Mental Health Services

Earl of Listowel Excerpts

Wednesday 25th February 2015 Lords Chamber

Asked by

[The Earl of Listowel]

To ask Her Majesty’s Government what plans they have to improve mental health services for infants, children and young people, for care leavers, and for adults with care experience.

[The Earl of Listowel (CB)]

My Lords, I am delighted to have this opportunity to discuss the mental health needs of children and young people in care.

I am grateful to the people I have worked with—the young people who are in care and leaving care who have shared their experiences with the parliamentary group; the clinicians, academics and practitioners who have made time to talk to me; and all those who have equipped me to speak to noble Lords today. I am grateful, too, for the lessons I have learnt from MPs who have chaired the parliamentary group for young people in care or who have campaigned in the area. They include former MP Hilton Dawson, Timothy Loughton MP, Edward Timpson MP, Craig Whittaker MP, Ann Coffey MP and the late lamented former MP Paul Goggins.

I have learnt that a cornerstone for mental health is to be able to make and keep relationships, and that family breakdown can destroy or impair that ability. Much of our job in repairing the mental health of abused or neglected children is to provide them with an opportunity of at least one enduring, consistent and benign relationship. Ten years ago, the charity Voice consulted young people on a blueprint for the care system. The children told us that they wanted one adult who would consistently follow them through their experience of care. They called him the Big Friendly Giant, after a character by Roald Dahl.

I hope that many of your Lordships present may attend future meetings of the all-party parliamentary group for children and young people in care. I know that it would mean a lot for the 60 or so young people who visit us each couple of months to see your Lordships there. There you will hear how young people have valued their relationships with foster carers, social workers and teachers. You will also hear children speaking of having more than 20 placements of fostering or more than five different social workers in a year and a half. From the care-experienced adults, you may hear from successful broadcasters who still see their social worker for tea today, or family men who now visit their children’s home to celebrate the manager’s birthday.

I am always pleased to hear the Minister say that he recognises the importance of an infant’s attachment to his mother. When key relationships fail, young people need to find someone else to be that reliable parental figure. A clinical psychologist, Sylvia Duncan, recently described the process of trauma in a seminar for the Institute of Recovery from Childhood Trauma. Many of us experienced trauma as a child—the loss of someone we love, a serious illness, even perhaps sexual harm. In the context of a loving family, where the trauma is not repeated, where one has not been betrayed by someone one trusts, where one can speak immediately about the trauma, recovery may be quick and leave no scars. Where the harm has been undertaken by one who one trusts, where that harm is repeated over years, where there is no one to discuss the harm with, serious trauma of the kind most young people entering care have experienced results.

Therefore, the finding of the Office for National Statistics survey of the mental health of looked-after children from 2003 should not have been a surprise. Mental disorders in children among the general population stand at 10%, half of which are conduct disorders. In the care population overall, 45% have a mental disorder and 37% of those are conduct disorders. In residential care, 72% have mental disorders and 60% of those are conduct disorders.

What does this mean for the experience of those working in children’s homes and foster care, and for adoptive parents? I will try to describe it. One may be caring for a strong, tall and beefy 15 year-old boy. Yet, for weeks or months, he may behave like an infant. He may not be prepared to leave his bed, may never show any gratitude for help given, may never clean up in the kitchen, and may not wash himself or cut his fingernails. Over time he may move towards his chronological age. Then one may be faced with rages from nowhere, with the fear that he may throw himself under a train when he next leaves the house, or that he may attack oneself or another child. One may be worried that he could set fire to the building.

Should the child be a girl, one may be worried about her sexual exploitation by men—although that might also be a concern for a boy. All this may leave one feeling bitterly resentful against the child; after all, he is 15 years of age. How can any trauma justify such selfish behaviour? One might say: “Next time he misbehaves, I will call the police, exclude him from the home, shout at him and see how he likes it, give him a slap in the mouth, the little wretch”.

This is where clinical group supervision is so important. Residential workers and foster carers need a space where they can vent the frustration, anger, fear and despair they feel about the children they work with. They need a clinician who can remind them that the child has regressed to an earlier stage of development, remind them how lonely and bereft that child is, and remind them that the most important thing that they can do for that child is to be reliable and tolerant, and continue to care. Without such support, carers are likely to burn out, quit, emotionally withdraw, or possibly even—we know this happens—attack the child. The most important thing for the recovery of that child is that there is nothing he can do to break the relationship with his carer.

It is therefore vital that the Minister is involved in ensuring that staff in children’s homes receive regular supervision or consultation from an appropriate mental health practitioner. I am very disappointed that in neither the guidance nor the new quality standards does there seem to be a stipulation on this. The psychiatrists who gave evidence to the noble Lord, Lord Warner, for his report on children’s homes in the mid-1990s advised that such an ongoing relationship with a mental health professional was the norm on the continent. Yet I am advised that this multidisciplinary approach may be applied in only about half our homes, even today. Does the Minister agree that such supervision or consultation is necessary? If so, what means will he use to see that it is implemented uniformly? I suggest that some of the payment for this—perhaps 50%—should come from the Department of Health.

A great deal of good work has been undertaken by this Government on reforming residential care. Serious consideration has been given to staff qualifications and staff are now better qualified. I commend the education Minister Edward Timpson MP, his predecessor Timothy Loughton and their officials on what has been achieved in a very difficult financial climate. However, I would urge whoever is responsible in the next Government to push further on qualifications as soon as possible.

If one of your Lordships’ children was deeply troubled and you were seriously troubled about their health and whether they would self-harm, would you wish to put them in the care of staff required to have only one A-level qualification? Would it satisfy you that the managers of these homes are required to have only a foundation degree—one year of higher education? The contrast with the continent is stark. There the status and qualification of staff is higher, yet they care for less challenging children.

Professor Berridge’s research on staff training is oft quoted by those who prefer the status quo. Yet in his recent blog for the NSPCC he emphasises the challenges of residential care, particularly in the light of the Rotherham experience, and the need by the next Government to raise the professional status of these people by raising the required qualifications.

Much of what I have said applies equally to foster care and adoption. While their children might be less trouble if they are with them 24/7, excellent social work support for foster carers and adoptive parents is vital, and I am grateful for the Government’s additional funding to support work with fosterers and adopters; and to my noble and learned friend Lady Butler-Sloss for her committee’s work in achieving this. Much training is offered to foster carers; consultation to groups of foster carers is rarer, but should be the bread and butter of specialist looked-after CAMHS. Access to individual therapies, including child psychotherapy, is important. I much look forward to the report of the taskforce that the Government have set up, due in March; I hope that it might refer to these therapies.

The last meeting of the parliamentary group discussed access to CAMHS for young people who are care leavers. We heard from one young woman who faced long delays in beginning therapy, and met her therapist once and only once because she was about to turn 18. A group of about 50 young people from all parts of England voted on the move from a 15 to a 25 year-old CAMHS service. All but one supported it. The Tavistock and Portman NHS Trust currently provides such a service to all young people. How is the Minister addressing the transition from child to adult mental health service for care leavers?

Finally, the Royal College of Psychiatrists points out that we can prevent so many children being taken into care each year by investing in parenting programmes. Does the Minister recognise the value of such programmes in keeping children out of care? So much good work has been undertaken by this and the previous Government on the education of looked-after children. I very much hope that in future, Governments will give as much attention to the mental health of looked-after children as to their education. I look forward to the Minister’s reply and to the contributions of your Lordships.