Young People’s Mental Health

Baroness Keeley Excerpts

Thursday 27th October 2016 Commons Chamber

[Tim Loughton]

The hon. Gentleman is right; he pre-empts a couple of my comments. From my experience as a former Minister—and, I am sure, from his—the term “joined-up government” is a complete illusion. Joined-up government does not happen in practice. On becoming a Minister, one is cocooned in a Department, and instead of having a dialogue with colleagues in the Division Lobby or wherever, a huge wall suddenly comes between you. Trying to get interdepartmental action becomes really frustrating.

I remember setting up something called the youth action group, which consisted of Ministers from nine or 10 Departments and representatives of six major children’s charities. It was co-chaired by the Prince’s Trust and Barnardo’s. The charities came to us with problems—often complex ones—affecting young people. One example related to housing benefit and accommodation for children in care. I cannot remember what the specific problem was, but it involved housing, which was the remit of the Department for Communities and Local Government, and benefits, which were the remit of the Department for Work and Pensions, as well as children in care, who came under the remit of the Department for Education. Normally there was a vicious circle that involved people being pushed from pillar to post. Alas, that committee has not met for the past 15 months or so, but our meetings used to consist of at least six actual Ministers—not just civil servants—from the relevant Departments as well as their officials. We would get Ministers together and ask them to go away and solve the problem.

Mental illness falls into that category, in that it is not simply the remit of the Department of Health or the Department for Education. There are many other implications and knock-on effects that can relate to the underlying cause of somebody’s mental illness problems. The hon. Gentleman is absolutely right that the structure of government needs to be much better. We need taskforces that genuinely cut across Government Departments, but in my experience they will flourish only if they have the buy-in and direct engagement of Ministers at the top. One welcome initiative from the hon. Gentleman’s party was the appointment of a Cabinet-level Minister for mental health. I think that that appointment has slightly gone by the wayside now, but the principle behind it was absolutely right, in that it tried to join up all the relevant Departments at the top table.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

May I remind the hon. Gentleman that I am the shadow Cabinet Minister for mental health? That post has not gone away on this side of the House.

[Tim Loughton]

I am delighted to hear that; I did not in any way mean to underestimate the hon. Lady’s contribution. However, when the hon. Member for Liverpool, Wavertree (Luciana Berger) held the position, she sat at the Cabinet table. I hope that that is still the case, and I would very much like to see my own party replicate that position in government, because this is such an important cross-cutting issue.

Mental health remains the Cinderella service of the NHS. Indeed, the report describes child and adolescent mental health services—CAMHS—as the Cinderella service of a Cinderella service. The whole question of parity of esteem and funding is important. We can have arguments about how much the NHS budget has increased and kept up with inflation, but in every year in which the funding for mental health remains static or, worse still, declines as a portion of the overall NHS budget, we are sending out a clear message that it is a secondary priority within the NHS, and therein lies part of the problem.

I do not want to be too negative, however. We are making progress, as are other countries. For example, when you go in through the main entrance of a hospital in Copenhagen, in Denmark, you turn left if you have diabetes and you turn right if you have a mental illness. And nobody cares whether you turn left or right; there is no stigma attached to mental illness. People are treated on exactly the same basis, and that is how we need to treat mental illness here. Despite the best intentions of many Ministers, that is just not happening in practice at the sharp end where our young constituents are trying to access the mental health support that they desperately need. It is certainly not happening in a uniform way across the whole country. As a result, at least one in four people in this country is still suffering from a mental health problem.

I have a particular interest in perinatal mental health, and I declare an interest in that I chair the all-party parliamentary group for conception to age two—the first 1,001 days. I am also chairman of the trustees of the Parent and Infant Partnership Projects charity. We now have seven parent infant partnerships—PIPs—across the country providing direct support and specialist perinatal psychological help to mums and dads with newborn babies. About half of all cases of perinatal depression and anxiety go undetected, and many of those that are detected fail to receive evidence-based forms of treatment. Alarmingly, at the time of the publication of the all-party group’s report, “Building Great Britons”, in February last year, just 3% of clinical commissioning groups in England had a strategy for commissioning perinatal mental health services. The upshot of all that, as the Maternal Mental Health Alliance has calculated, is a cost to the NHS of £8.1 billion for each one-year cohort of births in the United Kingdom. That is the equivalent of almost £10,000 for every single birth in this country, and it is a cost that the NHS can ill afford.

Why is this relevant to young people? Nearly three quarters of that cost relates to the adverse impacts on the child rather than the mother. Followers of attachment theory, which the hon. Member for West Ham (Lyn Brown) mentioned, will appreciate the strong link between achieving a strong attachment between the child and the primary carer and good nurturing from the earliest age—that is, from conception to the age of two, as our report puts it—when the synapses in the brain are developing at a rate of some 40,000 a second and the child’s brain, character and development are being formed. The earliest experiences shape a baby’s brain development and have a lifelong impact on that person’s mental and emotional health.

Research shows a direct link between what happens to a mum during the perinatal period and her child in later life. If a teenager aged 15 or 16 is suffering from some form of depression, there is something like a 90% chance that his or her mum suffered from perinatal depression. The link is that clear, so it is absolutely a false economy not to help mum out at that early stage. And let us not forget dad, who also plays a crucial role. Getting it right with parents and children early on is crucial to the good mental health of children and young people. This is not rocket science—technically it is neuroscience—and we should be doing it better, sooner.

Certain other factors have been flagged up in the report. My hon. Friend the Member for High Peak (Andrew Bingham) spoke about many of them, including the peer group pressure that our children and young people experience. In fact, I have no children any more. My youngest is now over the age of 18, but we went through the teenage years together and I have seen these things at first hand. No one can go out in the morning without the latest iPhone, without checking Facebook and without tweeting what they are having for breakfast and Instagramming a photograph of it. And that all happens just after they have got up. The pressure to succeed in school and the hothouse of exams and testing are not conducive to the best mental health, and young people need support to help them through the challenges. We never had those challenges in my day, which I guess was even earlier than that of my hon. Friend the Member for High Peak. Social media is a huge influence on young people, and it was just not around in my day. I would hazard a guess that it was not around in your day either, Madam Deputy Speaker.

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[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in this important debate on the Youth Select Committee’s report, “Young People’s Mental Health”. I too want to thank the Backbench Business Committee for allocating time for the debate, but I agree with the Conservative Members who suggested that this matter should have been debated in Government time. We must underline the importance of this report.

I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) and the hon. Member for South Cambridgeshire (Heidi Allen) on securing the debate. My hon. Friend talked about the focus on the need for early intervention, as did many other Members. She also talked about the need for beds, saying that sending seriously ill young people away from home had to stop. I think we all support that view. She made it clear that, in her view, the state of the service was a national scandal, and she raised a number of points that we hope the Minister will respond to. They included the recommendations for ring-fenced funding for CAMHS and for co-production involving young people in the design of CAMHS, and the need to improve mental health education in schools. I will talk about those issues as well. My hon. Friend also referred to the notion in the YMCA report on stigma, “I am Whole”, of young people feeling as though they are

“trapped inside a thousand invisible prisons”.

We should keep that in mind.

The hon. Member for High Peak (Andrew Bingham) acknowledged the legitimacy of the Youth Parliament. He also talked about the pressures on young people and related that back to his own experience when he was young. That has been a bit of theme in this debate. My hon. Friend the Member for West Ham (Lyn Brown) stressed the need for early intervention. That subject that has come up many times today, and quite rightly, because early intervention can decrease the severity of mental ill health. She made a powerful case for the Government’s funding pledges to be fulfilled.

The hon. Member for East Worthing and Shoreham (Tim Loughton) talked about the importance of the status of the report and rightly said that it should have been debated in Government time. I am glad to have his support for the fact that Labour has a shadow Cabinet Minister for mental health, which is me. It is interesting that the Scottish National party Government also have a dedicated Minister for mental health. I think we are moving towards a position in which that is seen as something to be supported. The hon. Gentleman also talked about the effect of the pressures of social media on the mental health of young people. It is interesting to note that we shall debate the impact of social media on the mental health of young people in Westminster Hall next Wednesday.

My hon. Friend the Member for North Durham (Mr Jones) talked about the real problems that parents and grandparents face in navigating mental health services. He talked about commissioning and made some important points about the difficulty of working through GPs in our medical model. He also talked about local government cuts and said that they were a false economy. I shall talk about that as well. He also talked about the need for open-access services, given the difficulty in navigating the system.

The hon. Member for Wealden (Nusrat Ghani) talked about a teenager with an eating disorder, the suicide rate and the problems faced by young men. Although there is a focus on the impact on women of mental health issues, young men are also badly affected.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) talked about access to mental health specialists in schools and training for staff, which has been a theme this afternoon. She also mentioned the need to modernise approaches. We keep hearing about the importance of IT and social media, and she referred to the SafeSpot app. Like several hon. Members, she also talked about online bullying.

The hon. Member for Bexhill and Battle (Huw Merriman) is back in the Chamber. He came out of a Bill Committee to speak today and regards this topic as very important. His clear commitment to mental health was shown by it being the subject of his first question at PMQs. He also talked about social media and the need for early intervention.

I did not know that my hon. Friend the Member for Ilford North (Wes Streeting) was elected an honorary president of the British Youth Council. He quite rightly thanked the Speaker for his support for the British Youth Council and the Youth Parliament. It is important, as he has done, to listen to young people’s concerns about mental ill health because that can lead to open, candid and courageous discussions. It is good that groups of young people can become more at ease with discussing mental health—there is hope for the future. He also talked about the exceptionally high incidences of mental health issues among LGBT young people, including high rates of self-harm and suicide. He referred to the poor standards of care at Brookside adolescent unit. It took a damning report from the CQC to highlight its problems, the consequence of which was the death of the young man Simon.

My hon. Friend the Member for Neath (Christina Rees) gave us the first speech of Matthew, a member of the Youth Parliament who works in her team, and talked about the lack of full and proper support for young people’s mental health. She also mentioned the difficult experience of a young person who had to visit the GP seven times before getting help and felt crushed by the lack of support. Like other Members, she referred to training for teachers and having a trained counsellor in every school.

My hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury) talked about hospital wards not being safe for young people with mental health problems. A headteacher in her constituency reported having three children sectioned from school, which is a sobering thought indeed.

The hon. Member for Linlithgow and East Falkirk (Martyn Day), the SNP spokesperson, talked about many local groups. It is a sign of the difficulties facing support within the NHS that there is a need for all the groups he mentioned.

Before I move on, I want to pay tribute to the work of my predecessor, my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger). She has campaigned tirelessly for improvements to the mental health system. Her work helped to raise the profile of many issues that had not previously been given the attention they deserve. I join other Members in congratulating the Youth Select Committee on its excellent report.

The Secretary of State for Health recently admitted to failings in mental health services for children and young people. He said:

“I think we are letting down too many families and not intervening early enough when there is a curable mental health condition, which we can do something about when a child is eight or nine, but if you leave it until they are 15 or 16, it’s too late”.

People working in mental health services know all too well the truth of what the Secretary of State says. We know that on average one in four people experience a mental health problem, that 50% of adult mental health problems start before the age of 15, and that 75% start before the age of 18. Yet just 8% of our mental health budget is spent on children, with CAMHS, which have been referred to extensively, representing just 1% of the NHS budget. Members have quite rightly referred to that as the Cinderella of the Cinderella service. Does the Minister agree that 8% is far too small a proportion of the budget to spend on youth mental health, and does she agree that more needs to be done to intervene earlier when mental health issues are involved? Demand is clearly outstripping supply. Demand for child and adolescent mental health services is growing, but Government action is not meeting that demand. Funding for overstretched mental health services is not reaching the frontline, where it is so badly needed.

As my hon. Friend the Member for North Durham said, essential support services are being lost as a direct consequence of Government cuts to local authority budgets. Ofsted has reported that between 2010 and 2015 there was a 38% cut—£538 million—in funding for children’s centres, and a 53% cut, which is £623 million, in funding for youth services. Very many children and young people are not receiving the help that they need until they reach crisis point, and those cuts in local authority services are part of the problem. By failing to address these critical issues, Ministers are letting down vulnerable children and young people.

Sarah Brennan, the chief executive of Young Minds, has said that children’s mental health services have been “woefully” underfunded for years and that:

“While the government’s extra investment is welcome, it’s unclear whether it’s making a difference to frontline services. Even if the new money is spent where it’s intended, the Chief of NHS England has admitted that it will only be enough to reach a third of the children who need help.”

She goes on to say:

“Because of long waiting lists the threshold for accessing specialist services has got higher. Without treatment, problems are very likely to escalate and children are more likely to self-harm or become suicidal, to be violent and aggressive, or to drop out of school, which can ruin their prospects for the future. Delays can also have a disastrous effect on families, with parents forced to leave their jobs to look after their children”.

A report for the British Medical Association underlines that by telling us that the number of young people aged under 18 attending accident and emergency because of a psychiatric condition more than doubled between 2010 and 2015. The number of children and young people self-harming has also risen dramatically in the past 10 years, with the upward trend more pronounced among girls and young women. We have heard examples of that in the debate.

The number of referrals to child and adolescent mental health services increased by 64% between 2012-13 and 2014-15, but 28% of children and young people referred to CAMHS were not allocated a service. Members have referred to that fact in this debate. A report by the Children’s Commissioner found that 79% of CAMHS imposed restrictions and thresholds for children and young people accessing their service—I could go on. We have a tale in this debate of an increasing number of referrals to CAMHS, high thresholds for care and long waiting times. What all those things mean is that many children and young people are not receiving help.

Let me come back to the Secretary of State, because in reference to the quality of care that CAMHS teams provide, he said:

“I think this is possibly the biggest single area of weakness in NHS provision at the moment.”

Does the Minister recognise that the statistics we have heard in this debate show that demand for mental health services has clearly outstripped supply? Can she tell us what actions Ministers plan to take to address those issues?

I want to talk about regional variation, because it is an important aspect of the issues we are seeing. The Children’s Commissioner’s report also highlighted regional variations in treatment, suggesting that access to CAMHS is, in effect, a postcode lottery. The data gathered suggest that in England the average waiting time between referral and receipt of services from CAMHS ranged from 14 days in the north-west to 200 days in the west midlands. Does the Minister agree that that level of variation is totally unacceptable? Can she highlight what Ministers are doing to achieve swift access to care across the country at the same levels? A recent report on the state of mental health by the Public Accounts Committee warned:

“Good access to mental health services matters. Many people can make a full recovery if they receive appropriate, timely treatment. However, a high proportion of people with mental health conditions do not have access to the care they need.”

I wish to dwell for a moment on the state of CAMHS services, because that has been an important aspect of this debate. There is a lack of crisis services, a lack of accountability for transformation plans, and a lack of co-production with parents, carers and service users. One person asked, “Who cares for the carers because it certainly isn’t the mental health service?” That view of CAHMS is borne out by nurses who work in CAHMS. In a survey of 631 CAMHS nurses, 70% said that the services were “inadequate” or “highly inadequate”—I put it to the Minister that it is very worrying that the very people who work in CAMHS refer to the services in such a way—73% said that the main problem was too few nurses, 48% said that there were too few doctors, and 62% said that there were too few beds for patients.

Last December, the Secretary of State made this pledge:

“CCGs are committed to increasing the proportion of their funding that goes into mental health.”

However, as we have heard in this debate, increased front-line funding is not being delivered, and that is clear in the provision of services.

Let me refer to a matter that was raised by a number of my hon. Friends. In the responses to the freedom of information requests made by my hon. Friend the Member for Liverpool, Wavertree, 73 out of 128 CCGs—more than half those that responded—admitted that they plan to cut the amount they will spend on mental health, which underlines the fact that the funding issue is just getting worse.

Does the Minister agree that the Secretary of State has clearly broken his promise and that many CCGs are not increasing funding for mental health? As we have heard in this debate, the pledge to achieve parity of esteem is repeatedly being broken. Despite Ministers’ promises about achieving parity of esteem between mental and physical health, there is still a great difference in the treatment of families of children with physical rather than mental health needs—a number of Members referred to that disparity. Indeed, many physical health hospitals now have family rooms or flats in which parents can stay to support a child, and parents can, in some cases, get help with transport costs. By contrast, the families of children in mental health units feel isolated. There is no provision for families to stay, and no support with transport costs, which can become prohibitive. Often a child can be sent home with no transition plan. It is clear from this debate that the Government are failing to achieve parity of esteem.

We had four questions on mental health at Prime Minister’s questions yesterday, which is an indication of the level of concern among hon. Members. The hon. Member for Bexhill and Battle made mental health the subject of his first such question. As my hon. Friend the Member for Ilford North said, there was real disappointment about the responses from the Prime Minister, so I hope that we get better answers from the Minister today.

Much has been said about education and the role of schools. A report by the Education Committee on the mental health and wellbeing of looked-after children made the clear recommendation that schools should have a role in teaching about mental health and wellbeing. That report said:

“The interface between schools and health services needs to be strengthened to ensure that teachers and schools are better equipped to identify, assess and support children and young people with mental health difficulties.”

It has been quite clear in this debate that Members feel that schools and colleges should play a key role in promoting the good mental health of children and young people. More young people are experiencing serious psychological distress because they are under unprecedented social pressures. It is a credit to Members that those pressures are recognised.

Although we will not have time to cover this subject today, I have to say that easy access to the internet poses new challenges for young people. Cyber-bullying is increasing with more than one in 10 children now saying that they have experienced it. Young people cannot get away from bullying even when they have closed the door of their homes.

A number of Members have stressed the role of schools in ensuring that these problems are spotted as early as possible and addressed. Counselling services are vital. As a Salford MP, I am pleased that Salford has launched a register of approved providers of counselling in schools, and that one provider has already been appointed to deliver a two-year pilot to train and support a cluster of schools in counselling. My hon. Friend the Member for North Durham talked about the importance of counselling, but we recognise that there are funding problems. Many schools will not be able to afford to pay a trained counsellor.

Clear guidance is needed for schools on how to commission high-quality mental health support programmes and how to tackle mental health discrimination and stigmatisation. Will the Minister outline the Government’s plans to ensure that education, health and social services work together to provide an extra layer of support to spot and treat mental health problems? The hon. Member for East Worthing and Shoreham talked about how cross-departmental working can help.

Clearly, the best way to deal with a crisis is to prevent it from happening in the first place. It is critical that people can access the right information and that better support is provided in childhood and adolescence. That can help to reduce the incidence of young people developing mental health problems.

Overall, it is clear from the debate that actions speak louder than words. If Ministers are serious about tackling these issues, they must follow through with their funding pledges. Government cuts to local authority budgets, which I and others have referred to, have meant that many of the local services providing early intervention have had to scale back services or close their doors. I have talked about cuts to children’s centres, social workers, educational psychologists and mental health services in schools. There has been a reduction in care and support for under-18s, so we need urgent action. The Minister has been urged by Government Members, as well as Opposition Members, to relieve that pressure on overstretched CAMHS, but we also need to develop prevention and early intervention strategies. Crucially, the right help and support must be available for vulnerable children and young people when they need it, not 200 days later. I look forward to the Minister answering my questions and those of my hon. Friend the Member for Dulwich and West Norwood, and telling us what action will be taken to improve provision in this vital area.

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[Nicola Blackwood]

One of the ways in which we are ensuring that money reaches the frontline is through driving accountability through transparency. Mental health services have lagged behind the rest of the NHS in terms of data and our being able to track performance. That is why the NHS will shortly publish the mental health dashboard, which will show not only performance but planned and actual spend on mental health. This is real progress.

[Barbara Keeley]

Let me make a couple of points in addition to the useful points made by my hon. Friend the Member for West Ham (Lyn Brown). First, it is clear that CCGs are ignoring the Government’s requests, so we will need more action than the dashboards and transparency that the Minister has mentioned. The Secretary of State will need to go back to CCGs and make the position very clear to them. Secondly, as other hon. Members and I have said, there is the question of local authority funding. Over £1 billion has been taken out of various services for children and young people such as children’s centres and youth services. That is a factor too. Those two things need to be addressed.

[Nicola Blackwood]

It is not fair to say that CCGs are ignoring the funding that is coming through. Moreover, it will not be possible for them to ignore what is going on when transparency and accountability is put in place with data sets that clearly show not only performance down to CCG level but the amount of funding that CCGs are given and the amount they are spending. These data will be much more detailed than before. In January, we introduced the first ever provider-level data set on children’s mental health services, and that will provide data on outcomes, length of treatment, source of referral, and location of appointment.

[Nicola Blackwood]

I am happy to look at it. We are very clear that there is a vital role for the voluntary sector to play in delivering some of these services. We hope that local transformation plans will be part of the way in which this is clarified. The programme to deliver transparency and accountability will be essential if local areas are not only to design effective services that match the needs of their local populations, but to be held to account for delivering them. I will not beat about the bush. We recognise that a complex and severe set of challenges faces children and young people’s mental health services. This area has been undervalued and underfunded for far too long.

While I am happy to investigate funding formulas such as those mentioned by the hon. Member for Ilford North in relation to Redbridge, I agree with him that leadership and accountability are also key to making the changes that we need. That is why we are committed to delivering real changes across the whole system, not just in funding, and to building on the ambitious vision set out in “Future in mind”. I pay tribute to my predecessors for the work they have done to bring those forward. As the hon. Member for Dulwich and West Norwood has said, we need to go further to drive through these changes, which young people have told us they want to see.

Children want to grow up to be confident and resilient, and they want to be supported to fulfil their goals and ambitions. We are placing an emphasis on building in that resilience, on promoting good mental health and wellbeing, on prevention—it is so important, as the shadow Minister has said—and on early intervention, as a number of the recommendations propose. We are looking, in particular, at how we can do more upstream to prevent mental health problems before they arise.

[Barbara Keeley]

The Minister is about to move on to intervention. Before she leaves funding, which has been pretty key, does she believe that the 8% of the budget spent on young people’s mental health—1% for CAMHS—has been anything like adequate? I did put that question to her. If she does not think that that is adequate, could Ministers tell us what they think it should be? If CCGs are ignoring Ministers’ continual urges to them to make pledges, will there be sanctions against CCGs that do not put in that extra funding?

[Nicola Blackwood]

I think I have already answered those questions. The Government have been clear that we think that mental health funding for children and young people, as well as for other areas of mental health, needs to increase. That is why we have increased mental health funding to local areas and we are putting in place measures to improve accountability and transparency, and the STPs, to make sure that that can be tracked locally. We are going to see how it works in the first instance.