Mental Health of Children and Young Adults

Baroness Thornton Excerpts

Thursday 16th May 2019 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I congratulate my noble friend on bringing this important debate to your Lordships’ House. It is of course appropriate that we are having it during Mental Health Week, as my noble friend Lord Haskel said at the beginning of his remarks. Indeed, he is quite right: we have been on a mental health journey in this country over the past 10 to 20 years. My noble friend described most eloquently the issues facing students and others with mental health problems. I should like to address the scale of the challenge we face.

I start with a shaming aspect of this challenge. Some 22 children have died suspected self-inflicted deaths while admitted to mental health hospitals and in-patient units in the past five years. My noble friend Lord Giddens spoke more widely about the tragic issue of suicide and related behaviour. Figures released by the Department of Health and Social Care show that four patients aged under 18 have died already in 2019, matching the highest number of fatalities in any previous year.

A Sky News investigation reveals that poor care in privately run child and adolescent mental health services units is putting vulnerable young people at risk. Patients, parents and whistleblowers have shared their experiences of privately run facilities paid directly by the NHS to care for some of the most challenging mental health patients, including those with serious eating disorders and those engaged in persistent self-harm and suicidal behaviour. One former patient told a story of the brutal physical restraint she had experienced, and of how she had been able to inflict life-threatening self-harm while in a privately-run unit. She said, “I would rather have been dead than alive in that place”. Former staff at another facility run by the same company until it was closed last month, described the culture of self-harm as “out of control”, and alleged that employees were directed to downplay serious incidents. Sky News revealed that a former member of staff at a third unit, also now closed, is subject to a police investigation.

These children are often placed in units many miles from home and family because of a shortage of appropriate services in their area. In 2017-18, NHS England paid private providers £156.5 million for specialist mental health services, which is 44% of its specialist budget. Inspection reports compiled since 2016 for 60 CAMHS units show that 88% of the NHS units were rated good or outstanding, while just 58% of those run by the largest private recipients of NHS funding were rated good. No privately run unit was rated outstanding, five were rated inadequate, and, since 2017, five have been closed.

First, how acceptable does the Minister think this is? Does she think that the NHS is getting value for money from these units? What is the incentive to make these young people well, given that the duty of the private units is to their shareholders, which must mean keeping full occupancy? There is a potential conflict of interest here. Those of us who have recently been engaged on the Mental Capacity (Amendment) Bill will be familiar with this issue. I would like to know from the Minister what the safeguards are.

A recent FoI request by the Labour Party found that 1,039 children and adolescents in England were admitted to non-local beds in 2017-18 for NHS mental health treatment, in many cases more than 100 miles from home. Is it acceptable that patients from Canterbury in Kent were sent 285 miles for in-patient mental health care, those from Cornwall and the Isles of Scilly 258 miles, and those from Bristol 243 miles? What effect does the Minister think this has on the youngster and their family? If that family are on a low income, it might prove impossible to visit on a regular basis, or for them to know what treatment their youngster is receiving.

Let us look further at the scale of this challenge. As my noble friend Lady Royall said, three in four children with a diagnosable mental health condition do not get access to the support they need. Three in four: that is graphically illustrated by the narrative from my noble friend Lady Massey. CAMHS turn away 26%—more than a quarter—of children referred to them for treatment by concerned parents, GPs, teachers and others. The average waiting time is more than 26 weeks. In a YoungMinds survey, 76% of parents said that their children’s mental health had deteriorated while waiting for CAMHS treatment.

Therefore, is it surprising that the number of A&E attendances by people aged 18 or under with a recorded diagnosis of a psychiatric condition has almost tripled since 2010? This translates, for example, to a severely depressed or anxious young person being at home for several months, unable to go to school because they feel so ill, with all the strain that puts on them and their family, to say nothing of the education they might be missing. They may become even more severely ill, which could have been avoided had treatment been readily available.

As many noble Lords have said, this means a huge cost to our NHS. Can the Minister provide assurance that the Government’s forthcoming Green Paper on prevention will include measures to improve the promotion of positive mental health for children and young people? Given that one in six young people aged 16 to 24 have symptoms of a common mental health disorder such as depression or anxiety, how does the Minister’s department aim to address the specific needs of that age group?

My noble friend Lord Bradley and the noble Baroness, Lady Tyler, have approached the workforce issues more than adequately. It is concerning that the number of doctors working in child and adolescent psychiatry has fallen every month since the beginning of 2018. There are serious societal problems that need addressing because of our children’s growing mental health issues. My noble friend Lady Morris gave us a great message of hope, but children who have had the most difficult and complex starts in life, experiencing abuse, neglect, bereavement, discrimination or poverty, are more likely to have mental health problems as they grow up. A study by SafeLives showed that 52% of children who witness domestic abuse experience behavioural problems in later life.

At a time of austerity, rising personal debt and precarious work, we are all encouraged to be individuals and not rely on anybody. Society perceives us to have failed in life and look weak if we do. There is a narrative that many people choose to be on zero-hours contracts. Then there is the gig economy. All these things put stresses on families, which puts stresses on our children. It is not only a well-funded NHS that we need. It is no accident that countries with stable welfare systems and school systems that do not focus on endless testing have good records on workers’ rights. That, surely, is where we must aim to be.

I thank my noble friend Lady McIntosh for her brave and honest speech. I too watched Nadiya Hussain yesterday, and was very moved by her story. I also thank my noble friend Lord Bragg for reminding us of the change we have seen and the reducing of stigmatisation, and my noble friend Lord Layard for asking very pointed questions about money, which is where I wish to end my remarks.

One of the key targets in the Five Year Forward View for Mental Health is to go from 25% of CYP to 35%. That still leaves 65% not receiving access, which is not good. I am so pleased that my noble friend Lord Bradley shared his huge experience with the House. He got to the nub of it. Research by YoungMinds demonstrated that only 14% of STP plans at local level showed evidence of engagement with children and young people. Can the Minister provide assurances that integrated care systems will be required to consult young people about the services that affect them, as part of the implementation of the NHS long-term plan?

[Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I thank the noble Baroness, Lady Royall, for introducing this debate and giving us the opportunity to discuss such an important issue during Mental Health Awareness Week. She spoke movingly and importantly. We have had an extraordinary debate today, with many personal reflections; it is an incredibly valuable contribution to this week. I also thank those who have asked the huge range of questions which I am now tasked with trying to respond to in less than 20 minutes. I hope your Lordships will forgive me if I do not cover each one; I will write on those points I am not able to cover today.

The noble Baroness, Lady Royall, is absolutely right when she says that, unfortunately, it remains true that many young people who seek help for their mental health find it difficult to access the right support at the right time. This is wrong, and we need to work harder and faster to get it right.

I would like to start by responding to a point about data, made by the noble Lord, Lord Storey. We have recently improved the available data in two key areas, with a significant prevalence survey on mental health in young people that was done in 2018 with 9,117 children and young people aged between 2 and 19. It showed that the prevalence of mental health diagnosis has increased by 1.1% since the previous survey, and that 25.2% of young people with a diagnosable disorder report having been in contact with NHS mental health specialist services in the last year. This is important, because the previous prevalence survey was 10 years old, and during that period social media has intervened, which we expected to have had a significant effect. The CMO then did a review which created evidence-based guidelines on screen time—an important intervention. In addition, we have brought in the dashboard to track data at a local level and the implementation of various standards which we have brought in.

This is a huge improvement on the level of data and tracking that we have on mental health within the community and the performance of our mental health trusts compared to the last time I was in the post. Therefore, I would like to reassure the noble Lord on the point about data. It is not where we would like it to be, but it is still a significant step forward. I wanted to start on that, because you cannot talk about policy and where we are if you do not have the data to know about it. That is why I want to talk about where we have come to before I talk about where we need to go.

We are on track to meet the commitment to improving access that we made in the five-year forward view, and to have 70,000 more children and young people accessing treatment each year by 2020-21 compared to the 2014-15 baseline. We have introduced the first-ever access and waiting time standards for mental health services. For young people experiencing their first episode of psychosis, we have a target for early intervention to ensure that treatment begins within two weeks for more than 50%. Nationally, the NHS is exceeding this: over 75% of patients started treatment within two weeks in March 2019. We have also set a target for 95% of children and young people with eating disorders—which have been on the increase—to access treatment, with a one-week referral for urgent cases and four weeks for routine cases by next year. Nationally, we are on track to meet this, with the most recent data showing that over 82% of patients started routine treatment within four weeks. We need to pay tribute to those who work incredibly hard within the mental health system and are making some very difficult changes to achieve this, coming from what was a very low base. It is important to pay tribute to them for their achievements.

I would like to move on to some questions put to me by the noble Baroness, Lady Royall, about crisis care, before moving on to those from the noble Baroness, Lady Thornton, about out-of-area placements and the private sector. The noble Baroness, Lady Royall, is absolutely right that we need to improve access to crisis care for those young people who need it most. A commitment has been made that we will invest £400 million in 24/7 crisis resolution home treatment teams in every local area by next year, and £249 million in mental health teams in A&E departments to improve the system. The long-term plan makes a commitment to ensure timely, universal mental health crisis care for everyone, including young people, and to drive out the variability which we recognise exists for them.

We also recognise the concerns raised by the noble Baroness, Lady Thornton, about out-of-area placements. We have made a commitment that inappropriate out-of-area placements must come to an end. Where there are specialist cases, a young person will need to travel, but we want in-patient stays to be as close to home as possible and to avoid inappropriate stays. For that reason, we have introduced the accelerated bed scheme, which has already created 117 new beds, with 69 new beds on the way. This is being done to reduce variability of access to in-patient care, but we also want to reduce that care by bringing in more prevention and earlier access to lower-level care, such as that pointed out by the noble Lord, Lord Layard. I shall return to the point that he made.

We are very concerned about the recent reports of failings within mental health care, which the noble Baroness raised. She is absolutely right that all providers of NHS services, whether NHS or private, must abide by the same high standards. Where this is not the case, we are ensuring that the NHS looks into the circumstances and considers what action should be taken. Private providers play an important role in the provision of children’s mental health services, but these must be safe and of high quality. We have tough regulators to ensure that that happens.

I will move on now to the points made on early intervention by the noble Baroness, Lady Royall, and the noble Earl, Lord Listowel, who is not in place.

[Baroness Thornton]

He is there.

[Baroness Blackwood of North Oxford]

I apologise—perhaps the noble Earl is sitting low in his seat.

They are absolutely right that prevention and early intervention are crucial. We prioritised improving perinatal mental health when I was previously the Mental Health Minister for exactly that reason. The noble Earl put it so eloquently: it is vital for newborns to form that early attachment with their mother and father. We must also consider the role played by the wider family, as those on our own Benches have put it. From 2020-21, we have put in place increased access to perinatal mental health services in all areas for at least 30,000 women, backed by £365 million in funding, as part of the five-year forward view for mental health. The long-term plan will also go further, with a commitment to increase evidence-based care for women with severe perinatal mental health difficulties and a personality disorder diagnosis, to benefit an initial 24,000 women per year by 2020-21. That is reassuring, but we also need to ensure that it carries on beyond the early years and into the school years—a point made by a number of your Lordships.

I recognise the impatience surrounding the Green Paper, but I would like to clarify a few points. The commitment within the Green Paper is to have a pilot, for 25 schools in the first instance, but it is then to incentivise every school and college to identify and train a designated senior lead for mental health to create new mental health support teams in and near schools and colleges. We are starting by piloting so that we can work out what the best design is and then move it across to all schools. The idea is not to have variability but to drive it through the whole system. While I recognise the frustration with rolling out these proposals in a phased way, it is a very ambitious commitment. We need to recruit and retain a workforce numbering in the thousands for the mental health support teams alone. We cannot do that overnight, given that there are over 20,000 schools and colleges. To roll out a fifth to a quarter of these by 2022-23 is already a challenging target. We must ensure that we train that workforce in an appropriate way to meet the challenges they will face.

I will also respond to the eloquent words of the noble Baroness, Lady McIntosh, and the moving experience which she spoke of. She is right that I do not speak for the Department for Education, but the thing about being at the Dispatch Box is that I can say whatever I like; once I am up here, they cannot pull me down. As she said, I speak as a former music graduate of Somerville, and I believe strongly in the importance of the arts, and in particular music, for education and mental health. I back her entirely on its importance for social prescribing as well. I will advocate strongly for that in this role. I agree with the noble Baroness that it is extremely important that young people’s experience should be safe, inspiring and nurturing. We should all be pushing in our roles for more joy within our society.

I know that I will run out of time quite quickly, so I will move on. I would like to talk a little about the work we have been delivering for university students. This key aspect has arisen on a number of occasions, and I know that the mental health of young people in universities is vital. Noble Lords will be pleased to hear that NHS England and Universities UK are working together on a programme to support and improve mental health at universities through Universities UK’s StepChange programme, which calls on higher education leaders to adopt mental health as a strategic priority and to take a whole-institution approach to mental health. As part of this programme, the Government are actively backing the introduction of a sector-led university mental health charter, which will drive up standards in promoting student and staff mental health and well-being.

NHS England is also working closely with Universities UK through its mental health in higher education programme to improve welfare services and access to mental health services for the student population, including focusing on suicide reduction while improving access to psychological therapies. There is funding attached to this and I am happy to meet with the noble Baroness if she would like to discuss that further, as it is a vital part of the picture.

I will move on to the questions raised regarding stigma and social media, which are crucial if we are to have a preventive approach to the situation we find ourselves in. The noble Baroness, Lady Massey, and the noble Lord, Lord Bragg, spoke incisively on this issue. We are committed to eliminating the stigma around mental health and are providing £20 million in funding to the Time to Change national anti-stigma campaign, which has been hugely successful. As the noble Baroness rightly said, it involved high-profile individuals who cut through the noise that often comes at young people every day. The campaign aims to improve social attitudes towards mental health, including promoting the importance of well-being in all areas.

However, we should also think about one area that did not get aired within the debate, and that is those who face double stigma when they have a chronic condition. As I think was raised by the noble Baroness, Lady Tyler, there are those have learning disabilities and mental ill-health. It is challenging for them to navigate their way through the system. Public Health England is delivering a £15 million national health campaign called Every Mind Matters, with the aim to equip 1 million people to be better informed to look after their own mental health. This will be of huge benefit going forward.

It is important that we do not imply, in this place, that everybody who suffers from mental ill-health will end up in the criminal justice system. I do not believe that is the case.

I also point out that this Government have been committed to addressing the agenda of social media and the harms it can produce, even though it is beneficial in other areas when it is used as an effective tool. That is why the Secretary of State has not only taken this on as a personal commitment in the round tables he has held with internet companies, but we are also bringing forward the online harms White Paper. The noble Lord, Lord Haskel, was right when he said that we have to make sure this has teeth. That is why there are commitments to bring forward a new regulator under it and why the CMO brought forward recommendations on screen time.

None of this is relevant if we do not have the workforce and funding that we need. I am pleased that NHS funding for young people has increased. I was concerned to hear the noble Lord, Lord Bradley, and his comments about reduced funding. The information I have is that children’s mental health funding is increasing. It has gone up from £516 million in 2015-16 to £687.2 million in 2017-18. Planned spend next year is £727.3 million, an increase of 5.8% compared to the previous year. This will be monitored with the investment standard and dashboard. I am happy to follow this up with the noble Lord, but I believe that NHS funding for mental health is increasing and at a faster rate than overall NHS funding. We are tracking this and ensuring that local CCGs stick to that commitment. This transformative investment will ensure that more young people receive the mental health support they need.

I finally turn to the questions about suicide prevention, which was movingly spoken about by the noble Lord, Lord Giddens, and others. The noble Lord is right that we have an excellent suicide prevention strategy. It must be based on accurate data. It is challenging to ensure we have that data, but I have a great deal of confidence in Public Health England working with local authorities to ensure we raise the standards of that work. Understanding the reasons for suicide is complex. Suicides among children are relatively rare, but each is an appalling tragedy, so we must work with every ounce of our abilities to move forward and make that better.

I am proud that we recently increased the amount of research funding for mental health, by a record amount, to £74.8 million. This will play an important role in helping us understand the sources of all forms of mental ill-health, including those that drive individuals to suicide.

While I am sure that noble Lords feel there are other areas I could have covered, and would like answers to other aspects, I hope that, by pointing out the areas of rising investment today and that we are improving access and waiting times, I have communicated to you that the Government are genuinely working across all departments to ensure that we see this as a priority agenda. I have demonstrated that we understand that we still face significant challenges. While we are impatient for faster improvement, there can be no question of our commitment to a brighter, healthier and more joyful future for our children and young people.

I was deeply moved to hear the words of the noble Lord, Lord Bragg, his testimony of his own experience some years ago and how different he feels things are today. Each of us still feels frustrated by how far we still have to come and how many things we still have to deliver to give our children the services that they deserve. I cannot think of a better way to close than by repeating some of the comments that he gave in his speech. We are only as good as the way we treat the weakest among us. There is a long way to go, but we are now on the road. If we can make as much progress in the next 20 years as we have in the last 20 years, we can give young people the stigma-free lives that they deserve.