Mental Health of Children and Young Adults

Baroness Morris of Yardley Excerpts

Thursday 16th May 2019 Lords Chamber

[Baroness Morris of Yardley (Lab)]

My Lords, I too congratulate my noble friend Lady Royall on the way she introduced this debate and on giving us the opportunity to speak on such an important issue. I accept all the points made about the lack of resources in the National Health Service, the queuing for CAMHS and the need to invest there. Having said that, I do not want to talk about that aspect of well-being and how we can support young people. If our approach is that we always use an external health model to deal with this issue, we will never actually solve the problem: if we are always treating the crisis, there will always be a crisis. Whatever Government are in power, CAMHS and other mental health services through the NHS will always be rationed to some extent. At the moment, we are seeing teachers in schools spending their time queueing to get their children into the acute services of CAMHS and the health service.

I want to put forward as an example an approach to go alongside that but not replace it, because I know that for some children that level of expert clinical support will be needed. Essentially, we need public health working through schools. As a parallel, in dealing with obesity we deal with the causes of obesity; we have dentists, but we deal with the causes of children having bad teeth.

My noble friend Lady McIntosh made an incredibly powerful and effective speech. But even if we had the sort of curriculum in schools that she would like—and I wish that too—there would still be a need to make school a place where the well-being and mental health of young people are supported. That is the job of adults, whether parents, family, community or teachers. It is for us to create an environment where more young people develop the skills and knowledge to have better mental health and well-being throughout their lives.

I chair the Birmingham Education Partnership; in saying that I declare my interest in the register. Four years ago, we were approached by the clinical commissioning group in Birmingham. It wanted to do this sort of work and knew it did not have the access to the city’s children that we did through the schools system. BEP provided funding to work with schools on a public health model. With its resources, we have appointed a team led by a psychotherapist—a brilliant woman called Anna Robinson—and made up of a family therapist, a head teacher and a learning mentor. So far, the team has worked in 53 secondary schools in Birmingham, appointing a designated senior lead in each school. The job is quite simply this: to help those teachers identify vulnerable children as they come into school from primary; to develop training packages for teachers and all adults who work in the school; to work with external partners, as managed by our group, such as the excellent YoungMinds, the public health authorities and clinical commissioning groups; and, now and again, to bring together the leads from all the schools so that there is a community of interest and support for this work. We are working with 53 schools, and when we finish our fifth year of funded work we think we will be working with all 80 secondary schools in the city. We are now turning our mind to working with primary.

The examples that the noble Lord, Lord Storey, talked about, of some schools having support and not others, are what I experienced and are usual. As an ex-Education Minister, I know that the most difficult thing is not to find what works but to get it into every school. The real challenge is rolling out good practice. I am cautiously excited, if that is not a contradiction in terms, to have got this model into 80 schools in Birmingham in five years and to be all ready to move to the primary schools. I wanted to bring that to the attention of this debate as something I hope we can take forward.

I know that, after we started, the Government came forward with their Green Paper, the first aid kit and measures to work with schools. I applaud that and am grateful for it, but the worry of our team in BEP is that elements of this still use the NHS-based model. If I get over one fact in this debate, it is that that by itself will not work. It has to be a model that is wrapped round, runs through and envelops the life that children have in schools, so that attention to mental health is part of how we do our job and not something that we have to refer children to.

I will finish by giving four or five points that BEP has learned and wants to bring to the attention of this debate—I am merely chair of the organisation and pay tribute to the team. First, quick wins are possible and there is nothing wrong with them, but sustained work needs time and consistency. The fact that we are going into our fifth year of this project is an important message in itself. Secondly, these lead teachers need to be confident and well trained, and have good subject knowledge and the confidence to train others. They therefore need training on an ongoing basis that will bring them together and enable them to do their job. Thirdly, schools need to be supported by an integrated team with other skills and other professionals.

I will make two points to finish about things that are not around yet but which will come. Schools need to know who to go to in order to buy or get good quality support. This will become a market. There are lots of organisations—some good and some not so good—selling or giving services. We will get to the point where we as politicians can list the organisations and resources which schools can access to support this work, but we do not give teachers the information they need to make wise decisions about what they buy or access.

Lastly, our team made a point which made me smile: you have to work within the school year. The National Health Service does not work in line with the school year. If we are to bring professionals together to create in our schools an environment where children are given the skills and knowledge to create as good mental health and well-being as possible, we have to work around the rhythms of what they do.

As I say, I am not putting this forward as something that is guaranteed to be a success, but I am confident that it is a more than valuable and important contribution to the debate, which I am delighted we are now having.

Breast Cancer Screening

Baroness Morris of Yardley Excerpts

Thursday 3rd May 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord makes a good point. We are encouraging people to use the helpline. Indeed, the number will be written in the letter that is sent to women, whether they are offered a screening because they are aged 72 or under or want to refer themselves for a screening. At the same time, many women will be anxious and will want to see their GP, or are seeing them anyway. We recognise that. We have liaised with the Royal College to make sure that GPs are properly briefed on a potential increase in the number of women referring themselves so that they are able to cope with that and provide the necessary signalling.

It is also important to highlight that we are working very closely with the key cancer charities, such as Macmillan, Breast Cancer Care and Breast Cancer Now, and others to make sure that there is a proper, broad approach so that women, whatever their anxieties—mental health issues may have been triggered as well as physical ones—get the support that they need and deserve.

[Baroness Morris of Yardley (Lab)]

My Lords, I obviously share in the concern about what has happened. I want to emphasise a point that has already been made and make sure that it will be part of the review. It is unimaginable that some women realise that they have not got the recall for their regular breast screening appointment. As a woman, you are sort of aware when it is about to come around; if the letter had not come, some people—though not everybody—would have either contacted the helpline or gone to their GP. I am worried that the response was, “Well, the computer says you’re not ready for a screening yet”, so the person was not listened to. I am seeking some assurance that the inquiry will come back with an answer on what happened when women said, “I think my breast screening appointment is late”.

Secondly, I am not sure about the scope of the inquiry, which I of course welcome. Will it look at all the circumstances surrounding this incident or will it go further, for example by looking at other causes of the drop in the percentage of people taking up such opportunities, as well as the regional disparities, which have already been mentioned?

[Lord O’Shaughnessy]

As always, the noble Baroness makes a very incisive point. The inquiry must look at whether there were signals and whether they were missed. That may be at the macro level or the micro level, with individual women saying to their GP, “Hang on, this is odd, I haven’t got this”. The problem has arisen because of the interaction between the screening process, which is due to run until a woman’s 71st birthday, and the extension, which was meant to run from a woman’s 71st birthday to the end of her 73rd year but was taking women into this clinical trial prematurely and randomising them. Hence, women in their 70th year did not get anything. It was the interaction of the two. It is technically quite devilish. A 70 year-old woman might or might not have known that she was due to have another one. This is one of things we have to get to the bottom of because, as the noble Baroness said, although this is about technology and computers, ultimately humans are at the centre of this problem.

The inquiry is primarily focused on the incident itself, but I imagine that if, during the course of its work, it finds out or establishes that other issues need to be pursued, such as increasing screening rates variation and so on, it will have the freedom to make those recommendations.