National Marriage and Mental Health Awareness Weeks

Fiona Bruce Excerpts

Thursday 16th May 2019 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

I beg to move,

That this House has considered National Marriage and Mental Health Awareness Weeks.

It is a pleasure to serve under your chairmanship, Sir David. This year, National Marriage Week and Mental Health Awareness Week fall at the same time—this week. I am grateful to the Backbench Business Committee for allowing debate time to explore the connection between these two issues.

Increasingly, evidence is showing that mental health challenges are exacerbated when we experience relationship difficulties. There is a link between emotional health and wellbeing and mental health and wellbeing. As our most important and closest relationships are within our families, it is not surprising that when they are broken or dysfunctional, there is an increased likelihood of our mental health being affected. Evidence from a variety of sources, which I shall turn to shortly, increasingly demonstrates that.

However, the point of this debate is not just to draw the findings together, but to ask what the Government can do to address the matter through public policy decisions. We are suggesting not that the Government should tell people how to run their lives, but that a little bit of support—often it does not take much if it is provided early enough, whether that means early enough in life or early enough when relationship challenges occur—would help people to build stronger and more enduring relationships and, in turn, help to address the distressingly high level of mental health challenges in our country today, particularly among young people, reaping potentially lifelong benefits for them and benefits for wider society. That, of course, is a key thrust of “A Manifesto to Strengthen Families”, which was launched a year and a half ago here in the House of Commons and which has the support of more than 60 Conservative MPs as well as colleagues from other parties. Some are here today, and I thank them for attending.

At this point, I want to thank the Government, because they increasingly recognise the importance of addressing these issues. They are, for example, addressing poorly functioning relationships through the troubled families programme. The Department for Work and Pensions publication from a couple of years ago entitled “Improving Lives: Helping Workless Families” resulted in £39 million of funding for the reducing parental conflict programme, which focuses specifically on the couple relationship and on conflict that falls below the domestic violence and abuse threshold, but which means that parents need help to communicate and relate to each other. There is increasing recognition of the need to improve inter-parental relationships, as a primary influence on children’s long-term mental health and future life chances. I therefore welcome what is being done. Of course, it is geographically limited and, in terms of funding, will not reach all those who need the help and need it now.

It is also encouraging that the Government have committed some £90 million to addressing mental health problems in young people—probably, my right hon. Friend the Minister for School Standards tells me, with a particular view to providing mental health nurses in schools. However, the impact of that investment, as I have said to the Minister, will never be as it could be if those professionals worked not only with the children involved, but with their families. So often, the relationship issues within the home mean that families are the source of the mental health challenges that children bring into school. Unless the whole family are worked with, helping the child in school and then sending them back to the source of the challenges will never resolve the problem.

I want to divert for a few moments and commend a charity called Visyon, which it has been my privilege to be patron of for many years. A mental health charity based in my constituency of Congleton, it supports children and young people from the age of four when they have mental health challenges and it provides help right across Cheshire East and into north Staffordshire.

I am grateful to the chief executive for providing me with some pointers for today’s debate, which I shall summarise. The document states:

“The Government’s Green Paper, Transforming Children and Young People’s Mental Health Provision, recognises the important role that the voluntary and charities sector will play in the formation and delivery of support to schools and colleges. With an ever increasing demand for specialist NHS mental health services for children and young people, it will be vital that schools are able to identify the most appropriate interventions or services to prevent the escalation into costly specialist provision, where possible.”

I shall refer to one area of intervention where the charity works as a priority, which is with parents, but first I shall give a few statistics from Visyon. It says that three in four mental illnesses start in childhood, 75% of young people with a mental health problem are not receiving treatment, and the average wait for effective treatment is 10 years. It also says that UK funding for mental illness research equates to just £8 per person, compared with £178 for cancer and £110 for dementia.

The document that I have from the charity states:

“Visyon’s approach is to look at mental health holistically and provide interventions that involve and impact on all aspects of the…young person’s life…When a young person is struggling with their mental health it has a huge impact on the whole family. Parents are often desperate to support their children but…end up feeling lost, isolated and under skilled…At Visyon we approach our mission to improve a child’s mental health in a holistic way…parents can be a child’s biggest resource.”

Visyon runs a “Parent Empower Hour” programme and states that in a recent evaluation of it,

“parents were asked how family dynamics had changed since taking part in the group. Comments included ‘Our house is so much calmer. I feel less angry and overwhelmed’ and ‘I have found even ground now. I feel more in control and I know this is what my daughter needs’.

There is a conscious focus in Parent Empower Hour to encourage parents to look after their own wellbeing. This serves two purposes—it is important to model to children the importance of self-care and it recognises the emotional toil of caring for children who are struggling with their mental health. One parent commented ‘I have learned to look after myself more and not feel guilty about it. This makes it easier to cope when difficult situations arise.’”

It is encouraging that the Government recently launched their new relationships and sex education in schools curriculum, which requires an emphasis on building healthy relationships. The regulations recently passed by both Houses require that pupils learn about the nature of marriage and civil partnerships and their importance for family life and the bringing up of children; safety and forming and maintaining relationships; the characteristics of healthy relationships; and how relationships can affect physical and mental health and wellbeing.

I am delighted that my right hon. Friend the Secretary of State for Education has made the points for me in his foreword to the documentation that launched this. In his foreword to the guidance, he says:

“In primary schools, we want the subjects to put in place the key building blocks of healthy, respectful relationships, focusing on family and friendships, in all contexts, including online. This will sit alongside the essential understanding of how to be healthy. At secondary, teaching will build on the knowledge acquired at primary and develop further pupils’ understanding of health …Teaching about mental wellbeing is central to these subjects, especially as a priority for parents is their children’s happiness.”

I welcome all that the Government are doing, because that work is crucial, but much more needs to be done. We need to recognise that, just as fractured family relationships can affect the emotional wellbeing and, in turn, the mental health of us all, the impact on the mental health of children growing up and experiencing poor or broken family relationships from an early age can be lifelong.

How can Government help people in the earliest stages of life? I will review a number of recent studies on this issue, not all of which come from organisations that have what might be called a vested interest in the subject. Relate—the relationship people—cites the Early Intervention Foundation’s statement that the inter-parental relationship is a “primary influence” on children’s life chances. In particular, frequent and intense unresolved inter-parental conflict is highlighted as a key factor affecting children’s long-term health and wellbeing.

A 2017 Office for National Statistics survey, no less, showed that children aged between two and 16 who are living in families that struggle to function well are more likely to have mental health challenges than are children from healthy, functioning families.

Interestingly, just today The Times has published details of the latest 2019 ONS survey, under the headline:

“The key to happiness? Eat, drink—and be married”.

The article says that according to research published by the ONS just yesterday on relationships, married people gave the highest score when asked to rate their life satisfaction out of 10, as compared with those who are not married. Researchers looking at data from 2017-18 found that marital status has overtaken economic activity—for example, whether someone is in work—as the most important factor contributing to happiness after good health. That is good news in National Marriage Week, and from an unlikely source.

I will turn to other sources. The National Childbirth Trust says that new mothers may experience multiple mental health problems during pregnancy or after giving birth, including post-natal depression, as we know, as well as anxiety, eating disorders, obsessive compulsive disorder and post-traumatic stress disorder, with suicide the leading cause of direct maternal death after the first year following pregnancy. However, the NCT says that there is no requirement in the six-week maternal check, which mainly focuses on the baby, to include a check on the emotional health or wellbeing of the mother. NCT research shows that nearly half of new mothers’ mental health problems are not picked up by a health professional.

Also, as the National Society for the Prevention of Cruelty to Children says in “All Babies Count: The Dad project”, the role of fathers in supporting mothers can have a significant influence on improving the mental health outcomes of mothers after they give birth. Such early support is critical because parental mental health is a key factor in understanding the mental health of children.

Research by the Marriage Foundation found that family breakdown also has a major impact on teenagers’ mental health. Although its statistics showed that one in five 14-year-olds with a mental health problem live in an intact married family, just under double that number—two in five of teenagers with mental health problems—were the children of parents who live apart and had never married.

The Marriage Foundation also recently conducted an evaluation of factors affecting teen mental health, using data from the millennium cohort study of young people who are now aged about 14 or a little older, who were born around the millennium. The Marriage Foundation report suggests that family breakdown is the biggest factor behind the UK’s child mental health crisis. Its analysis of almost 11,000 families found that having parents who split up was the strongest influence on girls’ mental health in their teenage years, with strong links to emotional problems. It was also the joint strongest factor, alongside relationship happiness, in teenage boys’ mental health, with strong links to behavioural problems.

ChildLine’s latest annual review cites family relationships as the second leading reason why children contacted the service to talk. The Samaritans says that divorce increases the risk of suicide, because the individual becomes disconnected from their domestic relationships and social norms, and that those who divorce may experience a deep sense of “emotional hurt”.

The Mental Health Foundation kindly provided me with a briefing for this debate, entitled, “Relationships in the 21st century: the forgotten foundation of mental health and wellbeing”. The Mental Health Foundation says that people who are more socially connected to family, friends or community have fewer mental health problems than people who are less well connected. It also states that, as I have said, conflict within the family environment impacts negatively on the mental health of children within the family, and the negative effects can be felt across the whole of life’s course.

The Mental Health Foundation’s briefing says:

“The family relationship environment in pregnancy, infancy and childhood is of fundamental importance to future mental health. This is only now starting to be fully appreciated as the neuroscience of brain development is becoming known and being seen to support understanding gained through observational studies of human beings and their mental health.”

In this respect, I commend the Leader of the House, because she has set up a working party of Ministers to look at helping families with children in their very earliest years—the first 1,001 days of life. This subject needs to be focused on more closely by Government, so I am very pleased that my right hon. Friend has done that and I look forward to reading her report, which will come out soon, about what Government can do to support those early days, although of course there is a lot more that needs to be done in later childhood, and indeed in adulthood.

The Relationships Alliance concludes that relationships are a vital public health concern, stating:

“Evidence shows that the quality of our couple and family relationships is linked directly to specific areas of public health concern. Such areas include cardiovascular disease, child poverty, alcohol/substance misuse, depression and mental health, obesity/child obesity, children’s mental health/cognitive development, and infant attachment.”

Of course, the first attachment that we make with others is with our parents; that relationship is one of the most important in all our lives. Positive and secure attachment is important for positive emotional and social development, with children being able to adjust better to adversity and change; to use a favoured word now, they are more “resilient”. By contrast, insecure and disordered attachment relationships in early childhood are associated with depression, anxiety, self-harm, suicidal tendencies and post-traumatic stress disorder, among other mental health problems.

Living with parents who divorce before their child is 18 has now been assessed as an adverse childhood experience, or ACE, for that child. Having one or more ACE increases the risk of a child experiencing depression, poor academic achievement, time in prison or sexual violence, among other negative outcomes. As the Mental Health Foundation says, toxic relationships and negative experiences can have a serious impact on a young person’s mental health.

We should bear it in mind that our children are growing up in a country that has one of the highest levels of family breakdown in the world; indeed, the UK now has the highest divorce rate in Europe, such that nearly half of all our teenagers do not live with both their parents. This is a massive issue, as we also know from those who work in schools, colleges and universities, where supporting young people with mental health challenges is now a major concern.

Why am I referring to all this during National Marriage Week? Because it is not just the quality of the parents’ relationship that matters; it is also being increasingly recognised that the stability of the parents’ relationship matters, if that relationship endures through a child’s childhood. That is important not only for the children, but for the adults within that relationship. As the Centre for Social Justice says:

“Family environment is crucial to children’s outcomes. It is the instability and disruption caused by family breakdown, coupled with poor parenting, that is so damaging to their outcomes.”

Therefore, one of the factors that promotes wellbeing is stability in family relationships, and all the evidence shows— we cannot avoid it—that marriage, as opposed to cohabitation, is much more likely to endure and to promote stability. Just one married couple in 11 splits up before a child’s fifth birthday, compared with one unmarried couple in three.

The CSJ produced a substantial new report just last month, entitled “Why Family Matters—A comprehensive analysis of the consequences of family breakdown”. Before I give Members the statistics, and people reject the comments made in that report as the mere opinions of those who have an interest in promoting such arguments, I will clarify the methodology that has been used. These statistics have been calculated using a sophisticated methodology known as logistic regression. I know; I had never heard of it before, either. That means that the influence of other demographic attributes such as gender, age, socioeconomic grade and ethnicity, as well as experience of social issues, are controlled for. The result is that the statistics arrived at are a true reflection, in this case, of the impact that family breakdown has on the life of a young person.

Here are some of the statistics that the report has produced: those who experience family breakdown when aged 18 or younger are over twice as likely to experience homelessness; twice as likely to be in trouble with the police or spend time in prison; almost twice as likely to experience educational under-achievement, not being with the other parent of their children, alcoholism, teenage pregnancy or mental health issues; and more likely to experience debt and living on benefits. Surely those statistics alone should persuade us that Government should be doing much more to address family breakdown. The cost of not doing so is too great, not just in financial terms—although that cost is huge, far more than the £51 billion often quoted for tackling these issues, which are the consequences of family breakdown—but, tragically, in terms of the lost life potential of the millions involved.

The CSJ states that one adult in 10 who experiences mental health issues says that family breakdown was a contributing factor. Put simply, the CSJ says:

“Marriage leads to the better mental health of children. Children of married parents are more likely to achieve at school, less likely to use drink and drugs and less likely to get involved in offending behaviour.”

Marriage reduces the risk of violence and abuse, and the CSJ states that marriage is more enduring and stable than just living together:

“Marriage is directly linked to better mental and physical health amongst adults, the same benefits are not found amongst co-habiting couples. It is specifically a marriage effect.”

This is very much a social justice issue. Better-off people get this; they get married in far greater numbers than poorer people. Poorer people do not marry as much, and therefore are the ones who sadly experience the consequences of breakdown that I have described. That is not social justice, and it is a key reason that we need to address this issue.

Those tragic, heartrending consequences for millions of young people surely cry out for Government to prioritise supporting all of us to build healthy, close personal relationships, just as no one now blinks when Government recommend that we should eat healthier so that our physical wellbeing is maintained and improved. The steps that we can learn for improving our close personal relationships are not that complicated—I will mention a few shortly—but the benefits we can all glean are unquantifiable. If we can strengthen our emotional wellbeing, we can help to protect our mental health. Not just children in school who are learning through relationships and sex education, but all of us who are learning about relationships capability, would benefit.

The term “relationships capability” has been given to me, and very well promoted, by the organisation Soulmates Academy. About two weeks ago, its founders came to speak at a meeting of the all-party parliamentary group for strengthening couple relationships and reducing inter-parental conflict. That organisation says that we have ignored investing in relationships at our peril. It provides courses and helpful advice on relationships capability to individuals and groups, as well as corporate organisations, which increasingly understand the beneficial effect of relationships capacity on productivity. As Soul- mates Academy says, building a stronger relationship need not be complicated; its relationship tips can be summarised as follows:

“BE CURIOUS, not critical…BE CAREFUL, not crushing... ASK, don’t assume…CONNECT, before you correct”.

I recommend its website for more information.

The Mental Health Foundation also provides tips for building and maintaining stronger relationships, which again can be summarised. It says that there are five things we can do: make more time to connect with our family; try to be present with them, not always on our phone; actively listen in a non-judgmental way; concentrate on the needs others are expressing; and express our own feelings honestly. It says:

“As a society and as individuals, we must urgently prioritise investing in building and maintaining good relationships and tackling the barriers to forming them. Failing to do so is equivalent to turning a blind eye to the impact of smoking and obesity on our health and wellbeing.”

People are with us. In a recent YouGov poll carried out for Relate, the relationships charity, no fewer than 99% of people agreed that strong and healthy couple relationships are important to a person’s physical and mental wellbeing—I am sure that any colleague in the House would love a poll that was 99% in their favour. That is why Government need to invest much more in helping all of us to develop our relationship capability. Supporting organisations such as Soulmates Academy to do so would be a good start during National Marriage Week. As that organisation says:

“If we agree that our committed, long-term personal relationships & marriages are actually what anchor us in life and allow us to go on to achieve our potential, what are we doing to invest in them and build skills to develop them?”

We need a national strategic approach to strengthening families. We have a dedicated Minister for loneliness; why not one for relationships? A coherent strategy across Departments, led by a dedicated Minister at Cabinet level, would be very helpful in ensuring that relationships and families were supported at all stages and ages in life, not just when they run into trouble.

Such a Cabinet Minister could promote all the other policies in the manifesto to strengthen families, including the development of family hubs in local communities where that kind of relationship help could be made available. I am pleased to say that those hubs are springing up in different areas across the country, and the launch of the family hubs network to connect the growing number of hubs in local authorities will happen in Parliament’s Jubilee Room on 5 June. I hope the Minister, all colleagues and all those who have come to listen to today’s debate will attend.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

Thank you, Sir David. I am sure you do not want to listen to me until 4.30 pm; in fact, I know very well that you do not. It is a pleasure to be here with you this afternoon.

I have really enjoyed listening to this debate. There have been some compelling arguments on a subject that we do not really discuss very often, yet it is the foundation of our society. This debate is a welcome opportunity to do that. Certainly, listening to all hon. Members’ remarks, I was given considerable food for thought, so I shall do my best to address the points that were made. I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) on securing the debate and on having the imagination to bring together National Marriage and Mental Health Awareness Weeks.

My hon. Friend the Member for South West Bedfordshire (Andrew Selous) talked about who might have responded to the debate were it not for the reference to mental health, which is an interesting question. Various Departments have an interest, including the Department for Work and Pensions, the Department for Education where the issue affects children, my Department where it impacts on mental health, the Ministry of Justice where it might lead to offending behaviour and the Ministry of Housing, Communities and Local Government in so far as it might lead to addiction.

This all comes back to the state delivery of services and how it tends to rely on a uniform process, yet we are dealing with human beings. If they require support, a one-size-fits-all, tick-box approach will not necessarily be effective in all cases. To be honest, when we see people whose adverse childhood experiences have led them to harm either themselves or others, I view that as a state failure. Perhaps we ought to look at the drivers of child poverty and see whether we can ensure a more effective Government response. When I sit on various cross-departmental working parties looking at domestic violence, mental health or knife crime, I often think they could all be brought together to look more holistically at the children who need early intervention. We need to get much better at that.

Obviously, how we raise our children and family relationships are crucial to how they turn out. We know that for some people, particularly those living in poverty or with an addiction or those who suffer stress, life can be hard. It ought to be available to us to give people extra help. My hon. Friend the Member for Congleton referred to the troubled families programme in her opening remarks. The ethos behind the programme was to support the families that needed extra help. We need to learn from that programme to see what works best so that we can do things better. That is very much in our thinking.

My hon. Friend also talked about some of the initiatives that we are already taking with respect to mental health and highlighted the new mental health teams that we are creating. She suggested that the teams need to work not only in schools but in families. Sir David, you heard me speak about the Charles Dickens primary school in Southwark in another meeting. I visited it as we were developing our thinking on the new support teams, and it had taken a very imaginative approach to embedding mental wellbeing throughout the school and the curriculum. Instead of having teaching assistants in the classroom assisting, the teaching assistants were doing one-to-one interventions with children. As well as one-to-one tuition, some of them were involved in reaching out and building relationships with the parents. Our school network is exactly where we ought to be able to identify the people who need a little more help.

[Fiona Bruce]

I am delighted to hear that. I do not know whether the Minister has heard of a similar approach taken by Middlewich High School in my constituency, but what is excellent about that is that the school is now reporting improved GCSE results because it works not only with the pupil, but with the whole family.

[Jackie Doyle-Price]

As my hon. Friend says, it is not rocket science. If someone is physically, mentally and socially fit, they will have a feeling of wellbeing overall. If any of those pillars falls down, it drags down the rest. If people have a happy environment at home, they will be happier in school and more disciplined and focused. If they live in a dysfunctional environment, they will want to escape, and that will not be good for their GCSEs or anything to do with their long-term development.

[Fiona Bruce]

Will the Minister allow me to intervene again? I do not want to interrupt too many times.

[Jackie Doyle-Price]

We have plenty of time.

[Fiona Bruce]

Yes, so we have heard from Sir David. Corporates are also realising how important this is to the bottom line: productivity. If people arrive at work having left a happier home, they will be more productive, which is an interesting factor to consider if we multiply it across the nation. It is fascinating that we have one of the highest levels of family breakdown in the world, but also low productivity compared with many of our competitor countries. The Minister touches on that when she talks about the flourishing of a human being in terms of relationships and productivity, which are not disconnected.

[Jackie Doyle-Price]

That is a very good point. We can expect employers to start doing things when they can see a return for themselves. It is interesting also that, as we reach higher levels of employment and as an appropriately skilled workforce is harder to come by, employers see the advantage of giving more help and support to their staff in order to retain them and keep them productive. We look forward to seeing more of that. Certainly our work through “Thriving at Work” with Mind, Paul Farmer and Lord Stevenson is designed to share best practice and encourage more.

My hon. Friend also talked about the long waits for children’s mental health services, which the hon. Member for Worsley and Eccles South (Barbara Keeley) also talked about. We have to concede that, historically, children’s mental health services have been very poorly funded and supplied, and we are dealing with the aftermath of that now. Everyone knows the extent of our ambition to deliver much improved mental health services to children and young people. However, we still have to properly address the situation that we have inherited. We are playing catch-up, but we will push forward and make sure that children have access to services. The mental health support teams are the first point of contact for children, helping them look after their own wellbeing.

--- Later in debate ---

[Fiona Bruce]

I am sure, Sir David, that colleagues were relieved and impressed by your astute wisdom in announcing after I had spoken that the debate could continue for longer. I thank all hon. Members who spoke, and I particularly thank the hon. Member for Strangford (Jim Shannon) and my hon. Friend the Member for South West Bedfordshire (Andrew Selous) for their thoughtful contributions. I was very pleased to hear the Minister respond in such a constructive way. Her tone, as well as her words, said a lot when she recognised both the impact of family relationships on mental health and the fact that more needs to be done.

I thank the Minister for not sticking to her notes, but instead responding so thoughtfully to so many of the comments that were made. As we have heard—it is a matter of social justice—there is a real need to put strengthening relationships at the heart of Government policy, nationally and locally, to provide joined-up support for families. As the Minister said, the troubled families initiative has started to do that.

As the Minister also said, we need to better support the many excellent voluntary organisations engaged in this area. Crucially, today we have also recognised the importance of marriage in helping to address the country’s major mental health problem. As Members have said, that is not in any way to criticise or condemn those whose home circumstances are different—far from it. We are saying that building relationship capability is for all of us, because we all aspire to have beneficial and flourishing relationships in our lives. We know their benefits.

I was particularly interested to hear the Minister say that because these issues straddle so many Government Departments, and because of the processes and the way that Departments work in silos, addressing them is quite a challenge. That is exactly why the proposal of a Cabinet Minister for the family, to draw together the work on such issues across Departments and support people more effectively, is so important. I close by saying that after the authoritative and compassionate speech that he gave today—it represented the tip of the iceberg of many years’ work on this issue—I cannot think of any hon. Member who would better fill that role than my hon. Friend the Member for South West Bedfordshire; I hope the Minister will forgive me for saying so.

Question put and agreed to.

Resolved,

That this House has considered National Marriage and Mental Health Awareness Weeks.