Children and Mental Health Services

Andrew Griffiths Excerpts

Tuesday 16th July 2019 Westminster Hall

[Andrew Griffiths (Burton) (Con)]

I beg to move,

That this House has considered children and mental health services.

It is a great pleasure to serve under your chairmanship, Mr Pritchard. We could not be in better hands. It is a delight to have the Minister here. I know she comes to this issue with great personal interest and a commitment to deliver for all our constituents. It is fantastic to see so many right hon. and hon. Members from across the House here to take part in the debate. That is testament to the interest in this place and the concern across the country about mental health, particularly that of children.

I praise the Government for what they have done to date. When it comes to mental health, there is no doubt that this Government get it, making it a priority like no other. They have tackled the stigma of mental health and put in much-needed resources, but although they have done great work, like Oliver, we would all say, “Please, Minister, can we have some more?” because although we are getting on board with the issues, and royals, TV stars, politicians, and people from sport and all spheres talking about mental health, the problem is snowballing, getting bigger and bigger. Such are the pressures and stresses placed on our children’s mental health that this is an ever-increasing problem, which demands our attention, resources and commitment as a Government.

One in eight five-to-19-year-olds—12.5%, or 1.25 million children across the country—have a mental health difficulty, according to the Government’s own survey of November 2018, “Mental Health of Children and Young People in England”. The Local Government Association says that children’s services are seeing more than 560 cases of mental health issues every day. Some 75% of adult mental health illnesses begin before the individual turns 18 and over 50% start before the age of 14. Some 23% of the population are affected by mental health difficulties at some point each year. The economic and social costs of mental illness in England total £105 billion.

[Mr Jim Cunningham (Coventry South) (Lab)]

I congratulate the hon. Gentleman on securing the debate. About 10 or 11 years ago I introduced a Bill that would have provided a specialist to a cluster of schools, to help teachers to identify children with health and mental health problems. Does he agree that the Government should think about that? Secondly, and most important, employers do not recognise the problems young people have with mental health when they start out in industry, nor do they recognise adult mental health problems. Does he agree that more could be done in that area?

[Andrew Griffiths]

I could not agree more with the hon. Gentleman. It is a pity that more people did not share his foresight, so that we could have acted sooner. We are laying the foundations for mental health problems in adulthood. Childhood mental health has a lifelong impact, so it is important that we do not waste a moment. Rates of depression and anxiety among teenagers have increased by 70% in the last 25 years.

[Gloria De Piero (Ashfield) (Lab)]

I thank the hon. Gentleman for securing this important debate. My constituent Elodie Fleet, who is now 18 years old, experienced anxiety, which came to a head at the age of 13. She wanted to see the school counsellor, but her needs were not deemed to be urgent enough because “she hadn’t tried to hang herself or taken a blade to her wrists.” I hope the Minister will say how we can get more counsellors in our schools to deal with people such as Elodie, because she is not alone.

[Andrew Griffiths]

The hon. Lady makes a powerful point. It is true that her constituent is not alone. When I publicised this debate on my Facebook page, I was amazed by the number of parents who got in touch. I was overwhelmed by parents who have either battled through and managed to get to the other side, or are in the midst of fighting to keep their children alive, safe and well. As a parent, I realise what a scary thought that is.

[Rosie Cooper (West Lancashire) (Lab)]

To reiterate that point, does the hon. Gentleman agree that this is a state of emergency? In my constituency, the parents of a 12-year-old boy are being advised that there is a 72-week wait for their son to get help, even though there is a risk of serious self-harm.

[Andrew Griffiths]

I agree that we are in a crisis. The Government are putting record amounts of money in, but the hon. Lady is absolutely right to say that that is an unacceptable wait. I will discuss waiting times later in my speech. Any parent would be terrified at the thought of that long wait and their child being further harmed by it.

[David Simpson (Upper Bann) (DUP)]

The statistics the hon. Gentleman is outlining are horrific. Some years ago figures were released showing that across the whole of the United Kingdom, over 10,000 young people under the age of 10 were manic depressives. That is a horrendous figure. Such a situation puts horrendous pressure on parents and carers.

[Andrew Griffiths]

I have spoken about my own mental health challenges and my battle with depression and anxiety. As an adult it was very difficult to cope with, but for a small child it must be an incredibly hard to have to deal with.

[Andrea Jenkyns (Morley and Outwood) (Con)]

On the social and economic effect, does my hon. Friend agree that we need a more joined-up approach across Departments? Earlier this year, I met chief superintendent Paul Hepworth of West Yorkshire police, who is a fantastic guy. He mentioned that nationally there is a lack of forensic beds for children with severe mental health issues. He told me the story of a young girl who was in police custody with a severe illness; she was suicidal, self-harming and violent towards others. Does my hon. Friend agree that the Government must address this issue, to offer safe space and support for people in dire risk?

[Andrew Griffiths]

I point my hon. Friend to some of the work done in my area by Matthew Ellis, the Staffordshire police and crime commissioner, and the work done by the Prime Minister when she was Home Secretary on how we treat mental health in our police stations. That is very important, but it is even more important for vulnerable young children. She makes a valid point. I will canter through some more points before taking more interventions.

The Government’s own survey shows that one in four children with a mental health disorder are seen by a mental health specialist and over 400,000 children are receiving no assistance at all. The NHS is managing to see only a fraction of the young people who have problems. My hon. Friend talks about cross-departmental working. I am delighted that the Minister is here, because she has done a huge deal to bang heads together and make this a priority. It involves the NHS, local government, the police and so many different areas, which we need to bring together.

The Children’s Commissioner’s analysis of NHS figures from 2017-18 shows that 325,000 children were treated by community services, while another 5,000 are in hospital—less than 3% of the population. Around £700 million is spent on child and adolescent mental health services and eating disorder support. By comparison, services for adults received 15 times more, despite the fact that children represent 20% of the population. While it is important that we are putting money into mental health services, we are turning it on its head. We need to put more money into children’s services, not only because there is such a great demand, but because if we can nip problems in the bud by making that early intervention, we can avoid those services being needed later in life.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my hon. Friend on securing the debate; he is making some very good points. As he recognises, CAMHS are the Cinderella services of the Cinderella service—mental health is still woefully underfunded in comparison with many other parts of the NHS. Does he also recognise that CAMHS recruitment is a real challenge? The August 2019 fill rates for higher trainees in the UK stand at only 63% for those entering CAMHS specialist training and at only 23% for learning disabilities, which means that almost 80% of new posts in learning disabilities for new trainees will be unfilled. Does he agree that that is a key issue for the Government to address if they want to improve CAMHS provision?

[Andrew Griffiths]

I absolutely agree with my hon. Friend, whom I congratulate on his work in our NHS; I am grateful that he does such a great job on mental health work in the community. He raises the very important point that it is all very well wanting to deliver these services and putting the money in place, but if we do not have the staff to deliver on the ground, we will always be running to catch up.

[Rachael Maskell (York Central) (Lab/Co-op)]

The hon. Gentleman is giving an excellent speech. In York, we have seen a 26% increase in referrals into CAMHS over the past five years. As a result of such high demand, one referral in four is turned away from the service, including children who are self-harming and have experienced abuse. Surely we need to focus on investment in the workforce, as well as on funding.

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[Andrew Griffiths]

The hon. Lady is absolutely right, and we must not underestimate the immense added stress and pressure for families whose child is self-harming. She makes a very good point.

[Julian Sturdy (York Outer) (Con)]

I congratulate my hon. Friend on securing this important debate. May I follow up on the point made by my colleague the hon. Member for York Central (Rachael Maskell) about the figures for York? Are not parents under huge stress because of these referral figures? In York, CAMHS referral times are peaking and troughing, which has a lot to do with not getting the resources needed. Sometimes referral times are down to six months, but at other times they are longer than 12 months, which has a huge impact on the children involved. It also means that schools are having to take action and exclude young people before they can get the treatment they need.

[Andrew Griffiths]

My hon. Friend is absolutely right, not only about the impact on schools—I will say more later about what we can do in schools—but about the pressure on CAMHS and the massive importance of getting children seen as soon as possible. Just imagine if one of us were having a mental health episode and were told that we could see someone in 12 months who would then refer us for treatment. CAMHS are not the doctors or the psychiatrists who see the patient. They are not the help; they are the doorkeepers to getting help—the triage, as it were. Even when someone gets through the CAMHS door and jumps over the very high bar for getting treatment, it could be many months before they receive it.

It is a great challenge. I know that the Government take it seriously; their 2017 Green Paper “Transforming Children and Young People’s Mental Health Provision” outlined their ambitious new plans for delivering mental health support in schools, and the announcement this week of the mental health services trailblazers is a welcome part of that strategy. I am delighted that my area, Burton, is to be in the second phase of those trailblazers, which I genuinely believe will make a difference. However, figures from the Children’s Society suggest there has been little expansion in the provision available in schools since 2015, so we are starting from a low base. In particular, the figures point to a worrying lack of awareness among parents about the counselling offered in their children’s schools: just under a third are not aware of what is available at all.

I am pleased that the Government have announced that every school, college and alternative provision across England will be offered training as part of the £9.3 million mental health services and schools and colleges link. However, even though my area is one of the trailblazers, priority access to mental health training for schools and colleges will not be available in my constituency until next year. It is clearly needed now. There are so many MPs, constituencies and constituents who want access, so how can we roll it on quicker? To use my “Oliver!” analogy again—

[Anne Marie Morris (Newton Abbot) (Con)]

My hon. Friend is making an excellent speech. May I ask him to reflect for a minute on the particular issues for rural communities, including the distances? The lack of broadband means that the opportunities for dealing with those distances are missed. It seems to me—perhaps we will hear more from the Minister about this—that the Government could use technology more effectively in rural areas. We will certainly not get the help we need in time otherwise. My schools will not be getting help under the new scheme any time soon—we are not even one of the pilots. My teachers are very concerned that they will have more burdens, rather than an added resource.

[Andrew Griffiths]

My hon. Friend, who is always a champion for rural communities, makes an important point about rural isolation. We have known for a long time about the mental health challenges of farmers and rural communities, but it is all the more difficult for young people who are isolated from their friends. We talk about the social media pressure on young people with Facebook, Twitter and so on, but it is even more difficult for kids in isolated rural communities, because they are even more separated. That social media connection is often their only chance to talk to their friends.

[Dr Poulter]

My hon. Friend is making one of the best speeches that I have heard in this Chamber for some time, and is going into granular detail to make his case. In the medical workforce, the numbers of mental health nurses have fallen nationally over the past decade, and we know that there are challenges with CAMHS and LD recruitment. We cannot deliver mental health care without bodies on the ground. Unless we get the workforce challenge right, it will just be rhetoric. We need to start turning rhetoric into reality by recruiting the right number of staff on the ground to deliver high-quality mental health care.

[Andrew Griffiths]

My hon. Friend is absolutely right. It is about not just the psychiatrists and the doctors, but the mental health nurses out in the community. I have witnessed their great work at first hand, so I know just how important they are.

The extensive roll-out—as the Government rightly claim it to be—over the five-year pilot is great, but it will address just 20% to 25% of the country’s need. So many young people will miss out on support until at least 2023 or perhaps even later. The mental health training for schools and colleges announced in the past week is fantastic, but under the NHS long-term plan, an extra £2.3 billion is due to be put into mental health services by 2023-24. That is a lot of money, and I want us to make sure that as much of it goes into children’s mental health services as is humanly possible. If we spend it wisely, it can have a double-whammy effect.

[Louise Haigh (Sheffield, Heeley) (Lab)]

Does the hon. Gentleman agree about the importance of bereavement counselling for children with mental health issues? As shadow Police Minister, one of the most common factors that I see among young offenders is a close family bereavement in their childhood, yet so many children languish on waiting lists for bereavement counselling. Indeed, I had a young constituent who waited for bereavement counselling for three years. Unfortunately, his life was taken by another teenager. That just shows the absolute importance of getting in there and delivering that mental health care.

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[Andrew Griffiths]

The hon. Lady is absolutely right. Trauma in young people’s lives is often the trigger, whether it is sexual abuse, domestic abuse, violence perpetrated by other young people, or bereavement. All those triggers set off a train of deterioration in young people’s mental health that is often lifelong. It is so important that they get the access they need.

Several hon. Members have mentioned waiting times for CAMHS. I have certainly found that my constituents cannot get on Facebook quick enough to tell me about their CAMHS experiences. I do not want to denigrate CAMHS, which have great people doing great work; the problem is that there are just not enough of them and they are under too much pressure. As the hon. Member for York Central (Rachael Maskell) noted, CAMHS are turning away nearly a quarter of children who are referred to them. In 2017-18, they turned away 24.2%, meaning that at least 55,800 children were not accepted for treatment. Of those who were referred, the average waiting time was 34 days for an initial assessment and 60 days for treatment—significantly longer than the four-week standard set out in the Government’s Green Paper. We can all point to examples of much longer waiting times in our constituencies.

One constituent contacted me to say that her son had been self-harming for years. It took them months to get an appointment with CAMHS, and when the appointment happened, her son suffered a meltdown. That is not unusual, due to the pressures that those appointments put on young people. Because he is 15, their GP cannot prescribe anything for him. My constituent has had to watch her son throughout the night to make sure he does not do any permanent damage to himself. Another parent told me how her daughter was discharged from CAMHS, with it saying there was nothing more it could do to help with her anxiety.

Young people have told mental health charity Mind—I am very lucky to have Burton and District Mind in my constituency, which does a great job—that the wait for support is one of the most difficult issues they face. They say that sometimes, they find that their mental health deteriorates while they are waiting; the wait actually makes it worse. In England as a whole, half of those accepted for treatment during 2017-18 were still waiting for treatment at the year’s end. That proportion was lower in my area, east Staffordshire, where it was just over one third. However, that is still a substantial figure.

A school counsellor from my constituency contacted me to say that the waiting lists for referrals to child services outside of school can be months long. She believes that when it is established that a child needs help, a counselling session needs to happen within 48 hours. She goes on to say that too much red tape is preventing children from getting the help they need. I think we all recognise, as the Government have done, that support in school, delivered in a way that is accessible to young people—they feel comfortable asking for it, and know of other young people who have accessed it—is a real help.

One parent told me that she decided to fight to get her son’s care commissioned outside of the county they lived in because of her disappointment with the support she had received. She says that early intervention is key, and that there have been too many endless reports and not enough action has been taken. Another parent in my constituency said that she took her daughter to the GP two years ago. She was referred to That Place in Burton, which is a fantastic facility; she took her for assessment, only to be told that her daughter was not old enough to be accepted. Yet another constituent told me that after a referral for her daughter, aged nine, it took three years for them to see a psychiatrist. That kind of wait is difficult, and all the time, the young people are getting worse.

There is also a problem with the transition from childhood to adulthood. According to the British Psychological Society, about one in six 17 to 19-year olds have a mental health disorder; according to the Children’s Society, 16 to 17-year-olds are the biggest service users of mental health services. However, young people often face barriers to accessing support, and end up falling through the cracks of adult and children’s services as they transition. Some young people who are discharged from children and young people’s mental health services at 18 find it can be very difficult to get a referral to adult mental health services at all, and can end up completely isolated. In some circumstances, young people are not accepted into either children and young people’s or adult mental health services, due to them falling between the gaps.

Again and again, I hear that CAMHS discharges young people on their 18th birthday, and that there is no provision at all for them. The challenges those young people are facing do not magically disappear when they become adults. Just last Friday, I met with a constituent who was getting ready to leave CAMHS and had been left to organise her future on her own. She was not automatically transferred to adult services, and had to organise a private therapist in order to get the ongoing treatment that she needs.

One of my constituents sums the problem up better than I could:

“All the time the kids are getting no support, becoming suicidal, becoming adults with even more complex issues, families are breaking up because of the pressure, parents quitting work to do the job of education/social care/health, and all of this causes more and worse financial pressure later on. No one sees the bigger picture because they can’t afford to. No one sees long term because that’s too expensive. Early interventions are crucial but they aren’t funded. We will reap the whirlwind then wring our hands and say ‘how could we have prevented this’”.

That is absolutely pertinent.

The Government have set a five-year forward view for mental health, which is for one in three children and adolescents with a mental health disorder to access NHS mental health community services by 2020-21. In the new long-term plan, they have set a target that 100% of children and young people who need specialist care will be able to access it by 2028-29. However, that is so far down the track.

[Anne Marie Morris]

I totally agree with my hon. Friend: it is so far down the track. Does it not further concern him that in that same 10-year plan, the NHS talks about “parity of esteem”, but that is in 10 years’ time, and it is very unclear what will be done about the timelines for getting there? As my hon. Friend has said, 10 years is much too long to solve the problems we have today.

[Andrew Griffiths]

My hon. Friend is absolutely right. During that time, babies become children, children become adults, and the problem gets worse and worse. I do not deny the Government’s commitment and determination in this, but it is just not happening quickly enough.

The other thing we need to bear in mind is that, although we have heard about CAMHS and the pressures on the workforce, a huge number of brilliant voluntary sector organisations are also delivering these services. I am very lucky to have in my constituency an organisation called Youth Emotional Support Services, which delivers in schools in Uttoxeter, as well as Burton and District Mind. There are so many great organisations. However, even in my own patch, I have heard that a tendering process is currently going on in which the bar is so high, the requirements so difficult and the boxes to tick so numerous that third sector organisations simply feel unable to compete. The challenge is that the tender to provide the facilities goes to a private company, and the experience, dedication and benefits of those voluntary sector organisations are lost.

I was staggered to learn that some of the children’s mental health charities operating in my constituency are providing 85p of frontline services for every pound they receive. That is tremendous value, representing help for young people, and few businesses could get anywhere near matching that. However, the tender process that we go through makes it impossible for voluntary sector organisations to compete. I hope the Minister will look into that; I will be raising with her my particular issue in Staffordshire.

I think the Minister recognises that in this place, we are simply voicing the real concerns and fears of parents up and down the country. Like a snowball coming down a hill, young people’s mental health is under greater pressure than ever before, and as a result they are self-harming, committing suicide, or getting themselves into a situation in which they will, in future years, suffer from greater mental health disorders, addiction, and so many other long-term problems. I hope that the Minister will go away feeling that she has great support across this House for her campaign to get even more resources and focus on mental health services, particularly for children, because quite frankly our children’s lives depend on it.

[Mark Pritchard (in the Chair)]

I do not propose to enforce a formal time limit of four minutes, but I ask colleagues to be mindful of the number of people who wish to contribute to the debate.

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[Mr Kevan Jones (North Durham) (Lab)]

I thank the hon. Member for Burton (Andrew Griffiths) for securing this debate. It is important because the simple way to change attitudes around mental health in this country is to talk about it. The more we do it in Parliament, the better. I pay tribute to all those, including charities such as Rethink Mental Illness, that have made a real step change in the way that we consider mental health in this country. I also give credit to the Minister. She obviously does not know what will happen next week with the change in Prime Minster, but she has been a great champion for mental health in not only doing the work that she does, but caring about it. Sometimes we get a Minster who simply goes through the motions, but this Minister cares deeply about the subject and has made a real difference.

The point about finance is important in mental health. That point has been made over the years not only in respect of adult services, but in respect of children’s services, and it has been made again today. Having the proper workforce is also important. I do not want to relegate those two issues because they are very important in this debate, but the other thing that often does not get spoken about is having a proper pathway into a service, which is a mess at the moment, partly as a result of reorganisations in the health service. We have also had cuts to local authorities and they can no longer afford to fund voluntary sector organisations. Sure Start centres have been cut, and the cuts are having an impact on people’s access to services.

I pay tribute to CAMHS. They get a bad name, but they are trying their best in the impossible job that we give them. We have to try and turn down the pipeline of people going into CAMHS services. The only way we can do that is if we have a proper triage system before going into CAMHS, so that people know whether they can get help elsewhere. We often over-medicalise mental health conditions. The Tees, Esk and Wear Valleys mental health trust in my area has a good pilot that pays for a psychiatrist to sit in a GP’s surgery so that a mental health professional can triage cases as they come in. I do not want to criticise GPs, but they are not mental health professionals. They should have a mental health professional who can triage the cases that need to go through to CAMHS or other adult mental health services and then they can try to help the others.

We need a local network of support organisations, whether it is the voluntary sector, as the hon. Member for Burton rightly pointed out, or others that do fantastic work. He put his finger on the issue of how we tender for mental health services. I am sorry, but the ones that I speak to in County Durham have contracts that are too big and they do not have the capacity to take them on, but they do valuable work in the community. In some cases, it is a way of taking pressure off the pipeline going into CAMHS and adult mental services. Parents want to know where to go, so we need signposts and pathways so that people do not wait 12 months or longer to get into CAMHS, thinking that will somehow answer their questions.

[Andrew Griffiths]

I thank the right hon. Gentleman for giving way and for his great speech. Does he agree that one of the reasons why they tender in that way is because they want to have a uniform approach across the whole country? In reality, if someone wants access to a service, people understand the local charity and are much more aware of it, and more likely to go to it for that very reason.

[Mr Kevan Jones]

I do agree. In my experience the best local examples of mental health support are what is being done by local charities, most of which, frankly, run on a shoestring. They do not ask for huge amounts of money. I think it would be cost-effective for the taxpayer if we directed services into that, but we need that joined-up system. If we do not have it, we can pour as much money as we like into the system and it will not work.

I want to mention one last thing—students’ mental health, which is being highlighted in universities. Will the Minister contact Northumbria University, which is doing innovative work on using new technology to track students and highlight those who are vulnerable? I saw it a few weeks ago on a visit to the university. It is a new model, which could have implications nationally, and I think it is worth looking at. I will finish by just saying, let us keep on talking about this subject.

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[Andrew Griffiths]

At a time when the public look in on this place often with derision and sometimes with desperation about how we behave, this debate has shown Parliament at its best. There was lots of consensus, lots of cases were mentioned in a heartfelt way, and we heard lots of determination to make a difference. I think we all recognise that these issues involve young people in a desperate state and parents who are equally desperate about the future of those children. If we can come together and deliver the early intervention and support mechanisms that can make such a difference later in life, we can literally save the lives of those young people. I thank everybody who contributed to this really positive debate. I hope it is just a springboard for us to go further and ensure we deliver for all those young people across the country.

Question put and agreed to.

Resolved,

That this House has considered children and mental health services.