Children’s Wellbeing and Mental Health: Schools

Debate between David Simpson and Norman Lamb

Tuesday 10th January 2017 Westminster Hall

[Norman Lamb (North Norfolk) (LD)]

I beg to move,

That this House has considered the matter of supporting children’s wellbeing and mental health in a school environment.

It is a pleasure to serve under your chairmanship, Mr Nuttall, I think for the first time. It is timely to be discussing the incredibly important issue of children’s mental health and wellbeing, particularly in the context of schools, given what the Prime Minister said yesterday. I welcome the fact that the Prime Minister of this country chose to make a speech that was significantly about mental health. That in itself is quite a novelty and should be acknowledged as such. She spoke powerfully about the “burning injustices” in society and focused particularly on those who suffer mental ill health.

My problem is that the response must match the scale of the injustice, and I think that the response has ultimately fallen short, but as a society we are on a journey and it is an important step that the Government are now saying the right things. I suspect that it is acknowledged by many Conservative Members that there is still a gap between the rhetoric and the reality for many people throughout the country, particularly families experiencing mental ill health, who sometimes have to wait horribly long for any access to treatment.

I will briefly describe my own family experience. This goes back to the last decade, which makes the point that the situation we are discussing is not the fault of any individual party or Government. When our oldest son required treatment and as a family we were fairly desperate, we were told that he would have to wait six months to start treatment, so we did what I guess any family would do and paid for treatment. Of course, very many people cannot do that. I do not want to live in a country in which people who have money can access great care, but those who do not are left waiting. That for me is the injustice that we must confront, but I welcome the fact that the Prime Minister has raised this incredibly important issue.

One in 10 children are estimated to have a diagnosable mental illness, and 75% of mental health problems in adulthood started before the age of 18, so there is both a moral and an economic case for dealing with mental ill health among children and teenagers, because by neglecting it we store up enormous problems for people later in life, at enormous cost to the state—that is the key point that we must recognise. However, despite the prevalence of illness among children and teenagers, three in four children and young people with a clinically significant mental illness are not in touch with appropriate mental health services, and sometimes it can take up to 10 years before the first symptoms are diagnosed and addressed.

I stress that I do not want to over-medicalise this problem; we do not want to drive everyone into treatment. What we want to do, of course, is prevent the need for that, so we must shift the system so that it focuses much more on preventing ill health and deterioration in health, and schools are necessarily central to that.

[David Simpson (Upper Bann) (DUP)]

I am sure that the right hon. Gentleman will agree, in relation to mental health and schools, that it is important that young teachers are trained to recognise the difficulties that some children have, so that there can be early intervention to try to prevent the need for all the children to go into treatment.

[Norman Lamb]

I am grateful to the hon. Gentleman for that intervention. I totally agree. As I will explain later, giving professionals the tools to manage the issues in front of them seems to me to be fundamental to a sensible approach.

There appears to be growing evidence of increasing mental health problems among young girls. In August 2016 a survey for the Department for Education found that rates of depression and anxiety have risen among teenage girls in England, although the rates appear to be more stable among boys. The survey found that 37% of girls reported feeling unhappy, worthless or unable to concentrate; that was more than twice the percentage for boys. According to the Children’s Society’s latest “Good Childhood” report, a gender gap has opened up between girls and boys in relation to both happiness with life as a whole and appearance. One in seven girls aged 10 to 15 felt unhappy with their lives as a whole, and the figure had gone up over a five-year period. We need to seek to understand that situation better in order to make the right response. I pay tribute to the Children’s Society, which has supported me in bringing this debate to Parliament. I also thank, as I should have done at the start, the MPs who joined me in applying for the debate.

There also appear to be problems among women between the ages of 16 and 24, according to a major report by NHS Digital. Reports of self-harm in that group trebled between 2007 and 2014, so something very serious is going on. Research is urgently needed to understand the causes of the trend. Social media appear to be part of the picture—there are concerns about sexting, cyber-bullying and so on.

We must also remember the issues that relate to boys and young men. Horrifically, suicide remains the biggest killer of men under the age of 45 in the UK, and the rate has been increasing in recent years. In 2014 the male suicide rate was three times higher than the female rate. I am pleased that the Government focused on suicide in yesterday’s announcements. Ultimately, there is nothing more serious or important than seeking to prevent lives from being lost in that horribly tragic way, with the impact that it has on families—my family, along with many others in this country, have gone through that experience—so we need to give it the greatest possible attention.

The overall lifetime costs associated with a moderate behavioural problem amount to £85,000 per child, and with a severe behavioural problem they are £260,000 per child. That is why it is so important to deal with these issues early, rather than allowing them to become entrenched.

The Children’s Society has highlighted school-based counselling, which can be highly effective for children experiencing emotional difficulties. It can be used as a preventive measure, an early intervention measure, a parallel support alongside specialist mental health services, and a tapering intervention when a case is closed by the specialist services to help a child or teenager through to recovery. Research shows that children perceive it as a highly accessible, non-stigmatising and effective form of early intervention.

Studies have also shown that attending school-based counselling services has a positive impact on studying and learning. In 2009 Professor Mick Cooper assessed the experiences of and outcomes for 10,000 children who had received counselling in UK secondary schools. More than 90% reported an improvement, which they attributed to counselling, and 90% of teachers reported that counselling had a positive impact on concentration, motivation and participation. So we end up achieving better academic attainment if we make the investment for those children who need it. It can be cost-effective, given the long-term cost to the economy of problems that continue into adulthood; some studies have indicated that the long-term savings can be in the region of £3 saved for every £1 invested, and data from Wales indicate that the average cost of school-based counselling is significantly lower than the specialist treatment children get if that is the only alternative. So we save money by giving children access to school-based counselling rather than delaying intervention and referring the child to a distant service, probably with a long waiting time, which is also far more stigmatising.

The British Association for Counselling and Psychotherapy has estimated that the overall cost of statutory provision of school-based counselling across all of England’s state-funded secondary schools would be in the region of £90 million per year. On the basis that 60% of schools are already delivering it, the additional delivery would cost around £36 million. I suggest that that investment is well worth making given the improved preventive care.

Psychosis: Early Intervention

Debate between David Simpson and Norman Lamb

Wednesday 7th September 2016 Westminster Hall

[Norman Lamb (North Norfolk) (LD)]

I beg to move,

That this House has considered access and waiting time standards for early intervention in psychosis.

It is a pleasure to serve under your chairmanship, Sir Roger. May I welcome the Minister to her new role? I spent a great two and a half years in the Department of Health; it was the most invigorating time in my life. I wish her every success.

The debate is on something that I care a lot about: a new standard of access for people who suffer a first episode of psychosis, a cruel and punishing condition that can have a massive impact on people’s lives—incidentally, at enormous cost to statutory services. When I came into my role as Minister, I recognised that there was a complete inequality of access, standards and rights between those who suffer from mental ill health and those who suffer from physical health problems. That inequality of access has existed for many years. In the last decade, the Labour Government introduced comprehensive access standards in the NHS for physical health problems, and they were right to do so—the cancer standards that have transformed cancer care in this country are a leading example of those—but they left out mental health.

It is not just that individuals sometimes end up having to wait interminably for treatment in some parts of the country; that complete imbalance of rights between mental health and physical health drives where the money goes. There is enormous political interest in meeting those demanding access standards. The national media look at the four-hour A&E standard. Certainly in my time in the Department of Health, all the great and the good of the NHS gathered around the Secretary of State’s table every Monday morning to look at spreadsheets showing the performance of every hospital in the country against those access standards. That extraordinary almost micro-management from the centre on access standards in physical health sets the tone for the whole system and makes it clear that meeting them is critical. So what do clinical commissioning groups around the country do? They trim a little bit off funding for mental health, which is still funded primarily through block contracts, to feed the beast of those exacting access standards in physical health.

I was determined from the start to address that injustice—that is what it is; it is a discrimination at the heart of our NHS—and introduce access standards in mental health. We went through a long deliberation before coming up with two specific standards, which were set out in a Government document published in October 2014, that we wanted to introduce as the start of a process that would lead ultimately to comprehensive access standards in mental health so that everyone with a mental health problem had the same right to get treatment in our NHS as anyone else.

The first standard that we identified was a six-week standard for access to psychological therapies. That is part of the improving access to psychological therapies programme, a well-regarded, world-leading programme that does not do everything but has been a significant development. The other was a two-week standard to start treatment when someone suffers a first episode of psychosis. Those people are typically teenagers or perhaps in their 20s—that is the most common age—but such an episode could happen at any time in one’s life.

[David Simpson (Upper Bann) (DUP)]

I congratulate the right hon. Gentleman on securing this very important debate. He has hit somewhat on the point that I was going to raise about early intervention. At what stage does he believe that we should deal with this condition? He talks about 18 or 20-year-olds, but should we go right back to primary or secondary school and deal with it in younger children?

[Norman Lamb]

We should always be guided by clinical judgment. That is critical. The standard that was introduced was for people between the ages of 14 and 65, which gives a clue about the appropriate level. This condition could emerge during teenage years, but we know that 50% of adult mental health problems start by the age of 14, so getting in and addressing problems early is critical.