only £250 million to the support teams over the first three years. In current money, that is half the figure that was spent on adult IAPT in its first five years. This timorous approach means that, as has been mentioned, under a third of the country will be touched by the new children’s service in the first three years. Surely we should be more ambitious than that. In fact, I would like to suggest that we should be more ambitious about mental health overall. Since 2000, mental health has been the top priority of the NHS—that is what has always been said—but the share of NHS expenditure has remained exactly the same. That will change only if the NHS has a specific, separate, ring-fenced budget for mental health. This is an issue that we should all think about. I suggest that we need a budget for mental health growing at 6% a year in real terms compared with 3% for physical health.
Finally, I would like to ask two questions about schools. First, the Prime Minister has promised to enable schools to measure the well-being of their children. That is an excellent idea that will affect schools’ ability to help children and incentivise them to take well-being much more seriously as a goal alongside academic achievement. However, we have not heard what is going to happen as a result, and what I have heard has been worrying. Can the Minister tell us what, concretely, is going to happen with the Prime Minister’s promise?
My second question concerns life skills. This Government have been the first to make life skills compulsory. That is a huge and excellent step forward, but they have not said how much time as a minimum should be devoted to life skills. In some schools, it will be rather a small amount. Can the Minister assure us that some guidance will be given on the minimum amount of time to be spent on this? I suggest that it should be at least one lesson a week.
Therefore, things are moving forward, as many speakers have said. That is wonderful, but surely they need to move a lot faster.
Lord Woolf (CB)
My Lords, like previous speakers, I thank the noble Baroness, Lady Royall, for obtaining this debate, and I congratulate her on a remarkable speech in opening it. It was of a standard which has so far been maintained by the other speakers.
I have one thing in common with the noble Baroness, Lady McIntosh, in that I, too, am not an expert on this matter. However, I am speaking in this debate largely because of the interest I have gained as a result of a member of my family being autistic. I have seen at first hand, although not as a parent, the problems that autism can cause for families. Here, I acknowledge that the noble Lord, Lord Farmer, is undoubtedly right in saying that if you have a good family background, the problem can be more proportionate than it would otherwise be. Even for the best of families, where the parents are deeply devoted to an autistic child, the problems of having that child can be immense because things do not work as well as they should.
I draw attention to my interests in the register, and point out that as a judge, or a person who spends his working life largely judging, you become very much involved with prisons. At one time I was president of the Prison Reform Trust—I believe I am still technically president. I see the noble Lord, Lord Bragg, who helped me very much when I was chair. He is nodding his head. The fact is that you need to go around prisons to see what the consequence can be of young people not getting the assistance that we know they need. The sad thing is that the majority of youngsters you meet there have a mental health problem of one sort or another, and sometimes dyslexia. I would not say that that was a mental health problem but it is one that, like an earlier speaker, I suffered from myself at one time, so I am very conscious of the difficulties that it can create.
At the moment I am a member of the Joint Committee on Human Rights. Under the able chairmanship of Harriet Harman, the committee is taking an in-depth look at the people we are talking about today. The report will not be available until the summer but it is probably good for the House to know about the sort of evidence that has been presented to us. The adviser to the committee and our clerk from the Lords have kindly helped me to, I hope, tread on the right side of making revelations about what the committee is considering without prematurely disclosing some of our evidence.
From the evidence that we have received, there is no doubt that there are still substantial problems in this area for those directly involved. Evidence from parents and people who work in this area indicates the sort of problems that occur. My belief is that, unfortunately, although there has been the progress that previous speakers have mentioned, it has been nothing like as great as it could have been if the efficiency with which the help was provided had been greater. People caught up in the situation of doing what is right for a child who has problems of this sort find that they are pulled in different directions, and that they do not get the sympathetic hearing they would expect to receive. It is very disturbing that this should be the situation.
There is also the fact that, all too often, instances of separation and restraint occur because the children, if they receive help, are in institutions that cannot care for them. I accept that there are huge difficulties in managing the complex issues in custodial settings, but surely we can manage to ensure that our system works in a way that is compatible with the real needs of the people seeking help.
I notice that my time is running out, so I shall sit down.
Baroness Massey of Darwen (Lab)
My Lords, this is an important debate. I thank my noble friend Lady Royall for introducing it with such eloquence and for the information that she has supplied. I have listened to many moving speeches today containing evidence for urgent action on this issue.
I want to focus mainly on what young people themselves and their parents say about mental health services provision in schools. I draw on my experience of working with young people and parents and on evidence from the Association for Young People’s Health, of which I am a patron, and with which parliamentarians have just set up an All-Party Parliamentary Group on Young People’s Health. Our last meeting was on the mental health of students, with eloquent testimonies of some of the problems described by my noble friend.
I start with a quotation from a review by the Association for Young People’s Health, which spoke to parents about their concerns. One parent said about her daughter:
“She’ll come to me and she breaks my heart: ‘help me mum’, and I say, I promise I’ll help you pet, I’ll make sure you get help. And I feel like I’m banging my head against a brick wall because it doesn’t happen, it never happens”.
That sums up the situation described by many here today. We know that the situation is worrying. We know the Government have expressed concern in many ways and are putting money into their concern. However, there are problems of funding and of timing. This is an urgent issue. I feel that the situation is fraying around the edges, as described by some of my colleagues today.
I want to mention the aspect that concerns me most, as highlighted by the Local Government Association. Funding reductions to local authorities mean that many councils are being forced to reduce intervention work to support children and young people. The early intervention grant has been reduced by almost £600 million since 2013. Children’s services will have a projected funding gap of £3 billion by 2025. Youth clubs are closing, mental health services are overwhelmed and Sure Start centres are disappearing. I do not understand the logic of putting money into children and young people’s mental health, as this Government intend to do, when so many services are being eroded by these devastating cuts.
I turn to what young people and parents think about the state of mental health services and what might be done about it. I was involved in a seminar in Parliament in November 2016 at which young people, NGOs, academics and service deliverers met interactively and equally to discuss child mental health and child-friendly justice. Young people constituted half the group. One young woman said at the beginning of the seminar, “We are experts by experience”. That is why I make a strong plea for involving young people in defining problems and suggesting solutions.
Young people require protection and good services, but they also require empowerment to speak out and help themselves. Some points that the young people made in the seminar were about the stigma attached to mental health; the importance of cultural awareness in dealing with young people’s mental health issues; problems around consent and consensus for treatment; access to treatment, including waiting lists; there not being enough counsellors in schools; schools being too focused on academic results to note early warning signs—for example, eating disorders; a lack of sensitivity to vulnerable groups, such as BME and LGBT youngsters and those in the criminal justice system; and the negative impact of social media, which can also be a force for good—for example, with helpline support groups. They emphasised the need for campaigns of positive information about mental health. They suggested that good interventions include buddy systems in schools and youth services; committed, informed professionals; and awareness being raised by well-known, high-profile people speaking out.
I turn to what parents have said in surveys, and in particular to a project to support young people with mental health problems carried out two years ago by the Association for Young People’s Health. Some 41% of them said that agencies involved in mental health issues for children do not include or consult them. These parents created a network for parents, which snowballed into other networks. Things they found helpful were: the development of parent support groups; provision of more practical advice for parents; provision of mentors, support groups, helplines or advocates for parents; more consistency in how schools operate as intermediaries in involving parents; easier access to early intervention; crisis support; and acknowledgement that parents are important partners in helping young people recover. One sad and worrying thing that 36% of parents said is that they had had to resort to private treatment, because there was no access to CAMHS. I hope the Government will listen to this, and strengthen these services.
I do not have time to dwell on the local and national cost savings of tackling mental health problems, which are huge. Millions could be saved on this annually. However, the life chances of young people are being affected and the key to all this is the welfare and happiness of young people and families.
Lord Haskel (Lab)
My Lords, speaking last, I cannot help but observe that all of us, and the country, have been on a mental health journey—a journey making us more and more aware of the prevalence, growth and impact of mental ill-health, its effect on people’s lives and the shortage of related services. I congratulate my noble friend on moving this debate, especially during Mental Health Awareness Week when a lot of these considerations come together.
As I became more and more aware of mental health on my journey, so I was able to observe and recognise how young people were coming under greater stress, and how the services designed to deal with this stress were themselves coming under more and more stress and pressure. The causes are everywhere; noble Lords have mentioned school, home, the media, sport, relationships and the transition to adulthood. I have particularly noticed the polarisation of the generations, as shown in the recent FCA report, which I think deserves a lot more study. Others have spoken of social media, where platforms are set up to reward young people’s engagement so that they are encouraged to continuously feed off each other, adding to their stress. We really need to get on with separating control of the platforms from control of the content.
Like my noble friend Lady McIntosh, I have no expertise, but it seems to me that the best support one can give is to help those who are trying to establish good practice and sound procedures to prevent these problems emerging in the first place and, if they do emerge, to provide help in coping with them. YoungMinds has campaigned for additional investment in services for young people’s mental health while at the same time providing a parents’ helpline for information, advice and support for those concerned about the mental health of young people. It has also made people more aware of mental health problems so that they can be caught earlier. The earlier the intervention, the less pressure there is on services and on the child. Awareness is important, but it is absolutely no substitute for action.
These positive measures are the best sources of prevention, but of course they are difficult to measure. Can the Minister reassure us that, even so, the prevention strategy will include these positive measures? They are especially important now, with cuts to youth services and community workers, and sport, art, music and other activities in schools being cut due to academic pressures. As others have said, we know that the majority of mental health problems are established when we are young. This makes a prevention strategy especially important.
Another aspect of maintaining the mental health of young people is to ensure that the UN Convention on the Rights of the Child is upheld, in government, schools, health services and criminal justice. I came across this as part of my duties as a member of your Lordships’ Secondary Legislation Scrutiny Committee, when we scrutinised an order regarding children working undercover for the police. This brought me into contact with Just For Kids Law, a charity which campaigns for the rights of juveniles under this UN charter.
In May 2017, the UK was examined under the universal periodic review carried out by the United Nations, which includes examining the rights of the child. Among the recommendations coming out of this review are recommendations about age-appropriate mental health services. However, in spite of campaigning, the Government supported only 28% of the recommendations regarding children’s rights and mental health. Of course, the Government can choose whether to just take note of recommendations from the United Nations committee or to accept them; they do not have the force of law. However, they have a moral pressure. Can the Minister tell us the status of the recommendations which were not accepted? Are they under consideration, or have they been rejected?
Of course, the mental health of young people touches us all. To this end, in October last year the Government announced an ambitious programme to train 1 million people in mental health awareness, with a pilot in the West Midlands ahead of a national rollout which was to take place about now. Is this going to happen?
Real improvement in young people’s mental health is achieved by reaching young people early, hopefully before they actually need the services. For this, we all need to be aware. Mental Health Awareness Week is an important contribution to this and, together with other noble Lords, I welcome the opportunity to participate.
Baroness Tyler of Enfield (LD)
My Lords, I add my congratulations to the noble Baroness, Lady Royall, on securing this vital debate during Mental Health Awareness Week. I refer to my interests in the register.
It has been a powerful debate, which has confirmed in my mind that the worsening state of children and young people’s mental health is becoming one of the major social policy challenges facing our country. We are becoming familiar now with the statistic that one in eight five to 19 year-olds has a diagnosed mental health disorder. To try to make that a bit more real, that is roughly three children in every classroom.
Looking ahead, the Royal College of Paediatrics and Child Health’s report entitled Child Health in England in 2030 found that reported mental health problems in England are set to increase by 63% over the next decade—a huge increase. Already, the number of girls under 18 being treated in hospital after self-harming has nearly doubled compared with 20 years ago, and the number of referrals by schools seeking mental health treatment for pupils has shot up by over one-third in the last three years, with over 50% of these coming from primary schools. That is a really worrying trend.
We have already heard about the long-term plan for NHS England, which builds on the Five Year Forward View for Mental Health. It makes some very welcome commitments for further investment in children and young people’s mental health services. I particularly pick out the new waiting time standards, investment in eating disorder services and the expansion of crisis services to a 24/7 service. It is welcome that funding for children and young people’s mental health services will grow faster than both overall NHS funding and total mental health spending.
Then, of course, as others have said, we have the Green Paper’s proposals. Those proposals to bring schools and NHS services closer together and to act earlier to identify children who need effective help to prevent them falling into a crisis are of course welcome. The proposed new mental health support teams have the potential to make a real difference, but as my noble friend Lord Storey said, they really need to be rolled out a lot faster. Of course I understand why they cannot be created overnight, and I welcome the fact that training for the first cohort of these new teams started recently, at I think seven universities, but based on the Government’s own estimates, on current plans some children who are eight now may not receive any additional support before they leave school at 18—a full decade after the new teams have been launched.
To summarise, much is promised or in the pipeline, but what is the reality on the ground? Quite simply, too often children and young people’s needs are going unmet. Currently, less than one in three children with a diagnosable mental health condition is getting access to NHS treatment and care, which I am sure we all agree is a scandalous state of affairs. The Care Quality Commission’s review of access to children’s mental health services last year found a “complex and fragmented” system at local level with multiple providers and minimal co-ordination of service delivery, while high demand and limited resources meant that far too often the referral threshold to CAMHS, as we have heard, was far too high in many places. At the tail end of last year, we had reports from the NAO and the Public Accounts Committee that absolutely echoed these findings.
Further evidence, if we need any more, comes from Healthwatch. I am grateful to it for sending its recently summarised findings of 152 local Healthwatch organisations in each local authority around the country. In short it found, first, that children experience long waits to see a specialist and often complain about poor communications from services. Secondly, access to assessment services is challenging, the referral process is complicated, and often young people did not feel that they were listened to. Thirdly, a lack of timely and appropriate information for young people and parents was a problem. Indeed, young people often said that they felt patronised by the tone of materials produced for them and that they would like to discuss mental health more in schools, which I will return to in a minute. Fourthly, the transition from children’s to adult services is confusing and challenging. As we heard, we have too many young people falling through the gap. Fifthly, there is a real lack of integration between learning disability and mental health services, leading to services being not at all tailored to specific needs.
This is a very familiar and depressing catalogue of problems, so what do we do about it? I will suggest a short-term solution before coming to longer-term solutions. To help overcome the fragmentation that I have been talking about, the Royal College of Paediatrics and Child Health recommends piloting and evaluating a “local offer” for mental health, mirroring the existing local offer for special educational needs introduced by the Children and Families Act. This is something I strongly support. A local offer for mental health would provide comprehensive information about the available services in a local area and how to access them, but it would also very importantly identify shared responsibilities across authorities for ensuring that children and young people are supported as close as possible to their home.
This “local offer” approach has much to commend it. It would help to co-ordinate local services and make gaps in provision more visible, therefore encouraging local providers to work together to fill those gaps. I raised this with the Minister at Oral Questions on 25 March, and she kindly said that she would consider the suggestion and get back to me. Could I ask her if she is yet in a position to respond on this important point? I would very much like to know her thinking in this area.
I turn now to longer-term solutions. Workforce is the biggest issue that the system faces. It has been said many times in many quarters that it is the overriding barrier to improving access to children’s mental health services. I know that NHS leaders face the daunting challenge of delivering the changes set out in the NHS Long Term Plan, alongside a workforce that is under huge strain and struggling to cope with widespread staff shortages. Figures from Health Education England in 2018 showed that a very worrying 60% of training places for child and adolescent psychiatry were unfilled. Frankly, Health Education England has limited data to develop its workforce plan. New data very recently released by NHS Digital shows there has been an almost 4% fall in the number of CAMHS psychiatrists between 2012 and 2019, despite the number of doctors for all other medical specialties during that period having risen by about 15%.
I have been trying to understand these workforce challenges. They are quite complicated. I spent a bit of time poring over Stepping Forward to 2021, produced by Health Education England, and I commend it for it. Quite frankly, I find it quite confusing and complex. It is the workforce plan to support delivering the five-year forward view. Roughly, it talks about the need for about 20,000 additional workers in psychiatry, nursing and psychology to support the plans at the time. Now we have the expanded plans in the long-term plan. Others have mentioned that we are waiting for the workforce strategy that the noble Baroness, Lady Harding, is working on, which I am looking forward to. I very much appreciated the chance to meet with her last week. That was very helpful indeed. I have also talked recently to various mental health trusts that I have been fortunate enough to visit. I know how concerned they are about the need to expand the workforce and to retain staff at the same time.
I return briefly to schools, which have such a pivotal role to play. These points were raised very powerfully by the noble Lords, Lord Bradley and Lord Layard. We know that what gets measured gets done. That is why Peers on these Benches have called for Ofsted to include an assessment of the effectiveness of schools in supporting children and young people’s mental health and well-being. Ofsted released its new inspection framework earlier this week, with new guidelines about how schools should be assessed. On the plus side, the framework has a greater emphasis on personal development and the quality of education, including confidence and resilience building. I was pleased to see more references to mental health throughout the inspection, but frankly I am disappointed that the reforms have not gone far enough. Under the new framework, schools and colleges will not receive any recognition for developing a whole-school approach, having positive responses for identifying mental health problems and ensuring that young people get support when problems first become involved. This is a missed opportunity to turn school inspections into a mechanism that would inspire real change for children and young people’s mental health and psychological well-being. I would welcome the Minister’s thoughts on this. I see that my time is up.
Baroness Thornton (Lab)
My Lords, I congratulate my noble friend on bringing this important debate to your Lordships’ House. It is of course appropriate that we are having it during Mental Health Week, as my noble friend Lord Haskel said at the beginning of his remarks. Indeed, he is quite right: we have been on a mental health journey in this country over the past 10 to 20 years. My noble friend described most eloquently the issues facing students and others with mental health problems. I should like to address the scale of the challenge we face.
I start with a shaming aspect of this challenge. Some 22 children have died suspected self-inflicted deaths while admitted to mental health hospitals and in-patient units in the past five years. My noble friend Lord Giddens spoke more widely about the tragic issue of suicide and related behaviour. Figures released by the Department of Health and Social Care show that four patients aged under 18 have died already in 2019, matching the highest number of fatalities in any previous year.
A Sky News investigation reveals that poor care in privately run child and adolescent mental health services units is putting vulnerable young people at risk. Patients, parents and whistleblowers have shared their experiences of privately run facilities paid directly by the NHS to care for some of the most challenging mental health patients, including those with serious eating disorders and those engaged in persistent self-harm and suicidal behaviour. One former patient told a story of the brutal physical restraint she had experienced, and of how she had been able to inflict life-threatening self-harm while in a privately-run unit. She said, “I would rather have been dead than alive in that place”. Former staff at another facility run by the same company until it was closed last month, described the culture of self-harm as “out of control”, and alleged that employees were directed to downplay serious incidents. Sky News revealed that a former member of staff at a third unit, also now closed, is subject to a police investigation.
These children are often placed in units many miles from home and family because of a shortage of appropriate services in their area. In 2017-18, NHS England paid private providers £156.5 million for specialist mental health services, which is 44% of its specialist budget. Inspection reports compiled since 2016 for 60 CAMHS units show that 88% of the NHS units were rated good or outstanding, while just 58% of those run by the largest private recipients of NHS funding were rated good. No privately run unit was rated outstanding, five were rated inadequate, and, since 2017, five have been closed.
First, how acceptable does the Minister think this is? Does she think that the NHS is getting value for money from these units? What is the incentive to make these young people well, given that the duty of the private units is to their shareholders, which must mean keeping full occupancy? There is a potential conflict of interest here. Those of us who have recently been engaged on the Mental Capacity (Amendment) Bill will be familiar with this issue. I would like to know from the Minister what the safeguards are.
A recent FoI request by the Labour Party found that 1,039 children and adolescents in England were admitted to non-local beds in 2017-18 for NHS mental health treatment, in many cases more than 100 miles from home. Is it acceptable that patients from Canterbury in Kent were sent 285 miles for in-patient mental health care, those from Cornwall and the Isles of Scilly 258 miles, and those from Bristol 243 miles? What effect does the Minister think this has on the youngster and their family? If that family are on a low income, it might prove impossible to visit on a regular basis, or for them to know what treatment their youngster is receiving.
Let us look further at the scale of this challenge. As my noble friend Lady Royall said, three in four children with a diagnosable mental health condition do not get access to the support they need. Three in four: that is graphically illustrated by the narrative from my noble friend Lady Massey. CAMHS turn away 26%—more than a quarter—of children referred to them for treatment by concerned parents, GPs, teachers and others. The average waiting time is more than 26 weeks. In a YoungMinds survey, 76% of parents said that their children’s mental health had deteriorated while waiting for CAMHS treatment.
Therefore, is it surprising that the number of A&E attendances by people aged 18 or under with a recorded diagnosis of a psychiatric condition has almost tripled since 2010? This translates, for example, to a severely depressed or anxious young person being at home for several months, unable to go to school because they feel so ill, with all the strain that puts on them and their family, to say nothing of the education they might be missing. They may become even more severely ill, which could have been avoided had treatment been readily available.
As many noble Lords have said, this means a huge cost to our NHS. Can the Minister provide assurance that the Government’s forthcoming Green Paper on prevention will include measures to improve the promotion of positive mental health for children and young people? Given that one in six young people aged 16 to 24 have symptoms of a common mental health disorder such as depression or anxiety, how does the Minister’s department aim to address the specific needs of that age group?
My noble friend Lord Bradley and the noble Baroness, Lady Tyler, have approached the workforce issues more than adequately. It is concerning that the number of doctors working in child and adolescent psychiatry has fallen every month since the beginning of 2018. There are serious societal problems that need addressing because of our children’s growing mental health issues. My noble friend Lady Morris gave us a great message of hope, but children who have had the most difficult and complex starts in life, experiencing abuse, neglect, bereavement, discrimination or poverty, are more likely to have mental health problems as they grow up. A study by SafeLives showed that 52% of children who witness domestic abuse experience behavioural problems in later life.
At a time of austerity, rising personal debt and precarious work, we are all encouraged to be individuals and not rely on anybody. Society perceives us to have failed in life and look weak if we do. There is a narrative that many people choose to be on zero-hours contracts. Then there is the gig economy. All these things put stresses on families, which puts stresses on our children. It is not only a well-funded NHS that we need. It is no accident that countries with stable welfare systems and school systems that do not focus on endless testing have good records on workers’ rights. That, surely, is where we must aim to be.
I thank my noble friend Lady McIntosh for her brave and honest speech. I too watched Nadiya Hussain yesterday, and was very moved by her story. I also thank my noble friend Lord Bragg for reminding us of the change we have seen and the reducing of stigmatisation, and my noble friend Lord Layard for asking very pointed questions about money, which is where I wish to end my remarks.
One of the key targets in the Five Year Forward View for Mental Health is to go from 25% of CYP to 35%. That still leaves 65% not receiving access, which is not good. I am so pleased that my noble friend Lord Bradley shared his huge experience with the House. He got to the nub of it. Research by YoungMinds demonstrated that only 14% of STP plans at local level showed evidence of engagement with children and young people. Can the Minister provide assurances that integrated care systems will be required to consult young people about the services that affect them, as part of the implementation of the NHS long-term plan?
Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, I thank the noble Baroness, Lady Royall, for introducing this debate and giving us the opportunity to discuss such an important issue during Mental Health Awareness Week. She spoke movingly and importantly. We have had an extraordinary debate today, with many personal reflections; it is an incredibly valuable contribution to this week. I also thank those who have asked the huge range of questions which I am now tasked with trying to respond to in less than 20 minutes. I hope your Lordships will forgive me if I do not cover each one; I will write on those points I am not able to cover today.
The noble Baroness, Lady Royall, is absolutely right when she says that, unfortunately, it remains true that many young people who seek help for their mental health find it difficult to access the right support at the right time. This is wrong, and we need to work harder and faster to get it right.
I would like to start by responding to a point about data, made by the noble Lord, Lord Storey. We have recently improved the available data in two key areas, with a significant prevalence survey on mental health in young people that was done in 2018 with 9,117 children and young people aged between 2 and 19. It showed that the prevalence of mental health diagnosis has increased by 1.1% since the previous survey, and that 25.2% of young people with a diagnosable disorder report having been in contact with NHS mental health specialist services in the last year. This is important, because the previous prevalence survey was 10 years old, and during that period social media has intervened, which we expected to have had a significant effect. The CMO then did a review which created evidence-based guidelines on screen time—an important intervention. In addition, we have brought in the dashboard to track data at a local level and the implementation of various standards which we have brought in.
This is a huge improvement on the level of data and tracking that we have on mental health within the community and the performance of our mental health trusts compared to the last time I was in the post. Therefore, I would like to reassure the noble Lord on the point about data. It is not where we would like it to be, but it is still a significant step forward. I wanted to start on that, because you cannot talk about policy and where we are if you do not have the data to know about it. That is why I want to talk about where we have come to before I talk about where we need to go.
We are on track to meet the commitment to improving access that we made in the five-year forward view, and to have 70,000 more children and young people accessing treatment each year by 2020-21 compared to the 2014-15 baseline. We have introduced the first-ever access and waiting time standards for mental health services. For young people experiencing their first episode of psychosis, we have a target for early intervention to ensure that treatment begins within two weeks for more than 50%. Nationally, the NHS is exceeding this: over 75% of patients started treatment within two weeks in March 2019. We have also set a target for 95% of children and young people with eating disorders—which have been on the increase—to access treatment, with a one-week referral for urgent cases and four weeks for routine cases by next year. Nationally, we are on track to meet this, with the most recent data showing that over 82% of patients started routine treatment within four weeks. We need to pay tribute to those who work incredibly hard within the mental health system and are making some very difficult changes to achieve this, coming from what was a very low base. It is important to pay tribute to them for their achievements.
I would like to move on to some questions put to me by the noble Baroness, Lady Royall, about crisis care, before moving on to those from the noble Baroness, Lady Thornton, about out-of-area placements and the private sector. The noble Baroness, Lady Royall, is absolutely right that we need to improve access to crisis care for those young people who need it most. A commitment has been made that we will invest £400 million in 24/7 crisis resolution home treatment teams in every local area by next year, and £249 million in mental health teams in A&E departments to improve the system. The long-term plan makes a commitment to ensure timely, universal mental health crisis care for everyone, including young people, and to drive out the variability which we recognise exists for them.
We also recognise the concerns raised by the noble Baroness, Lady Thornton, about out-of-area placements. We have made a commitment that inappropriate out-of-area placements must come to an end. Where there are specialist cases, a young person will need to travel, but we want in-patient stays to be as close to home as possible and to avoid inappropriate stays. For that reason, we have introduced the accelerated bed scheme, which has already created 117 new beds, with 69 new beds on the way. This is being done to reduce variability of access to in-patient care, but we also want to reduce that care by bringing in more prevention and earlier access to lower-level care, such as that pointed out by the noble Lord, Lord Layard. I shall return to the point that he made.
We are very concerned about the recent reports of failings within mental health care, which the noble Baroness raised. She is absolutely right that all providers of NHS services, whether NHS or private, must abide by the same high standards. Where this is not the case, we are ensuring that the NHS looks into the circumstances and considers what action should be taken. Private providers play an important role in the provision of children’s mental health services, but these must be safe and of high quality. We have tough regulators to ensure that that happens.
I will move on now to the points made on early intervention by the noble Baroness, Lady Royall, and the noble Earl, Lord Listowel, who is not in place.
Baroness Blackwood of North Oxford
I apologise—perhaps the noble Earl is sitting low in his seat.
They are absolutely right that prevention and early intervention are crucial. We prioritised improving perinatal mental health when I was previously the Mental Health Minister for exactly that reason. The noble Earl put it so eloquently: it is vital for newborns to form that early attachment with their mother and father. We must also consider the role played by the wider family, as those on our own Benches have put it. From 2020-21, we have put in place increased access to perinatal mental health services in all areas for at least 30,000 women, backed by £365 million in funding, as part of the five-year forward view for mental health. The long-term plan will also go further, with a commitment to increase evidence-based care for women with severe perinatal mental health difficulties and a personality disorder diagnosis, to benefit an initial 24,000 women per year by 2020-21. That is reassuring, but we also need to ensure that it carries on beyond the early years and into the school years—a point made by a number of your Lordships.
I recognise the impatience surrounding the Green Paper, but I would like to clarify a few points. The commitment within the Green Paper is to have a pilot, for 25 schools in the first instance, but it is then to incentivise every school and college to identify and train a designated senior lead for mental health to create new mental health support teams in and near schools and colleges. We are starting by piloting so that we can work out what the best design is and then move it across to all schools. The idea is not to have variability but to drive it through the whole system. While I recognise the frustration with rolling out these proposals in a phased way, it is a very ambitious commitment. We need to recruit and retain a workforce numbering in the thousands for the mental health support teams alone. We cannot do that overnight, given that there are over 20,000 schools and colleges. To roll out a fifth to a quarter of these by 2022-23 is already a challenging target. We must ensure that we train that workforce in an appropriate way to meet the challenges they will face.
I will also respond to the eloquent words of the noble Baroness, Lady McIntosh, and the moving experience which she spoke of. She is right that I do not speak for the Department for Education, but the thing about being at the Dispatch Box is that I can say whatever I like; once I am up here, they cannot pull me down. As she said, I speak as a former music graduate of Somerville, and I believe strongly in the importance of the arts, and in particular music, for education and mental health. I back her entirely on its importance for social prescribing as well. I will advocate strongly for that in this role. I agree with the noble Baroness that it is extremely important that young people’s experience should be safe, inspiring and nurturing. We should all be pushing in our roles for more joy within our society.
I know that I will run out of time quite quickly, so I will move on. I would like to talk a little about the work we have been delivering for university students. This key aspect has arisen on a number of occasions, and I know that the mental health of young people in universities is vital. Noble Lords will be pleased to hear that NHS England and Universities UK are working together on a programme to support and improve mental health at universities through Universities UK’s StepChange programme, which calls on higher education leaders to adopt mental health as a strategic priority and to take a whole-institution approach to mental health. As part of this programme, the Government are actively backing the introduction of a sector-led university mental health charter, which will drive up standards in promoting student and staff mental health and well-being.
NHS England is also working closely with Universities UK through its mental health in higher education programme to improve welfare services and access to mental health services for the student population, including focusing on suicide reduction while improving access to psychological therapies. There is funding attached to this and I am happy to meet with the noble Baroness if she would like to discuss that further, as it is a vital part of the picture.
I will move on to the questions raised regarding stigma and social media, which are crucial if we are to have a preventive approach to the situation we find ourselves in. The noble Baroness, Lady Massey, and the noble Lord, Lord Bragg, spoke incisively on this issue. We are committed to eliminating the stigma around mental health and are providing £20 million in funding to the Time to Change national anti-stigma campaign, which has been hugely successful. As the noble Baroness rightly said, it involved high-profile individuals who cut through the noise that often comes at young people every day. The campaign aims to improve social attitudes towards mental health, including promoting the importance of well-being in all areas.
However, we should also think about one area that did not get aired within the debate, and that is those who face double stigma when they have a chronic condition. As I think was raised by the noble Baroness, Lady Tyler, there are those have learning disabilities and mental ill-health. It is challenging for them to navigate their way through the system. Public Health England is delivering a £15 million national health campaign called Every Mind Matters, with the aim to equip 1 million people to be better informed to look after their own mental health. This will be of huge benefit going forward.
It is important that we do not imply, in this place, that everybody who suffers from mental ill-health will end up in the criminal justice system. I do not believe that is the case.
I also point out that this Government have been committed to addressing the agenda of social media and the harms it can produce, even though it is beneficial in other areas when it is used as an effective tool. That is why the Secretary of State has not only taken this on as a personal commitment in the round tables he has held with internet companies, but we are also bringing forward the online harms White Paper. The noble Lord, Lord Haskel, was right when he said that we have to make sure this has teeth. That is why there are commitments to bring forward a new regulator under it and why the CMO brought forward recommendations on screen time.
None of this is relevant if we do not have the workforce and funding that we need. I am pleased that NHS funding for young people has increased. I was concerned to hear the noble Lord, Lord Bradley, and his comments about reduced funding. The information I have is that children’s mental health funding is increasing. It has gone up from £516 million in 2015-16 to £687.2 million in 2017-18. Planned spend next year is £727.3 million, an increase of 5.8% compared to the previous year. This will be monitored with the investment standard and dashboard. I am happy to follow this up with the noble Lord, but I believe that NHS funding for mental health is increasing and at a faster rate than overall NHS funding. We are tracking this and ensuring that local CCGs stick to that commitment. This transformative investment will ensure that more young people receive the mental health support they need.
I finally turn to the questions about suicide prevention, which was movingly spoken about by the noble Lord, Lord Giddens, and others. The noble Lord is right that we have an excellent suicide prevention strategy. It must be based on accurate data. It is challenging to ensure we have that data, but I have a great deal of confidence in Public Health England working with local authorities to ensure we raise the standards of that work. Understanding the reasons for suicide is complex. Suicides among children are relatively rare, but each is an appalling tragedy, so we must work with every ounce of our abilities to move forward and make that better.
I am proud that we recently increased the amount of research funding for mental health, by a record amount, to £74.8 million. This will play an important role in helping us understand the sources of all forms of mental ill-health, including those that drive individuals to suicide.
While I am sure that noble Lords feel there are other areas I could have covered, and would like answers to other aspects, I hope that, by pointing out the areas of rising investment today and that we are improving access and waiting times, I have communicated to you that the Government are genuinely working across all departments to ensure that we see this as a priority agenda. I have demonstrated that we understand that we still face significant challenges. While we are impatient for faster improvement, there can be no question of our commitment to a brighter, healthier and more joyful future for our children and young people.
I was deeply moved to hear the words of the noble Lord, Lord Bragg, his testimony of his own experience some years ago and how different he feels things are today. Each of us still feels frustrated by how far we still have to come and how many things we still have to deliver to give our children the services that they deserve. I cannot think of a better way to close than by repeating some of the comments that he gave in his speech. We are only as good as the way we treat the weakest among us. There is a long way to go, but we are now on the road. If we can make as much progress in the next 20 years as we have in the last 20 years, we can give young people the stigma-free lives that they deserve.
Baroness Royall of Blaisdon
My Lords, I am grateful to the Minister. That was a splendid summing up and it has been an excellent debate. I leave believing this is a priority for the Government, but I am still worried. We have had so many powerful speeches today and testaments to personal experiences. Many charities have been mentioned, and I pay tribute to them and, likewise, to the many brilliant projects taking place with the universities in Manchester and the schools in Birmingham. There is so much happening, which gives me great optimism and hope.
We have come a long way, as so many have said, and it is great that mental health is not the taboo it used to be. But far too many people are still suffering problems. I know that the Minister wants to do more, but we are all terribly impatient. Perhaps by working together we can make things move more quickly. There is so much more we could and should do. I am glad the Minister agrees with my noble friend about education and what we should be doing to make schools more joyful places, with more creativity and time for children. Our children need a happy, safe environment wherever they are, including in their schools, so I hope the Minister will work closely with her education colleagues and convince them they should be listening to her.
There has been more investment, and I suggest we need more investment to ensure that all these initiatives are not piecemeal pilots. They are not meant to be, as we want joined-up initiatives across the United Kingdom so, if any of our children are suffering, wherever they are, they will not be suffering in silence. If they need diagnosis or treatment, they will get that and it will be superb quality, wherever they are.
I feel relatively optimistic at the end of this debate, and I am glad and grateful to all noble Lords for highlighting these issues that are of such importance to individuals, and also to the future and well-being of our society. Thank you to everybody who participated.