Mental Health of Children and Young Adults

Baroness Tyler of Enfield Excerpts

Thursday 16th May 2019 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I add my congratulations to the noble Baroness, Lady Royall, on securing this vital debate during Mental Health Awareness Week. I refer to my interests in the register.

It has been a powerful debate, which has confirmed in my mind that the worsening state of children and young people’s mental health is becoming one of the major social policy challenges facing our country. We are becoming familiar now with the statistic that one in eight five to 19 year-olds has a diagnosed mental health disorder. To try to make that a bit more real, that is roughly three children in every classroom.

Looking ahead, the Royal College of Paediatrics and Child Health’s report entitled Child Health in England in 2030 found that reported mental health problems in England are set to increase by 63% over the next decade—a huge increase. Already, the number of girls under 18 being treated in hospital after self-harming has nearly doubled compared with 20 years ago, and the number of referrals by schools seeking mental health treatment for pupils has shot up by over one-third in the last three years, with over 50% of these coming from primary schools. That is a really worrying trend.

We have already heard about the long-term plan for NHS England, which builds on the Five Year Forward View for Mental Health. It makes some very welcome commitments for further investment in children and young people’s mental health services. I particularly pick out the new waiting time standards, investment in eating disorder services and the expansion of crisis services to a 24/7 service. It is welcome that funding for children and young people’s mental health services will grow faster than both overall NHS funding and total mental health spending.

Then, of course, as others have said, we have the Green Paper’s proposals. Those proposals to bring schools and NHS services closer together and to act earlier to identify children who need effective help to prevent them falling into a crisis are of course welcome. The proposed new mental health support teams have the potential to make a real difference, but as my noble friend Lord Storey said, they really need to be rolled out a lot faster. Of course I understand why they cannot be created overnight, and I welcome the fact that training for the first cohort of these new teams started recently, at I think seven universities, but based on the Government’s own estimates, on current plans some children who are eight now may not receive any additional support before they leave school at 18—a full decade after the new teams have been launched.

To summarise, much is promised or in the pipeline, but what is the reality on the ground? Quite simply, too often children and young people’s needs are going unmet. Currently, less than one in three children with a diagnosable mental health condition is getting access to NHS treatment and care, which I am sure we all agree is a scandalous state of affairs. The Care Quality Commission’s review of access to children’s mental health services last year found a “complex and fragmented” system at local level with multiple providers and minimal co-ordination of service delivery, while high demand and limited resources meant that far too often the referral threshold to CAMHS, as we have heard, was far too high in many places. At the tail end of last year, we had reports from the NAO and the Public Accounts Committee that absolutely echoed these findings.

Further evidence, if we need any more, comes from Healthwatch. I am grateful to it for sending its recently summarised findings of 152 local Healthwatch organisations in each local authority around the country. In short it found, first, that children experience long waits to see a specialist and often complain about poor communications from services. Secondly, access to assessment services is challenging, the referral process is complicated, and often young people did not feel that they were listened to. Thirdly, a lack of timely and appropriate information for young people and parents was a problem. Indeed, young people often said that they felt patronised by the tone of materials produced for them and that they would like to discuss mental health more in schools, which I will return to in a minute. Fourthly, the transition from children’s to adult services is confusing and challenging. As we heard, we have too many young people falling through the gap. Fifthly, there is a real lack of integration between learning disability and mental health services, leading to services being not at all tailored to specific needs.

This is a very familiar and depressing catalogue of problems, so what do we do about it? I will suggest a short-term solution before coming to longer-term solutions. To help overcome the fragmentation that I have been talking about, the Royal College of Paediatrics and Child Health recommends piloting and evaluating a “local offer” for mental health, mirroring the existing local offer for special educational needs introduced by the Children and Families Act. This is something I strongly support. A local offer for mental health would provide comprehensive information about the available services in a local area and how to access them, but it would also very importantly identify shared responsibilities across authorities for ensuring that children and young people are supported as close as possible to their home.

This “local offer” approach has much to commend it. It would help to co-ordinate local services and make gaps in provision more visible, therefore encouraging local providers to work together to fill those gaps. I raised this with the Minister at Oral Questions on 25 March, and she kindly said that she would consider the suggestion and get back to me. Could I ask her if she is yet in a position to respond on this important point? I would very much like to know her thinking in this area.

I turn now to longer-term solutions. Workforce is the biggest issue that the system faces. It has been said many times in many quarters that it is the overriding barrier to improving access to children’s mental health services. I know that NHS leaders face the daunting challenge of delivering the changes set out in the NHS Long Term Plan, alongside a workforce that is under huge strain and struggling to cope with widespread staff shortages. Figures from Health Education England in 2018 showed that a very worrying 60% of training places for child and adolescent psychiatry were unfilled. Frankly, Health Education England has limited data to develop its workforce plan. New data very recently released by NHS Digital shows there has been an almost 4% fall in the number of CAMHS psychiatrists between 2012 and 2019, despite the number of doctors for all other medical specialties during that period having risen by about 15%.

I have been trying to understand these workforce challenges. They are quite complicated. I spent a bit of time poring over Stepping Forward to 2021, produced by Health Education England, and I commend it for it. Quite frankly, I find it quite confusing and complex. It is the workforce plan to support delivering the five-year forward view. Roughly, it talks about the need for about 20,000 additional workers in psychiatry, nursing and psychology to support the plans at the time. Now we have the expanded plans in the long-term plan. Others have mentioned that we are waiting for the workforce strategy that the noble Baroness, Lady Harding, is working on, which I am looking forward to. I very much appreciated the chance to meet with her last week. That was very helpful indeed. I have also talked recently to various mental health trusts that I have been fortunate enough to visit. I know how concerned they are about the need to expand the workforce and to retain staff at the same time.

I return briefly to schools, which have such a pivotal role to play. These points were raised very powerfully by the noble Lords, Lord Bradley and Lord Layard. We know that what gets measured gets done. That is why Peers on these Benches have called for Ofsted to include an assessment of the effectiveness of schools in supporting children and young people’s mental health and well-being. Ofsted released its new inspection framework earlier this week, with new guidelines about how schools should be assessed. On the plus side, the framework has a greater emphasis on personal development and the quality of education, including confidence and resilience building. I was pleased to see more references to mental health throughout the inspection, but frankly I am disappointed that the reforms have not gone far enough. Under the new framework, schools and colleges will not receive any recognition for developing a whole-school approach, having positive responses for identifying mental health problems and ensuring that young people get support when problems first become involved. This is a missed opportunity to turn school inspections into a mechanism that would inspire real change for children and young people’s mental health and psychological well-being. I would welcome the Minister’s thoughts on this. I see that my time is up.