Children and Young People’s Mental Health

Gary Streeter Excerpts

Wednesday 16th June 2021 Westminster Hall

[Sir Gary Streeter (in the Chair)]

I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. The timing of debates has been amended to allow technical arrangements to be made for the next debate. There will also be suspensions between each debate.

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[Munira Wilson (Twickenham) (LD)]

I beg to move,

That this House has considered children and young people’s mental health.

It is a pleasure to serve under your chairmanship, Sir Gary. I am very grateful to be given the opportunity to lead a debate on this critical issue. Eighteen months ago in my maiden speech, I pledged that children and young people’s mental health would be an issue that I champion in this place. It is a cause for which I will fight relentlessly, because children and young people are our future. Their hopes and dreams depend upon us doing the right thing by them.

Those who are struggling with their mental health and wellbeing, whether those suffering mild anxiety to those young people attempting to take their own life, deserve the very best care and support. Yet children and young people do not have a voice in the political system and are too often overlooked. In fact, the former Children’s Commissioner, Anne Longfield, said in her final speech earlier this year that in Government there was an “institutional bias against children”—never more so than during the pandemic when, frankly, they have been an afterthought at every turn. From new born babies to schoolchildren to university students, the Government have let them down in planning and providing for their social and educational needs, and again in their announcements about children’s recovery.

Teenagers and young people in my constituency who are ambassadors for the fantastic local charity Off The Record tell me that uncertainty over exams, combined with the social isolation of being stuck at home away from their peers, worries about loved ones and now concerns about their future job prospects have all taken their toll. But this crisis in children and young people’s mental health started long before the pandemic. One reason why I made it my priority at the start of last year was because following my election, I was astounded week in, week out by the emails from parents or conversations at my surgeries, of stories of battles with child and adolescent mental health services to access treatment for children who are considering suicide, self-harming or withdrawing themselves from school. Yet they were having to wait six months or sometimes a year for treatment.

At a lower level, support in schools is patchy, with only some having access to a counsellor or mental health support team. Community-based support to intervene early can be dependent on voluntary sector provision in any given area. The pandemic has only served to highlight and exacerbate the existing lack of access and inequalities within children and young people’s mental health. In 2017, one in nine children had a diagnosable mental health condition. That rose to one in six at the height of the pandemic. The Government need to use this moment to renew their focus on mental health and overhaul the support available.

I want to focus on three elements within the system and what needs to be done: CAMHS, schools and community services. Turning first to CAMHS, referrals are at their highest ever level, with over 65,500 referrals for 0 to 18-year-olds received in March 2021. That is more than double the number in March 2020 and almost 70% higher than in March 2019. Behind the staggering numbers is a child or a younger person in turmoil, often left in limbo waiting for treatment, and a carer beside themselves with worry. From talking to NHS leaders in my area, I know that unplanned admissions for children suffering a mental health crisis are at extremely high levels with services struggling to cope.

While it must be acknowledged that the Government have increased spending in this area, resulting in the NHS slightly exceeding its 2019-20 target of community mental health support for 34% of children needing support, there is still a long way to go. Last week, a local GP said she is increasingly finding that children she refers to CAMHS are being knocked back, and she is routinely requesting schools make a supporting referral to secure therapy. When referrals succeed, the wait can seem interminable. I heard from the adoptive father of a seven-year-old who suffered significant trauma and abuse within her birth family. She was referred to treatment, the initial assessment took several months to secure, and then the family were told that there would be a year’s wait—yes, a year’s wait for a seven-year-old for an eight-session course of treatment, only if deemed necessary.

There is a postcode lottery of spending across the country. Eight local areas spend less than £40 per child on mental health services, while 21 areas spend more than £100 per child. That brings me to an important point about data and reporting, which is so important for accountability. Inconsistencies in financial reporting across clinical commission groups makes it difficult to interrogate the data to check they are meeting NHS England guidance to increase year-on-year the proportion of spending on children and young people’s mental health. This measure should be included in the mental health investment standard.

The other issue with data collection and publication is that it is impossible to judge whether different areas are meeting access targets, as the percentage of young people with a diagnosable mental health condition is only available nationally, not on a local basis. The Children’s Commissioner should not have to request this comprehensive data on waiting times and referrals every year. The Minister will know that I tabled an amendment during the passage of the NHS Funding Act 2020 to improve transparency in operational expenditure and performance at a local level. I discussed this with her ministerial colleague, the hon. Member for Charnwood (Edward Argar), a few months ago. He assured me that the Minister is taking this forward, and I hope she can update us on when this local data might be routinely available.

However much money is pumped into CAMHS, improving access to it is contingent on plugging big holes in the workforce. The Royal College of Psychiatrists’ 2019 workforce census found that the rate of unfilled NHS consultant psychiatrist posts in England has doubled in the last six years, with one in eight CAMHS psychiatrist posts vacant. We urgently need a proper long-term work- force strategy, adequately resourced and with an annual report to Parliament. The forthcoming heath and care Bill is the ideal opportunity to hardwire this provision.

Turning to the role of schools in tackling mental health concerns, they are key to early intervention, and step in where children do not meet the CAMHS threshold. Provision of counselling and other mental health support services in schools can be variable and dependent on already massively overstretched school budgets. Mental health support teams can fill the gap. However, the current roll-out rate is very slow. The Government are aiming to reach a fifth to a quarter of the country by 2022-23, and have recently provided more funding to accelerate the roll-out, but I urge the Minster to be more ambitious.

On children’s recovery from the pandemic, most of the education catch-up funding announced by the Government has been largely focused on academic catch-up, with little focus on emotional wellbeing and mental health support. All the research shows that it is difficult for children to learn if they are struggling with their mental wellbeing. Liberal Democrats supported YoungMinds’ call for a £178 million ring-fenced resilience fund to allow schools to provide bespoke mental health and wellbeing support packages, as appropriate to their pupils and context. So far the Government have committed just £17 million of dedicated mental health support for schools as part of the recovery. A recent Ipsos MORI poll showed that parents put increased wellbeing support at the top of their priority list as part of any education recovery plan.

Finally, I will touch on the importance of community support services. We know that half of all mental health conditions present themselves by the age of 14 and three quarters by the age of 24. That is why prevention and early intervention are so critical. We know that some children and young people do not want, or are unable, to access mental health support in schools, but community-based services can be a lifeline.

Waiting until children reach crisis point is far too late. For younger children, family-based interventions, such as those offered by Kids Matter, are an effective approach. The Purple Elephant Project in Twickenham, founded by the inspirational Jenny Haylock, who has built a team of art and play therapists, works with children and their families from a very young age. Coram is also doing some incredibly important work on boosting children’s self-esteem and resilience.

For teenagers and young adults, I warmly welcome the campaign launched by a range of children’s and young people’s mental health charities, called “Fund the Hubs”. It calls for early-support hubs, offering easy-access, drop-in support on a self-referral basis for young people up to the age of 25, who do not meet the threshold of CAMHS.

The hubs would offer a mix of clinical staff, counsellors, young workers and volunteers, providing a range of support services. Additional services could be co-located under one roof, such as sexual health services or employment advice. The hubs could be delivered in partnership with the NHS, through local authorities or working with the voluntary sector, depending on the local area. Such an approach has already been tried in Manchester, Ireland and Australia, and has been shown to relieve pressure on and deliver cost savings to the health service. I hope the Minister will look at that innovative model.

In conclusion, we owe it to our children and young people to offer them the very best start in life. As a Liberal, I am passionate that every child gets the maximum opportunity to reach their full potential. With spiralling figures of children suffering anxiety, who are self-harming or struggling with eating disorders, as well as many more who are grappling with low confidence and self-esteem, we need to use this moment as we emerge from the pandemic to hit the reset button.

I urge the Minister, who I know shares my passion on this issue, to develop a proper cross-departmental strategy to tackle this growing crisis. Let us re-envision what support looks like for children and young people. Let us break down the silos between schools, local authorities and the NHS. Let us make sure that we prevent and intervene early to stem the tide, while also investing in training the mental health workforce.

I have heard too many times, from too many parents sick with worry, that CAMHS is simply not fit for purpose. I have yet to see much evidence to disagree with them. I hope the Minister will make it her mission to fix it, and work cross-party, if she is willing. I stand ready to do so for the sake of our children and their future, and I hope my Labour counterpart will, too. Not only is it morally the right thing to do, but our country’s recovery depends on their success.

[Sir Gary Streeter (in the Chair)]

Colleagues, we have 45 minutes and nine Back-Bench speeches to fit in, so that is exactly five minutes each. Please try to keep to time, so that I will not need to impose any restrictions.

--- Later in debate ---

[John McDonnell (Hayes and Harlington) (Lab) [V]]

I thank the hon. Member for Twickenham (Munira Wilson) for not just securing the debate but superbly setting the scene.

I want to reinforce the message that has just come so eloquently from the hon. Member for Bath (Wera Hobhouse) with regard to eating disorders. I saw the recent paper by Dame Til Wykes and other scientists and campaigners, supported by the Government’s national adviser, Chris Whitty. They discussed the end goals for mental health research. The first end goal was halving the number of children and young people experiencing persistent mental health problems.

Eating disorders are just one of the serious persistent problems that start early and often persist into adulthood. As the paper sets out, they are associated with extremely poor outcomes, so it is appropriate to try and stop these disorders persisting from an early age. It makes sense for the individuals and their families, but also for the NHS, in terms of reducing costs, and for the economy overall, because people can contribute so much more fully to society.

What came out of that paper is the decision that we need to implement what we know already, but also support more research to improve recovery. As the hon. Member for Bath said, we already know that eating disorders are a growing problem. Some of the statistics are startling. The NHS 2019 health survey for England found that 16% of adults aged 16 and over screened positive for a possible eating disorder. In recent years, we have seen a fourfold increase in eating disorder hospital admissions, and waiting lists are at an all-time high. Hon. Member after hon. Member is finding this in their constituency, particularly when they are approached by distressed parents.

It is estimated that one in three young people experiences an eating disorder. Because these disorders occur among so many young people, they are still sometimes viewed as almost a teenage girls’ illness—a diet, a lifestyle choice or something a person grows out of. Yet, the statistics on their severity are shocking. It is reported that eating disorders have the highest death rates among all mental health disorders, and the rate of suicide is 23 times higher in people with eating disorders, compared with the general population—one in five deaths in eating disorder patients is reported to take place because of suicide, and I pay tribute to the work my hon. Friend the Member for Blaydon (Liz Twist) and her all-party parliamentary group on suicide and self-harm prevention are doing. According to the reports that we receive as constituency MPs, these serious consequences result from eating disorders partly because of the lack of access to psychiatrists who are fully trained in eating disorders and who specialise in eating disorder treatments.

As the hon. Member for Bath said, evidence is emerging that there has been a significant rise in people with eating disorders during the covid pandemic. Those in recovery have been set back, and new eating disorders have developed among a wider range of the population. From what I hear from my constituents, there is a vicious cycle of a lack of awareness, a lack of training and a lack of research funding at the scale needed. Let me just quote the parents from one family, who said: “Tell them right now the support, the treatment and the understanding is just not out there for us.”

Concerns have also been expressed about what some people consider unhealthy messages being pushed by the Government’s obesity strategy, which is being developed at the moment. I hope that more consideration will be given to consulting organisations that represent people with eating disorders in the development of that strategy.

I want to pay tribute to Hope Virgo. Many will have heard of her campaign “Dump the Scales”, which has been calling so effectively through the media for proper investment in eating disorder treatments. Just this week, Hope told me she has received numerous letters from parents whose children have been naso-gastric-fed on general wards, with no psychological support in some health settings.

F.E.A.S.T., a global website campaign, is reporting thousands of people contacting it through Eating Disorders Support UK, and 5,000 have signed up for its 30-day support scheme. Hope Virgo is the founder of the Hearts, Minds and Genes eating disorder coalition, which is the first coalition to declare a state of emergency around eating disorder treatment, and I am pleased that it is now meeting the Department of Health and Social Care. This serious issue needs ministerial support to drive through the new programme, and I hope that pathways and support will be developed within a timescale that recognises its urgency and seriousness.

[Sir Gary Streeter (in the Chair)]

The winding-up speeches will begin at 3.28 pm. Jim Shannon has five minutes.

--- Later in debate ---

[Sir Gary Streeter (in the Chair)]

May I remind the Minister to leave one minute at least for the hon. Member for Twickenham (Munira Wilson)?

[Ms Dorries]

I am going to sit down.

[Ms Dorries]

I do not think there is time.

[Sir Gary Streeter (in the Chair)]

You have one minute of your time left.

[Ms Dorries]

I have not got time, I am so sorry. There is only one minute left.

The hon. Member for Twickenham asked about data. That data is produced on the mental health dashboard every quarter. There is work ongoing, but I will come back to her on the details of it. I do not know whether she has access to the dashboard and the data, but I will make sure she does. If the hon. Member for Blaydon (Liz Twist) would like to speak to me when the debate is over, I will come back to her on the points she raised. I will sit down now to give her a chance to respond.