Schools (Mental Health Professionals) Bill [HL]

Baroness Tyler of Enfield Excerpts

2nd reading
Friday 1st March 2024 Lords Chamber

Moved by

[Baroness Tyler of Enfield]

That the Bill be now read a second time.

[Baroness Tyler of Enfield (LD)]

My Lords, I am delighted to introduce this Bill on a subject that is very close to my heart. I have been calling for counselling to be available in all schools since I first entered the House. I declare an interest as vice-president of the charity Relate. My heartfelt thanks go to the many organisations in the sector that have shared their expertise and briefings with me in preparing for this debate.

Only last Thursday, we had a good debate on the vital role that schools play in promoting good mental health and well-being. Along with other noble Lords, I talked about the need for a whole-school approach to mental health and highlighted evidence pointing out the links between children and young people experiencing mental health difficulties and attendance, exclusion, bullying and academic attainment. My Bill, which provides for all schools—primary and secondary —to have a counsellor or equivalent-level mental health professional, very much fits with that whole-school approach.

Our many previous debates on children’s mental health have revealed a fair degree of consensus that the scale of the problem is growing and requires an ambitious and comprehensive response. It is also clear that the Government take this issue seriously and have taken important steps to improve mental health support in schools, the NHS and the community. I have always welcomed that action. The only real difference is whether that action is sufficient and nationally available. My Bill is about plugging one vital gap in mental health support teams that many who are active in the sector have highlighted, which would improve much-needed mental health support for many young people.

Our debate today is timely. This week’s Resolution Foundation report, on poor mental health preventing people in their 20s working, provoked a predictably wide range of reactions in the press. However, there is simply no getting away from the fact that, unless they are tackled early, mental health problems can easily escalate as a young person enters adulthood and the workplace.

Let me briefly explain why the state of our children’s mental health and the support available to them is so important. I know that it is familiar territory for many noble Lords here, but it is vital to put my Bill into context. According to NHS statistics, almost one in five—18%—of children between the age of seven and 16 years old have a probable mental disorder. For slightly older children, almost half—44%—of those aged between 17 and 18 were classified as experiencing high psychological stress.

According to a report last May by the Children’s Commissioner, the number of young people urgently referred to mental health services had tripled since 2019. Last year, less than half—44%—of the 1.5 million children who needed additional support had received a CAHMS appointment. The average waiting time in England between referral and the start of treatment is the highest it has been in two years.

According to a survey conducted last year by Young Minds, 65% of the young people surveyed who were struggling with their mental health had not asked for any sort of formal help. Critically, 61% of those waiting for some support had stopped attending school, college or work, with one in five children waiting for support missing six months or more of school. According to a YouGov poll commissioned by Barnardo’s, 61% of parents with school-age children experiencing mental health difficulties said that those difficulties were affecting their performance at school. Almost half noted a drop in concentration and focus on their schoolwork.

The cause of this increase is much debated, including in this Chamber. In last week’s debate, although I recognised that many schools are doing a great job, I pointed to the increasing pressure from the academic environment, the growing influence of social media and the online world, and the lasting impact of the pandemic. Indeed, surveys show that most parents are worried about their children’s mental health, with the impact of social media a major cause of concern.

In January 2023, the House of Commons Education Committee stated that it had seen

“overwhelming evidence indicating a radical increase in mental health difficulties amongst school pupils since the Covid-19 pandemic”.

Additionally, the committee argued that the capacity of mental health services was “grossly inadequate”.

I turn to the detail of the Bill. Clause 1 places a duty on governing bodies of state-funded schools in England to provide access to a qualified mental health practitioner or school counsellor. Clause 1(2)(b) states that the qualified mental health professional or school counsellor should be an individual with a graduate-level or postgraduate-level qualification of that name accredited by NHS England. Normally that would be a counsellor or a psychotherapist. Clause 1(2)(c) states that schools with 100 pupils or fewer may collaborate with other schools and share access to this provision, while Clause 2 places a duty on the Secretary of State to give, or make arrangements for, financial assistance to state-aided schools to help them to meet their duty to provide this mental health support.

Before explaining precisely what the Bill would achieve, I reiterate my support for the concept of mental health support teams in schools, which were first piloted in 2019. These teams support a whole-school approach to mental health, working closely with school staff and delivering group and individual interventions offering low-intensity therapy—that is what cognitive behavioural therapy is called in the trade—for children and young people with mild to moderate mental health difficulties.

The teams are mainly staffed by educational mental health practitioners—I am sorry about all the jargon today—who study on a one-year postgraduate course. By last December, nearly 400 mental health support teams were operating in schools and colleges across England covering some 3 million children, which is roughly 35% of pupils. The Government have said that they aim to increase that coverage to 50% by April next year, although that will be considerably lower for primary schools and of course it still leaves millions of children and young people without any support.

An early evaluation of the programme found that many schools reported that they needed most help for children and young people whose mental health exceeded the threshold that the mental health support team practitioners could provide but either did not meet the threshold for CAMHS or needed support while they waited, so a gap in provision is becoming clear. However, I was encouraged by the evaluation showing that, where mental health support teams and counselling services were already working together, the teams were able to pick up and deal effectively with the lower-intensity need, enabling counsellors to work with the more complex issues. Those are two different roles and skill sets but they are a mix that works well together.

I was struck by the research evidence from Barnardo’s, which delivers a number of these teams across England. It found that support teams are effective at supporting children and young people with mild to moderate mental health problems; they improve outcomes for those with access to them and, critically, are cost effective, saving the Government £1.90 for every £1 invested. However, the research also identified a specific gap in the current model in addressing the needs of children with moderate or more complex needs, those with special educational needs or younger children for whom cognitive behavioural therapy is often not appropriate or who do not respond well to its structure. Simply put, some children need to explore their feelings more fully in other ways that are not time limited. The report recommended that the model should include school counsellors to fill this gap, which is what my Bill is all about: ensuring that every school also has access to a qualified school counsellor or psychotherapist.

I shall explain what has been called this missing middle in what I hope are everyday terms. Qualified counsellors and psychotherapists can work safely with young people who are experiencing trauma and abuse, self-harm, suicidal thoughts, violence, anger, issues with food and eating, bereavement, bullying and so on but none the less still do not meet the threshold for CAMHS. Lower-intensity interventions that are currently delivered by existing mental health support team practitioners might include such issues as motivation, exam anxiety, mild to moderate anxiety and depression and behavioural difficulties. Please do not get me wrong: existing practitioners within these teams provide a vital and valuable role, working with children experiencing less intensive symptoms linked to their poor mental health, but many are not trained to work with children who are seen to be at active risk, such as those who may be self-harming or experiencing suicidal thoughts.

There is a clear need for a wider range of therapeutic interventions to be delivered in schools by counsellors and psychotherapists, whose training generally lasts between two and four years, which enables them to hold a greater level of complexity and risk. Without a clear pathway to counselling where required, issues can easily spiral, increasing pressure on already overstretched CAMHS. It is very much a question of both/and, not either/or.

I turn briefly to workforce considerations. When we have had these debates before, Ministers have often raised workforce issues as the reason for the slow pace of rollout or the limited scope of support teams. However, there is good news to be had. The workforce challenge is not simply a question of training more practitioners from scratch. The major counselling and psychotherapy registration bodies—BACP, UKCP and NCPS—collectively represent over 25,000 therapists who currently work with children, most of whom are trained to work with considerably greater levels of complexity than existing support team staff. According to BACP’s most recent member survey, these existing therapists have the capacity to offer over 50,000 counselling sessions for children and young people every week. I strongly urge the Government to look at ways of harnessing the capacity of this workforce in schools, including exploring the integration of counselling within the national mental health support team model. This model has a richer skill mix and the benefit of providing important career progression opportunities and learning opportunities for existing staff, where there have been high levels of turnover.

I cannot end without a quick word on funding. Of course, it is important to acknowledge that the last couple of years have seen welcome increases in funding, but the money is not ring-fenced, nor is it presented in a format that easily enables us to look at total spending across the NHS, schools and elsewhere. There is simply no getting away from the fact that years of underfunding and neglect of children’s mental health services have taken their toll. Recent increases do not in any way match the scale of demand. Back in 2022, the House of Commons Health and Social Care Committee, in those days chaired by the current Chancellor, called on the Government to increase the funding and scale of mental health support teams to cover all schools by 2027-28. Might we expect to hear something to this effect in next week’s Budget?

To conclude, we have the opportunity to transform the landscape if mental health support teams are rolled out to all schools and colleges, as I fervently hope they are, and within that model include a school counsellor in every school, as my Bill proposes. I beg to move.

--- Later in debate ---

[Baroness Tyler of Enfield (LD)]

My Lords, I thank the Minister for her thoughtful response. It is true that we share broadly the same aspirations and, as she said, there is plenty in the spirit of the Bill that we can all agree on. I thank all noble Lords who contributed to this excellent debate. I know we often say, “It’s been an excellent debate”, but this really has been, and I have learned so much from it. It has really added to my understanding.

I particularly thank the noble Baroness, Lady Berridge, for pointing out the position of children detained under the Mental Health Act and in secure units. That was an extremely important point. I thank the noble Lord, Lord Watson, for his support and for emphasising that children need to go into schools ready to learn. At the moment, too many do not. I thank him for his support and for saying that the Bill would ramp up the provision needed.

I am particularly indebted to my noble friend Lord Russell, who, as other noble Lords said, so movingly referred to his personal experience. He highlighted the plight of parents who cannot afford to pay for the provision that they know their children and young people need. It is heart-rending, frankly, to think of that. He vividly described the missing middle that I have been talking about in the Bill. I just wish I had thought of that analogy myself.

I thank the noble Lord, Lord Jackson, for his insightful contribution and for raising the issue, which I had not thought of before, of children with Tourette’s, and how that is another example of children falling through the gaps in provision. The right reverend Prelate the Bishop of Winchester made a powerful and wide-ranging intervention; I was grateful to him for drawing the links with poverty and disadvantage.

It has been my pleasure to work closely with the noble Baroness, Lady Wyld. I am so grateful for her support for the principle of the Bill and for reminding us about the importance of family hubs. As she said, there must be hope, and I hope that the Bill can in some way add to that hope.

I thank my noble friend Lord Storey for his historical perspective on the development of mental health provision in both the NHS and schools. I thank him for his focus on teaching and non-teaching staff, which was a really important point.

I was grateful to the noble Lord, Lord Hunt, for his general support and welcome, and particularly for the way he highlighted the problem of navigating the system, which so many people and parents find so difficult.

Putting that all together, I have been heartened by the cross-party support for the spirit of the Bill. There is a strong understanding that at the moment too many young people are in that missing middle and falling through the gaps in provision. I am firmly of the view that mental health support teams, which do an excellent job, must contain professionals who are properly qualified to help young people who have moderate to more complex needs so that they do not fall through the gaps because they still do not meet the threshold for CAMHS.

I thank everyone for their contributions. It is heartening to have so much support on the principle. There is perhaps slightly less agreement on the precise way of securing it, but the consensus on the importance of this issue has been exemplary. That is why I hope we can carry on these discussions. I would welcome any amendments to the Bill to explore the practicalities that people have pointed out might not be quite right at the moment. I hope we can find a way that will allow us to take this debate forward and find a way forward. We all wait with bated breath for next week’s Budget—let us see what happens there—but I hope to continue engaging with the Minister on this important issue.

Bill read a second time and committed to a Committee of the Whole House.