Mental Health and Wellbeing in Schools

Dan Poulter Excerpts

Tuesday 4th December 2018 Westminster Hall

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I commend the hon. Member for Oxford West and Abingdon (Layla Moran) for bringing the debate to Westminster Hall today, when there are many other pressing demands on our time, because this is an important matter. She rightly highlighted a number of the challenges facing young people in our schools. I draw attention to my declaration in the Register of Members’ Financial Interests; I am a doctor practising in mental health services and a member of the Royal College of Psychiatrists.

We need to analyse first why the problem is happening. Is it down to the increased challenges facing young people—the stresses and strains of exams and the need to perform in tests at schools, as the hon. Member for Oxford West and Abingdon outlined, and general increasing distress among young people—or is it also due to increasing awareness and recognition of mental ill health among young people, and the fact that more young people are therefore prepared to come forward because there is generally a greater recognition of their needs? Perhaps it is a combination of the two. We do not fully know or understand the reasons for greater pressures presenting in services, but they are happening. It is right that the Government are beginning to turn their mind to the issue and have put forward a number of initiatives.

I entirely agree with the hon. Member for Oxford West and Abingdon that, in addressing young people’s mental health, it is important that we do not over-medicalise issues such as teenage angst or normal patterns of growing up. It is important that we do not follow the American system, where—in my view and, I am sure, that of many psychiatrists in this country—a lot of young people are on medication without there necessarily being a good evidence base for that. We have to be very careful about over-medicalising problems, or medicalising problems too quickly, which is perhaps how we should look at it.

The Government are making strides in this area. They are rolling out training for every school and college to ensure that a designated mental health lead will be in place by 2025 and that there will be greater mental health awareness training for teaching staff. There has also been a lot of talk by some, including the Secretary of State for Health and Social Care, about the dangers of social media and its potential impact on young people’s mental health. However, as the hon. Member for Oxford West and Abingdon outlined, eye-catching announcements will do little to deliver the meaningful expansion and improvements in care that young people need and deserve. Although such announcements may make good media headlines, I am afraid the lack of provision on the ground for young people is the real problem. I know that it will be one that the Minister will want to work with colleagues in the Department of Health and Social Care to address.

I want to look at some areas of challenge. The coalition Government had a commendable focus on improving special educational needs provision. We know that a lot of children with special educational needs may also suffer from poor mental health. There is a correlation between some conditions that are associated with special educational needs and psychosis or other mental illness. However, far too often the joint care plans that should exist between the NHS and schools take a long time to come to fruition. Schools are far too often frustrated by the identification of a problem that they have recognised for which the NHS does not have the resources available to support the school in meeting the needs of the child in the way that was envisaged when those joint care plans were legislated for in this House. That speaks very much to the issue of lack of workforce, which the hon. Member for Oxford West and Abingdon outlined in her remarks.

[Dr David Drew (Stroud) (Lab/Co-op)]

That is no more evident than with the huge problem of eating disorders, where all the medical evidence shows that what is needed is early intervention. The NHS has got to get much more involved with schools on that. Does the hon. Gentleman agree?

[Dr Poulter]

Certainly, eating disorders are an area of great challenge. One of the difficulties is that very often young people present in great distress after their illness has taken hold for quite some time, and the prognosis can be less good in those situations. A lot of young people may have to travel many miles or even out of area to get the specialist care they need, and that does need to be addressed as a matter of urgency. I know that my right hon. Friend the Minister will be raising such issues with his counterparts in the Department of Health and Social Care, because a number of the answers to the challenges raised in this debate have greater priority, and there is greater understanding of what the challenges are in that Department rather than in his.

[Layla Moran]

Does the hon. Gentleman agree that it is not just about talking; it is active co-ordination between the two Departments that will solve this? If they end up working in silos, as we know Government Departments often do, none of this is going to work.

[Dr Poulter]

I completely agree, but it is also about breaking down the silos on the ground. It is all very well Government Departments coming together to work together and the silos being broken down—that did help between the Department of Health and the Department for Education on special educational needs under the coalition Government, but in reality the levers or mechanisms do not exist on the ground to deliver meaningful change for young people in the timely manner that was envisaged by the legislation passed in this House. We must make sure that whatever legislation is passed and whatever co-operation there is at Whitehall level translates into the right levers on the ground to deliver the co-ordinated and joined-up approach to more integrated care that young people need, across health, education, social services and other statutory services as may be required.

On the broader issue of child and adolescent mental health, a key challenge is the lack of workforce to deliver the care needed for young people. We know that the number of full-time mental health nurses has fallen by more than 6,000 between 2010 and March 2018, with a reduction of 1,832 learning disability nurses alone during that period. The number of CAMHS and learning disability consultant psychiatrists has slightly declined over the past decade. Many parts of the country, particularly outside London, are struggling to fill higher registrar training posts in CAMHS and learning disability psychiatry. That is a real problem, because without the workforce to deliver care we will not have the bodies on the ground to make a difference for young people.

Perhaps more concerning is the fact that the recent rhetoric on child and adolescent mental health still bears little resemblance to the reality facing many children and their families. Given the shrinking CAMHS and learning disability workforce, it is difficult to see how current levels of care can be maintained, let alone how the step change in mental healthcare provision for young people, which the hon. Member for Oxford West and Abingdon and I—and everybody taking part in this debate—would like to see, can take place.

The focus on healthcare apps and the talk of fines for social media companies are no substitute for having enough trained professionals on the ground to deliver frontline care to young people and their families. The NHS is far too often viewed through the prism of A&E. As a result, acute hospitals often receive a disproportionate level of funding compared with primary care and community services. In child and adolescent mental health services, as in other parts of the NHS, community services are often understaffed and poorly resourced. In fact, we are hearing about reductions in staff levels and not about the increase that the Government talk about as being desirable. My message to the Minister today is that we need more staff in child and adolescent mental health services, whether they are working in schools or in the community. Without those staff, all the media announcements and well-wishing announcements to improve in this area will come largely to nothing, and young people will still be struggling.

On the issue of fragmented commissioning, which the hon. Member for Oxford West and Abingdon raised, we see silos not just in Whitehall but on the ground. CAMHS, social services and education providers do not always work in a joined-up way. Although there can be some good initiatives at local level, and there are examples of good, co-operative working, there is nothing to compel the providers of different services to work in a joined-up way for the benefit of young people. Unless we get the commissioning of services right in providing better mental healthcare for young people, and actually compel joint working rather than just encourage it, we will not make a meaningful difference.

I know that the Minister will want to pick up some of these issues with his colleagues in the Department of Health and Social Care. Unless we have a joined-up approach that we can compel at local level, all the announcements on improvements in tackling young people’s mental health will come to very little. We will still be having these debates in this place in 10 years’ time—those young people will have lost 10 years of their life and will still be struggling.

I know that the Minister has a great commitment to all he has done on schools and in education. He has been a very good Minister, and I hope that he will redouble his efforts to get joined-up working and collaboration with the Department of Health and Social Care in addressing some of these problems.

--- Later in debate ---

[The Minister for School Standards (Nick Gibb)]

Certainly, and thank you, Mr Stringer; it is a pleasure to serve under your chairmanship. I congratulate the hon. Member for Oxford West and Abingdon (Layla Moran) on securing the debate and introducing it so well.

Mental health can have a profound impact on the whole of a child’s life; it is not just about the effect that poor mental health can have on their attainment at school. We worry about the whole life ahead of them. Improving mental health starts with promoting good mental wellbeing and ensuring that children and young people have the help and support that they need. Schools can play an important role with the right support from specialist services, which is why the Government have made mental health a priority, with a shared approach between the Department for Education and the Department of Health and Social Care.

The hon. Members for Oxford West and Abingdon and for South Shields (Mrs Lewell-Buck) mentioned exam stress in schools. Tests and exams have always been times of heightened emotions for pupils and teachers, but they are not meant to cause stress and anxiety. As the hon. Member for South Shields acknowledged, I have said on many occasions that schools should encourage all pupils to work hard and achieve well, but that should not come at the expense of their wellbeing. Schools should provide continuous and appropriate support as part of a whole school approach to supporting the wellbeing and resilience of pupils.

The hon. Member for Oxford West and Abingdon also mentioned GCSEs. We have reformed GCSEs to match the expected standards in countries with high-performing education systems, so that young people have the knowledge that they need to prepare them for future success and the skills that Britain needs to be fit for the future. We are determined to ensure that no child has an inadequate education that reduces their life chances; we want to ensure that every child has an education that helps them to fulfil their potential. That is the key driver of all of our education reforms since 2010. Better education means better prospects of quality employment and better health outcomes for those young people in the long run.

As a psychiatrist, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) brings serious expertise to the debate. He said that it was important that Departments did not work in siloes. I can assure him that I worked very closely with the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price), in whose portfolio mental health resides. We worked particularly closely on producing the Green Paper on children and young people’s mental health.

We know that mental health is also a priority for teachers, because of the challenges that many children face in the modern world; a fact that has been referred to by other hon. Members. To get an up-to-date picture of children’s mental health, this Government commissioned the first national survey of children and young people’s mental health since 2004, which was cited by the hon. Member for Westmorland and Lonsdale (Tim Farron). The results published last month show that in 2017, 11.2% of children and young people aged five to 15 in England had a diagnosable mental health disorder. That figure stood at 10.1% in 2004, so the latest results show that there has been a slight increase since then. They reinforce what we have heard from schools and colleges about how many children face issues and about the need to act. We have listened to what schools have told us and are already taking steps to help schools to support children and young people with mental health problems. The findings of the survey will help us to ensure that the action that we take is informed by the most up-to-date evidence.

I understand the important points made by my hon. Friend the Member for Central Suffolk and North Ipswich about the number of staff in children and young people’s mental health services. The Government are already taking significant steps to improve specialist children and young people’s mental health services with £1.4 billion of funding to ensure that an extra 70,000 children a year receive the support that they need by 2020-21.

We recognise, however, that we need to do more, which is why the NHS will invest at least £2 billion a year more in mental health, including children’s services, under the recently announced Budget proposals, increasing NHS funding by an astonishing £20.5 billion a year in real terms by 2023-24. As I said, from that the NHS will allocate £2 billion a year to mental health services. The Budget also included a commitment to set up specialist NHS crisis teams for children and younger people in every part of the country.

[Dr Poulter]

The extra money is of course welcome, but the focus on crisis intervention is perhaps wrong. We should try to stop children getting to that point in the first place, and invest more in early intervention and community teams. In order to do that, we need to reverse the decline in the mental health workforce. I wonder whether that is an issue the Minister will raise in particular, challenging his counterpart in the Department of Health and Social Care on how to improve recruitment and retention of CAMHS professionals.

[Nick Gibb]

My hon. Friend makes a crucial point, which I will come to when I talk about the mental health Green Paper. It is absolutely crucial that we are able to devote resources and expertise to intervening early, before a child’s mental health problem escalates into something requiring medical intervention.