Mental Health: Children and Young People

Baroness Tyler of Enfield Excerpts

Wednesday 30th January 2019 Lords Chamber

Asked by

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what assessment they have made of the recent concerns expressed by general practitioners that children and young people with mental health problems are unable to access National Health Service treatments; and what steps they will take to address them.

[Baroness Tyler of Enfield (LD)]

My Lords, there is a growing consensus that children’s mental health services need to improve radically to address the ever-increasing incidence of children’s poor mental health. This matters because poor mental health during childhood shapes the rest of our lives: over half of lifelong mental ill health starts before the age of 14, and three-quarters by the age of 24.

As has been widely chronicled, mental health problems among children are on the rise. Recent data from NHS Digital show that: the prevalence of mental health disorders among five to 15 year-olds has risen from one in 10 in 2004 to one in nine in 2017; two-thirds of five to 19 year-olds with a mental disorder had contact with a professional in the past year because of worries about mental health, but only a quarter had contact with a mental health specialist; and the number of referrals to specialist children’s mental health services has increased by 26% in the past five years.

Many of these children receive treatment far too late or, in many cases, not at all. According to a recent report by the University of Birmingham’s Mental Health Policy Commission, the average wait for children between their first symptoms developing and being able to access support is 10 years. Following referral, the Children’s Society estimates that young people wait an average of 58 days until they are assessed, then a further 41 days until they begin treatment, although waiting times vary significantly across the country.

In a recent survey, 1,000 GPs expressed their concerns about access to children’s mental health services. It found that 78% of GPs were worried that too few of their young patients would get treatment for mental ill health, and a staggering 99% of them feared that under-18s would come to harm as a direct result of these delays in care. These concerns are not limited to GPs. According to a YoungMinds survey of more than 2,000 parents and carers, three-quarters of them said that their child’s mental health had deteriorated while they were waiting for support from CAMHS. Despite the clear need for alternative forms of support during this waiting time, such as peer support or drop-in facilities, two-thirds said that neither they nor their child had been signposted towards any other sources of support. It is hardly surprisingly, therefore, that a PAC inquiry published earlier this month concluded that most young people with a mental health condition did not get the NHS treatment they needed, and that this will be the case for years to come while many face unacceptably long waits. I make no apology for starting this debate with rather a lot of statistics because it is vital that the severity of the situation is laid bare.

As well as battling long waiting times, many children get lost in the gap between primary care and child and adolescent mental health services. The children who need these services are often too ill to be dealt with by primary care but not ill enough for CAMHS. Many GPs end up referring patients to CAMHS despite knowing that they will be rejected, but knowing that they need more support. According to the British Association for Counselling and Psychotherapy, as many as one in four children were rejected for treatment last year. Of utmost concern, the children and young people rejected as “not ill enough” for CAMHS include young people who have self-harmed and others who have experienced abuse.

For many of these children, the only way to access the care they need is for their mental health to deteriorate to crisis point or for them to turn to private care. In fact, almost two-fifths of GPs surveyed said that they would recommend patients whose families can afford it to go private. It is completely unacceptable that we have such a growing divide between those who can pay for treatment and others who are left waiting. Seventy years after the creation of the NHS, families should not be forced to pay for the mental health care that their children so desperately need.

The problem is indeed stark but what is to be done? There is a lot to welcome in the NHS Long Term Plan. For example, the new commitment that funding for children and young people’s mental health services will grow faster than overall NHS funding is clearly a step in the right direction. However, the plan remains silent about the current thresholds that need to be met by children presenting with mental health problems. Although I welcome the commitments in the plan that 100% of children and young people needing specialist mental health care will be able to access it in the coming decade—a far more ambitious target than the 35% access-to-treatment target in the Five Year Forward View—the reality is that only three in 10 currently receive NHS-funded treatment. There is a very long way to go. My overriding point today is: where is the money and the workforce coming from to achieve the 100% target? There are huge challenges in ensuring that funding reaches the front line to enable these ambitious targets to be met amid continuing staff shortages and cuts to children’s social care.

In summing up the debate, can the Minister set out what steps the Government are taking to ensure that they meet the 10-year target for 100% of children and young people who need specialist mental health care to be able to access it? Can she also outline how progress towards the 10-year target will be measured and reported to Parliament? Indeed, I call on the Government today to ensure that this should take place at least annually. Will the Minister also commit to a timetable for introducing the proposed new four-week waiting times for CAMHS services nationally and an implementation plan to ensure that these new waiting times do not result in threshold increases?

The NHS Long Term Plan pledges that children and young people experiencing a mental health crisis will be able to access the support they need. This is welcome since the lack of children’s crisis care is of escalating concern. A survey of emergency departments carried out by the Royal College of Emergency Medicine showed that only a third had specialist CAMHS services available in the evening and only 27% had such services available on weekends. The lack of services means that, according to a recent “Panorama” programme, 1.5 million children live in an area without access to 24-hour crisis care. This is totally unacceptable. As with physical health, mental health problems occur at all times of the day and night, including at the weekends. The plan includes a new crisis hotline delivered through NHS 111, training for ambulance staff and other provisions such as sanctuaries and crisis cafés. However, it is not clear whether these commitments will be extended to all children and young people and whether they will be part of, or separate from, adult services. Could the Minister clarify these arrangements in her reply?

We all know that workforce is a huge constraint on progress. The recent Public Accounts Committee report found little change in overall mental health workforce numbers since Future in Mind was published in March 2015. According to a recent National Audit Office report, slow progress on workforce expansion is emerging as a major risk to delivering the Government’s ambitions for children’s mental health services. To make the NHS Long Term Plan a reality, the NHS will need to both recruit and retain more staff, attract returners to the profession, offer rewarding jobs and a more supportive culture, and look at job redesign. This is particularly pressing given that the number of child and adolescent psychiatrists working in the NHS in England has fallen by some 6% in four years. Of course, with Brexit looming, the prospect of finding the more than 23,000 additional staff needed to treat all young people with mental health problems seems very unlikely.

Alongside supporting children with pressing mental health problems, it is essential that we take a preventive approach. Schools clearly have a key role to play in this. The Government’s Green Paper, which was published over a year ago, seeks to increase the support available within schools through new mental health support teams and a designated senior lead for mental health in each school. As the Commons Education Select Committee and Health Select Committee concluded last May, while laudable, these plans lack ambition and the very lengthy implementation, rolling out only to up to a quarter of the country by the end of 2023, will leave hundreds of thousands of children unable to benefit from the proposals for years to come.

The Mental Health Policy Commission at the University of Birmingham has found that children with high resilience are half as likely to have a diagnosable mental health condition and concluded that early intervention schemes are greatly cost effective. There are many other early intervention approaches which have not been the primary focus of this debate, such as the importance of counselling in schools and other community settings, peer support schemes and open access drop-in mental health hubs with no waiting lists of the kind being piloted in some areas, often by the voluntary sector, which can help to prevent problems escalating to the point where specialist mental health treatment is needed.

I call on the Government to ring-fence the new money announced for mental health in the NHS Long Term Plan, so that the much-needed investment in mental health services actually reaches the front line. I also call for this to be monitored by the introduction of a strengthened mental health investment standard for children, with sanctions imposed on those clinical commissioning groups which fail to meet the standard without a valid reason. I greatly look forward to hearing the speeches of other noble Lords, who I know will have much to contribute to this debate.