Draft Mental Health Bill
Baroness Royall of Blaisdon Excerpts(2 years, 4 months ago)
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Lord Kamall (Con)
As noble Lords discussed during the Health and Care Bill, prevention is crucial. One thing I became aware of when I became a Minister was, when talking to the NHS and others, how they want to move away from purely curing to prevention. In response to the noble Baroness’s specific question, I commit to write to her on the exact allocation of that, but there is one area that plays an incredibly important role. We know, for example, looking back on the crisis, that when we did not know how long it would last, that created a lot of uncertainty. Uncertainty is very unbalancing for people, and it is a huge factor in them having mental health issues. Clearly, one of the issues that came up during the Bill was the use of civil society organisations, social prescribing, music and art therapy, but also conversations—people being able to talk to someone about the issue they are facing and feeling they are not alone. Clearly, that is something we have looked at, in terms of prevention, but in response to the specific question I commit to write to the noble Baroness.
Baroness Royall of Blaisdon (Lab)
My Lords, I am sure that prevention will be part of the new 10-year mental health strategy—or I hope that it will be—and also part of the 10-year suicide strategy. My noble friend asked when we might expect to receive a copy of that strategy, because of the exponential need, which the Minister has recognised, especially in relation to young people. I remind noble Lords of my interests in the register. I urge the Government to produce that strategy as soon as possible.
Lord Kamall (Con)
Clearly, there are a number of different facets to mental health and what we are looking at, but suicide is one of those areas. In fact, my right honourable friend the Secretary of State met a very well-known anti-suicide charity, or support group, the other day, to talk about this specific issue. It is a tragedy; we must do all we can and treat it with the same urgency that we would any other major killer. We know about the high percentage of male suicides and what proportion that is of young men’s deaths. We are looking at the drivers linked to suicide, including those that were not necessarily reflected in our previous strategy, such as gambling, domestic abuse and online safety.
We are engaging widely to shape our plan. We have announced a number of commitments for that plan, including a best practice guide, safety plans, et cetera, by early next year. I do not have the exact date yet, but I keep being told it is soon. That is not very helpful, I know, but I will try to get more information for the noble Baroness.
Covid-19: UK Arrivals
Baroness Royall of Blaisdon Excerpts(3 years ago)
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Baroness Royall of Blaisdon
To ask Her Majesty’s Government why international students and others who have been fully vaccinated and are not required to self-isolate on arrival in the United Kingdom subsequently have to self-isolate if a close contact contracts COVID-19; and what plans they have to change this policy.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
Our current system for validating the vaccination status of close contacts relies on checking against records in the NHS national immunisation management system. We do not have access to equivalent records for those vaccinated overseas. We recognise the pressing need to resolve this issue as soon as possible and are urgently exploring a number of different options to extend the existing exemptions to contacts who have been vaccinated overseas. I hope to be in a position very shortly to brief the House on a proposed solution.
Baroness Royall of Blaisdon (Lab)
My Lords, I will welcome that solution when it comes. The Minister talks of urgency but we have been waiting since the beginning of September for a resolution to a problem that I believe is rather small but which clearly disadvantages international students. To me, it feels slightly xenophobic and as though to date the Government have been intransigent. I know that Public Health England agrees that the policy is not logical in any sense or form, so why do international students have to self-isolate for 10 days when our own students from the UK do not? This disadvantages the international students and puts people off coming to this country. Also, how can international students who have had non-MHRA-approved vaccines be immunised in the UK in order to get a Covid pass, should that be necessary in the not too distant future, as it is in some other parts of the UK?
Lord Kamall (Con)
As someone whose family comes from outside the EU, who has taught in universities and who recognises the great asset that there is and the great advantages that there are in being open to the world, and global Britain, I share the noble Baroness’s frustration. Yes, we have left the EU, which is very much a project of white privilege, and moved to a more global outlook. It is really important that we now focus on the world generally. The issue is quite technical at the moment. One of the things needed for the test and trace system to work is that you need access to the underlying data and verification. We are looking at a number of different options for how to achieve that.
Carers: Support
Baroness Royall of Blaisdon Excerpts(5 years, 5 months ago)
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Baroness Blackwood of North Oxford
This is crucial. We must ensure that young carers, who are often unseen in the system, have the support that they need and are not overburdened by caring responsibilities. That is why we have been working with the Carers Trust and the Children’s Society. The Children’s Society has led a project to identify and disseminate best practice to support and enable young adult carers, between the ages of 16 and 24, to make a positive transition. Guidance and resources have been published this week, and we will ensure that this is implemented effectively. As the noble Baroness rightly says, this is a crucial part of implementing the carers action plan.
Baroness Royall of Blaisdon (Lab)
My Lords, one group that is desperately in need of support and respite care is the carers of children who are dying. A recent report stated that hospices for children are no longer able to help parents in those categories. They are having to shut down some of their facilities because of lack of investment. What are the Government going to do to help the families who keep these kids going, without whom the whole system will fall apart? The Government must help children’s hospices.
Baroness Blackwood of North Oxford
The noble Baroness is absolutely right. This is an important part of the system. I noted those reports with serious concern. Significant work has been put into providing carers’ breaks and respite care within the Carers Action Plan. Local authorities are required to provide that support. We shall investigate what has happened in those instances.
Mental Health of Children and Young Adults
Baroness Royall of Blaisdon Excerpts(5 years, 6 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.
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.
Personal Social Care: Funding
Baroness Royall of Blaisdon Excerpts(6 years, 1 month ago)
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Lord O'Shaughnessy
My noble friend is absolutely right, which is why there must be a balance between what is paid by individuals and by the taxpayer through the state.
Baroness Royall of Blaisdon (Lab)
My Lords, are my ears deceiving me, or did the Minister talk about a sustainable social care system in England? If so, he ought to talk to some people who are seeking social care at the moment, because they and their families think the current system is not sustainable.
Lord O’Shaughnessy
What I said was that we need a sustainable system, and that will be the goal of the Green Paper.
Health: Medical Respite for Children
Baroness Royall of Blaisdon Excerpts(6 years, 8 months ago)
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Baroness Royall of Blaisdon (Lab)
My Lords, legal obligations are all fine, and of course the Government and everybody else have to comply with them, but unless there is adequate funding for local authorities, health services and commissioning groups, it is impossible for these authorities to comply with the legislation. What are the Government going to do to ensure that enough money is available to provide respite care for these children?
Lord O'Shaughnessy
The noble Baroness makes an important point. That is the reason we are providing more funding, both through social care budgets and through the NHS itself. More money was found at the Budget as well, but I do not think in this case the issue is necessarily funding. It is a case of the parties involved working together, as they are obliged to do, to find the right outcome and the right solution for these children.
Hospitals: Patient Transport
Baroness Royall of Blaisdon Excerpts(7 years, 7 months ago)
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Lord O'Shaughnessy
The chief executive of the NHS was talking about the relative priority and importance of achieving A&E waiting times in particular to the targets that it is not hitting at the moment. The five-year forward view delivery plan refers to the fact that elective operations will continue to increase and that the median wait may move marginally. However, it is worth pointing out that 10 years ago the median wait for an in-patient for an elective procedure was 15.6 weeks—under a Labour Government, of course—and in January this year it was 10.6 weeks. The median may increase but it is still within the 18-week target.
Baroness Royall of Blaisdon (Lab)
My Lords, the statement from Simon Stevens was very honest and welcome but it means some profound changes in the National Health Service. Will the Government come forward with a statement as to how these changes will be implemented and when?
Alcohol: Children’s Health
Baroness Royall of Blaisdon Excerpts(7 years, 7 months ago)
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Lord O’Shaughnessy
We are obviously looking at all aspects of alcohol control, and this has nothing to do with Brexit per se. It is worth pointing out that successive Governments’ alcohol policies have had a very positive impact on the activities of young people. Fewer young people than ever are drinking—it is fair to say that they set an example to older cohorts. However, there is more to do. Around 400 11 to 15 year-olds drink weekly. That is clearly not acceptable and we need to do more.
Baroness Royall of Blaisdon (Lab)
Will the Minister remind the House of what the Government’s attitude now is towards a minimum price for alcohol?
Lord O’Shaughnessy
The noble Baroness will know that on minimum unit pricing a court case is ongoing in Scotland, where the proposed introduction of minimum unit pricing has been challenged by the Scotch Whisky Association. We are awaiting the outcome of that court case before we move ahead.
Learning Disabilities: Transforming Care
Baroness Royall of Blaisdon Excerpts(8 years, 5 months ago)
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Lord Prior of Brampton
I am not aware of the specific case of the Camphill communities, although I know about Camphill. Certainly, the preference is to have an environment where there are not too many people, with houses containing between, say, five, 10 or 15 people, rather than large organisations with sometimes many hundreds of people. I believe that Calderstones Hospital in the north-west, for example, has 223 in-patient beds. The intention is to close that and reprovide those facilities in the community. The key thing that we should always bear in mind is the best interests of the individual.
Baroness Royall of Blaisdon (Lab)
My Lords, the Camphill Village Trust is an excellent organisation that provides small family units. May I ask the Minister to visit the excellent Camphill Village Trust in the Forest of Dean?
Lord Prior of Brampton
This is an area of healthcare about which I am least informed, so I would very much like to do that.
NHS: Bursaries
Baroness Royall of Blaisdon Excerpts(8 years, 6 months ago)
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Lord Prior of Brampton
My Lords, the loan will be available to mature students as well as to students taking their first degree. The loan structure is such that if someone will not be working for as long as a younger nurse they will not in all likelihood repay the whole of the loan, which will be written off at the end of the period. I agree entirely with what the noble Lord says; we depend heavily on mature students coming into nursing. Our view is that this will not put off those people.
Baroness Royall of Blaisdon (Lab)
My Lords, was permission given by the Department of Health for the disgraceful use of the NHS logo on the side of Boris’s blunder bus? I would ask the Minister to look at the precedents. At one stage we asked to use the NHS logo and were told that we could not because it was political. I ask the Minister to look into this.
Lord Prior of Brampton
My Lords, I do not think that this has much to do with the Question on the Order Paper. Clearly, the NHS logo is a powerful and very strong brand and we should be very careful where we use it.