Young People’s Mental Health

Huw Merriman Excerpts

Thursday 27th October 2016 Commons Chamber

[Huw Merriman (Bexhill and Battle) (Con)]

It is a great pleasure to follow the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron)—I hope I have got that correct.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. It is pronounced “Stray-ven and Lez-ma-hay-go”.

[Huw Merriman]

Thank you, Madam Deputy Speaker. I am suitably corrected and admonished at the same time. I am glad that you did not ask me to repeat that after you.

I particularly applaud the point that has been made about making this a cross-party matter on which we can all work together. As the young people have shown us in their fantastic report, working together will help to ensure that all voices are heard and recognised.

I thank the hon. Member for Dulwich and West Norwood (Helen Hayes)—her constituency is much easier for me to pronounce—for sponsoring the debate. I apologise for going back and forth from the Chamber, and perhaps I may explain to those who are watching why there are so few MPs on the Benches. My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) said that it would be good to hold such debates during Government time, when Members may not be in their constituencies. Of course, Thursday afternoon is also a time when Bill Committees sit, so Government and Opposition Members are required to attend those Committees. I hasten to add that I should also be in a Bill Committee, but I was so determined to speak on this matter that I have come to the Chamber. It is probably for that reason that I will always be asking Ministers for more from the Back Benches, rather than being on the Front Bench and able to deliver those things myself.

I commend the 2015 Youth Select Committee report, and I particularly applaud the 90,000 young people—many more took part in the vote—who voted that mental health services for young people should be the priority concern. They are absolutely right to focus on this subject, and I submit that they are in the best position to give their opinion on it.

I similarly decided that the subject would be a chief priority for me when I was elected as an MP in East Sussex 18 months ago. The severity of this issue, particularly among young people, became all too apparent to me. I found—I still do—the stories of carefree, confident and happy lives being shut down as young people enter a dark world of fear, anxiety and isolation to be incredibly upsetting.

As a result of my concern, I chose this issue as the topic of my question when my name was first pulled out of the hat for Prime Minister’s questions. I told the then Prime Minister that I had spent an afternoon in the small town of Battle in my constituency visiting three families, each of whom had a child who had not been given the early-stage intervention that they expected from the child and adolescent mental health services. I asked the Prime Minister for more focus on early-stage treatment so that young people’s conditions do not become more acute.

Providing such services is not only our civic duty, but an economic and social imperative. When my constituents ask me why the roads in East Sussex are in a state, I explain that I recently secured £250,000 from our county team to fund just one year of acute mental health treatment for one constituent. Fixing people has to come before fixing holes in the tarmac. The phenomenon may not have existed so openly when many of my constituents were younger, but it is now a huge financial concern to my county council colleagues.

I firmly believe that too much pressure is being loaded on to people too young. Social media and the internet, as pioneering as they are, are a curse on wellbeing, and internet service providers must be forced to do more. Every young person should have the right to have their web history expunged. Cyber-bullying is at last being recognised as a crime, but every school must ensure that its pupils are aware of good internet practice and the sanctions for abuse. We also need to be aware that young people and children are accessing graphic images and media on the internet that they cannot understand, process or cope with.

In the report’s consideration of education, I absolutely commend the recommendation

“that the Government develop and introduce statutory levels of attainment for mental health education…Schools should have autonomy to deliver mental health education flexibly but must be able to demonstrate how pupils reach the attainment levels.”

May I suggest that in so doing the Government should ensure that the curriculum combines a consideration of social media and the internet with wellbeing training?

We also need training for our GPs. The situation is summed up perfectly by the experience of a young person that is detailed in paragraph 32 of the excellent report. It is essential that the GP does not diagnose a mental health condition, but merely refers the young person to a specialist. I know that mental health specialists find it frustrating if GPs diagnose a mental health condition when the specialist does not regard it as such. Once that badge is given to someone, it is difficult to remove it. Equally, brilliant local GPs, such as those in Battle who have helped my constituents in their surgeries, have championed young people and become their advocate. They are incredibly frustrated by the delay in early intervention in mental health services. I work closely with my local CAMHS team, and I have the highest regard for the many excellent specialists who do their best. However, I am worried that constituents face lengthy waiting times and that some have been passed from pillar to post when receiving treatment.

Building up trust is a key ingredient of successful diagnosis and treatment. I hear stories about young people finding the courage and trust to open up about their condition, only to find a new practitioner at the subsequent session. It disappoints me that the young person can then regress because of that change of personnel. I would like a commitment to giving treatment on a fixed one-to-one basis. If we can do that for maternity provision, surely we can do it for mental health treatment.

When I attended the launch of the mental health taskforce, I was buoyed by the commitment of the then Minister and the chief executive of NHS England to implement the excellent “Five Year Forward View”. I was cheered by the commitment to funds to ensure that our acute hospitals have adequate mental health expertise on A&E wards to deal with those who are hospitalised as a result of mental health issues, or who have such a condition in addition to a physical illness.

My concern was driven by the experience of a family in my constituency following a suicide attempt. The NHS staff did not have the ability to deal with the mental health condition, and my constituent, a young man in his teens, was forced to wait until CAMHS staff could make their way over from another town miles away. I understand the need for specialist treatment, but it strikes me that there is a need for a culture change across the entire NHS, and that all staff should be trained to understand mental health and provide a basic level of treatment. Specialisation in health is important, but if the NHS becomes over-specialised, it can lead to a lack of general involvement in such care for patients.

I welcome the news that the Government will fund 24/7 mental health provision in our hospitals, but I was alarmed at the suggestion by the chief executive of my local trust that the funding may not stretch far enough. I also want to ensure that that specific coverage will not mean that other NHS staff with the necessary technical understanding and empathy will feel that they are not empowered to assist those many hospital patients who need help with their mental healthcare, in addition to their physical wellbeing.

Ultimately, getting early-stage intervention right is a key part of achieving a proper diagnosis for people with a mental health condition. We should not misdiagnose young people who are suffering growing pains and need the coaching and guidance of family and friends to overcome the problems of adolescence. However, I have met too many young children who face a difficult future because their mental health condition was not treated at an early stage. Funding mental health treatment is a most important investment, not only for people’s welfare and wellbeing, but to enable these amazing young people to fulfil their hopes and dreams in their careers, and to make something of themselves and their country.

I applaud the amazing work of all of those in the British Youth Council, many of whom live in my county of East Sussex, who have done so much to produce this excellent report. Those young people are leading the charge to ensure that the nation supports all those who are affected by this terrible condition. We owe it to them, and to all young people, to deliver a better mental health service, and many of the report’s recommendations will do just that.

--- Later in debate ---

[Wes Streeting]

It really does. One of the things that concerns me most about young people’s poor experience of mental health services—this was reflected at the discussion by the all-party group—is that it is not just GPs and headteachers who recognise that young people are being failed and turned away; young people themselves recognise that. I cannot imagine what it must be like to be a young person who is suffering from anxiety, depression or another form of mental ill health, who knows they have a problem, seeks help and is left to feel ignored, dismissed and unsupported. I have mentioned the proportion of lesbian, gay and bisexual young people who are affected, and it is even higher for trans young people.

I represent a constituency that is highly diverse ethnically and religiously. It worries me that Asian communities seem to be far less likely to seek access to mental health services. There is a job to do there to tackle stigma and to make the services more accessible. People from African-Caribbean communities face inequality. The failures of public policy on African-Caribbean people should shame our country. It is a further indictment that the majority of African-Caribbean people who come into contact with the mental health system seem to do so through the criminal justice system. That is a terrible state of affairs. Therefore, the issue of access and support is crucial if we are to deal with the problem.

This is partly about funding. We have had a good-natured debate this afternoon, so I do not say this to be objectionable or churlish, but on Wednesday, three or four Members on both sides of the House raised the issue of mental health with the Prime Minister, and her response was, to put it politely, inadequate. Beyond general statements about parity of esteem, she seemed unable to point to any meaningful actions her Government were taking on the issue of mental health.

I am sure that the Minister has come better briefed this afternoon, but the Prime Minister also needs to make this a priority. Much of this is about joined-up government—this will be a theme of mine this afternoon—and that requires leadership from the centre. It is not good enough for the Prime Minister to be sure-footed, although wrong-headed, when it comes to home affairs issues, but completely blind-sided on issues outside her comfort zone. We need stronger leadership on mental health from her and I was genuinely disappointed with what we saw during Prime Minister’s questions this week.

Parity of esteem is not about sentiment—it is about resources. About 11% of the NHS budget is spent on mental health and just 6.36% of that 11% is spent on children’s mental health. I recognise that the Government have made a commitment to invest £1.4 billion in child mental health in the next five years, and I welcome that, but I urge the Government to ensure that that funding is delivered sooner rather than later. Locally—other Members have referred to this—budgets are being cut or frozen in three in four mental health trusts. Seven in 10 CCGs and local authorities are freezing their budgets because of pressures from central Government reductions. My hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) has, through written parliamentary questions, highlighted that decisions coming down the track will make that picture even worse.

In the London Borough of Redbridge, the council is doing fantastic work with limited resources. However, I can say from first-hand experience—I declare an interest as an elected member of the council—that local government cuts are biting. The picture is compounded by the state of our local health economy. Both our NHS trusts are in special measures, although I hope one of them will be leaving special measures sooner rather than later. I hope that they will both leave, but I suspect one is nearer to the end of that journey than the other. Primary care is creaking, it is fair to say that our clinical commissioning group is struggling, and our community health trust has a rating that requires improvement. The challenge for Redbridge is not simply the funding reductions that affect my borough, but the fact that the funding formula does not lead to a settlement for Redbridge—for the local authority and for the wider health economy—that genuinely reflects the needs of our population. I urge the Minister to look carefully at how Redbridge has been disadvantaged through the funding formula, particularly in public health funding, and at what can be done.

[Huw Merriman]

I do not wish to get into a skirmish on funding, but does the hon. Gentleman agree that, as in my area of East Sussex, the way to find the efficiency savings that the NHS is required to make, in addition to the £10 billion that this Government have put in, is to have a “better together” organisation so that hospitals and all the other healthcare providers—at county level and so on—can talk together? That would not only save money, but mean that everyone is joined up, which is the way forward on such issues, as he has rightly said.

[Wes Streeting]

I very much welcome the hon. Gentleman’s intervention. He has anticipated some of my closing remarks about looking to the future. I will have some positive words to say about the direction of Government policy in that respect.

This issue is not simply about funding, but about leadership and accountability. I must say that the damning CQC report on the Brookside unit in the constituency of my hon. Friend the Member for Ilford South (Mike Gapes) has more than raised eyebrows. Some of its judgments about this facility for children’s mental health provision were:

“The ward environments were not safe, clean or suited to the care of children and young people… The wards were not adequately staffed… There was a high usage of restraint and rapid tranquilisation at the unit… The ethos of the unit was containment rather than therapy… Care plans reviewed were not recovery orientated and more behaviour orientated… During the inspection we saw staff refuse to facilitate the requests of young people… Young people stated the food was of poor quality and cultural and religious foods were not available”—

and those who know the London Borough of Redbridge will know how totally inappropriate that is. My question for the North East London NHS Foundation Trust is very simple: why did it take a damning inspection by the Care Quality Commission for sufficient action to be taken? From what I can see and from my conversations with colleagues in the local authority, there is clearly a road to improvement. It should not take inspectors coming in to highlight the fact that we have failed some of our most vulnerable young people in such a gross and unforgivable way.

Among my worst experiences as a constituency MP—these are universally my worst experiences—are in my surgeries on Friday afternoons when I see absolutely awful cases of people who have been very badly failed by public services. One case I will never forget was that of Simon Harris, a young man—he was 30 years old—who was failed by Goodmayes hospital because he was insufficiently cared for. While under the care of the NHS, he was allowed to take his own life, although he was in the very place that his family thought would keep him safe. I never again want to have a conversation with a constituent like the one I had with his incredibly stoic and courageous grandmother, Brenda. That is the consequence of mental health failure: it is simply the difference between life and death. I do not think that young people like Simon should ever be failed in such a way by the services that are there to keep them safe and well.

This subject is not just about public service provision, but about celebrating the work done by the voluntary sector. In the past year, I have visited a number of programmes in my constituency. I have visited Audacious Veg, a social enterprise that involves helping people suffering from mental ill health to set up their own social enterprise, growing and selling vegetables. This wonderful project runs in conjunction with the Forest Farm Peace Garden, another environmental and sustainability project, which gets people with mental ill health outside, interacting with others and active.

I cannot commend strongly enough to the Minister the importance of social prescribing. Here, public policy has a role to play. When Redbridge Youth Council, for example, commissioned the Redbridge Drama Centre to design and deliver a play on mental health to reach young people, 5,000 young people and counting across the London Borough of Redbridge were reached by that fantastic way of engaging young people in conversations about mental health.

Music can play a powerful role in therapy, as can sport. One of the most impressive projects I have visited in the past 12 months was Coping With Football, sponsored by the London Playing Fields Foundation and run in conjunction with the North East London Foundation Trust. Again, that project got young people outside, interacting and developing their skills and, most importantly, their self-esteem.

That brings me on to looking to the future, and I will press the Minister to take policy in a few directions. I have asked her to look at Redbridge’s funding formula, on public health in particular, and I hope she will undertake to do so. I also ask her to work with her colleagues in Government to think about funding nationally. The hon. Member for Bexhill and Battle talked about the value of joining up services locally, in particular local government and the NHS. I commend the approach being taken by the Government through the introduction of the accountable care organisations. In the pilot with Redbridge, the London Borough of Barking and Dagenham and the London Borough of Havering, that approach is bringing the local authority together with stakeholders from across the local health economy to join up public service provision. That will bear fruit.

We also need joined-up Government nationally, however. Other Members have made a compelling case for the Minister to fight her corner in public health, because investment in public health and early intervention is a money saver—and not just across Government; within her own Department we can reduce A&E admissions and the pressure on urgent and primary care if we get public health funding right.

The Minister also needs to make the case, along with the Secretary of State, across Government. For example, it is no good the Treasury making cuts to local government if that leads to cuts in public health funding and undermines the work of the Department of Health. It is no use cutting mental health provision if that leads to a spike in crime, an increase in the prison population and greater demand on the criminal justice system.

In education, it is no good asking Ofsted to inspect schools on mental health provision if school referrals to CAMHS are going unheard. We need to make sure the services are there to support schools. We also cannot continue with the postcode lottery on sex and relationships education and personal, social and health education. I hope we can revisit the issue of compulsory SRE and PSHE.

Finally, and most importantly—it is the reason we are here this afternoon—I urge the Minister and her colleagues in Government to listen to young people. That she is here this afternoon shows the importance the Government place on this report and the views of young people. My hon. Friend the Member for Dulwich and West Norwood talked about the importance of co-production and involving young people in the design of public services, and that is absolutely critical. But the Youth Select Committee has made a whole series of other recommendations that deserve not just the serious attention of this House but the response of Government. If that happens, we will get better public policy, and, I hope, we will have a generation of young people whose voices have not just been heard but, most importantly, listened to.