Mental Health Education in Schools

James Morris Excerpts

Monday 6th November 2017 Westminster Hall

[James Morris (Halesowen and Rowley Regis) (Con)]

It is a great pleasure to serve under your chairmanship, Mr Brady. I congratulate the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) on putting the case so cogently for the importance of education about mental health in schools.

In preparation for the debate, I reflected on the distance we have come and the sense that we still have a long way to go on what I would call mental health literacy. I remember being at school in the late 1970s and early 1980s and having, as a 13 or 14-year-old, a sense of anxiety and some sense of uncertainty about the future. I could not label the condition I was suffering from at that time, but subsequently I learned that it was called depression. I think I had a depressive episode of quite a severe nature when I was about 13 or 14 at school. At that time, it was not a condition that was being labelled, so I did not have a way of talking about it that made sense. In the school environment of the 1970s and 1980s, teaching staff did not have the capability and my peers did not have the awareness of what mental health really meant.

The truth is, as other Members have said, that we have come a huge distance over the last 30 years. It would be churlish to characterise what we face today as a unique set of contemporary circumstances. The debate about mental health and our understanding of young people’s mental health has come a huge distance, as has the way in which it is represented in our media and the way we have talked about it in Parliament over the last few years. As you may know, Mr Brady, I was chair of the all-party parliamentary group on mental health in the last Parliament, when we had a series of very important debates about mental health that galvanised and were a lightning rod for further discussion in the public realm about young people’s mental health.

The representation of mental health in drama and soap operas has undergone quite a revolution. There was a time when young people’s mental health was often talked about only in terms of negative, stigmatised associations with suicide and so on. The public’s and schools’ awareness of mental health has undergone some degree of transformation.

[Wera Hobhouse]

The broad consensus in the Chamber on this subject is really welcome. Like the hon. Gentleman, I very much welcome the fact that the stigma about mental health is starting to go away and people can talk more openly about their issue, but helping young people requires resources. Norman Lamb, who was the initiator of an initiative called Future in Mind, secured funding, during the coalition Government, of £1.25 billion, to be spent over the next five years. That should amount to £250 million each year, but only £143 million was released in the first year of the programme, 2015-16. Should not we all in this Chamber urge the Minister to continue that commitment and the budget that was secured under the coalition Government?

[Wera Hobhouse]

I apologise, Mr Brady.

[James Morris]

I thank the hon. Lady for her intervention. The simple answer to her question is yes.

[Phil Wilson in the Chair]

The Government are, as I understand it, fully committed to that additional investment over the five years of this Parliament. The truth is that a lot of progress has been made under the current Government in terms of further investment in child and adolescent mental health services. Obviously, there is more to do, and Future in Mind, to which the hon. Lady refers, was a very good initiative, led by the right hon. Member for North Norfolk (Norman Lamb) when he was the Minister with responsibility for mental health. I am not arguing that somehow that money will magically transform the CAMHS system, but the truth is that some progress has been made in understanding the extent and prevalence of children and young people’s mental health problems. The Department of Health is beginning to gather, for the first time, meaningful data about what is happening in the system. That was never in place before; child and adolescent mental health was a data-free zone until very recently.

Also, in terms of the extra money, we have only started to understand and have the data on where the money is actually being spent. The NHS dashboard that has been created for mental health is, for the first time, acting as a tool to put pressure on local commissioners to spend the money that they have been allocated. Clearly, there has been a discussion about this. The money is not ring-fenced currently, but with the dashboard created by the Department of Health, we can see what local clinical commissioning groups are spending on child and adolescent mental health. That should be used as a tool to continue to put pressure on commissioners to make the right sorts of choices.

I mentioned what the vision and set of principles should be for this area. In the school environment, we should be trying to move towards what I call mental health literacy, which means giving young people the facility to talk about the mind and their mental health in a way that is intelligible for them and their peers. That is what we should seek to achieve in this context. We have had a very rich debate talking about this issue. I do not think that it is just a question of what is in the curriculum. Young people and children as they are growing up will listen to teachers in a particular way. They might not really want to listen to the message that the teacher is giving, because the teacher may represent a position of authority that they feel uncomfortable with. I am not saying that it is not important that teachers are trained and aware and that there is provision in the school environment, but that is not the whole picture.

We need to consider two further aspects. Peer pressure or peer conversation is almost as important as what is in the curriculum. I am talking about a structure in the school environment that allows young people to talk with one another about mental health, equipping them with the knowledge, skills and literacy to be able to have that conversation. I remember that back when I was at school, I felt very isolated—a sense of isolation—that somehow what I was thinking about was not legitimate; it was something dark and horrible and I was the only person who could possibly be having that issue at the age of 13 or 14. It is extremely liberating for young people when they realise that a vast range of their peers have the same sorts of questions about the future. It is relatively normal for adolescents to have periods when they are very uncertain about the future and how they fit in with their peers. They may have particular issues, but that ability for the school community, for children and young people together, to be able to talk about that is vital. It is a kind of therapeutic valve in the school environment, which I think is critical. In fact, much of the evidence base that I have seen shows that peer-to-peer communication on mental health in schools is extremely effective as a mechanism for helping young people, so that is the vision of what we should seek to achieve.

Also crucial, as other hon. Members have mentioned, is the involvement of families in the conversation. Families should not be excluded from the conversation, but brought into it as part of the process that we are describing, because obviously the family is the crucible in which a young person is brought up. For many young people, that is, as my right hon. Friend the Member for Mid Sussex (Sir Nicholas Soames) said, a golden experience, but for many other young people it is characterised by dysfunction and relationships breaking down; it is often characterised by confusion.

[Sir Nicholas Soames]

I agree with that point and ask my hon. Friend to consider the excellent work being done by our hon. Friend the Member for Congleton (Fiona Bruce) on family hubs and centres, which I think is remarkable. If people are in the very unhappy position described, the trouble is that there is no one single signpost for them other than, as I said, the poor teachers, so the family hubs or centres are immensely important and must be encouraged and developed.

[James Morris]

I definitely agree with my right hon. Friend on that. As I said, the family is the crucible. The issue is often very complex, and the relationship between the family and the school is a critical part of what we are discussing because, again, families can be a place where therapy is very effective, and can be a very effective way of helping the child and making them resilient, so I very much agree with my right hon. Friend’s point.

[Robert Halfon]

Could I add just one qualification? Children with mental health difficulties may be experiencing significant family breakdown and may not be able to have the family involved, and therefore the school is literally the one place that can really help the child. That goes back to what my right hon. Friend the Member for Mid Sussex (Sir Nicholas Soames) and others said about teacher training and a young person being able to go to someone in the school who can actually look after that student.

[James Morris]

I thank my right hon. Friend for that intervention. I totally agree: clearly, it will not be possible to involve the family in all cases. I have seen examples in my constituency, particularly in the primary school environment, in which headteachers and teachers have taken really interesting and creative decisions to replicate the family environment for children who have not been brought up in a stable family environment and have not entered primary school in a properly socialised way. They have replicated the family environment and tried to create those kinds of structures because they have been absent, so I completely agree with my right hon. Friend on that.

Other hon. Members have talked about CAMHS and I want to make a few comments about early intervention. If you look at the spectrum of what we are talking about, it could be argued that by the time children get to school any mental distress and difficulties they suffer from will have been baked in for many years. There has been a debate about early intervention and mental health for years; it is what I would call a policy no-brainer. Everybody agrees we should intervene earlier. Everybody agrees that in principle that is a good thing. Yet we are still debating about whether we are doing it sufficiently well and how it should be done. The truth is that we should shift resources to where the evidence points us.

The evidence points to the joint Green Paper on children’s health and education, and adolescent mental health, which other hon. Members have mentioned. The evidence suggests that interventions at an early age, sometimes pre-primary school, are the most effective interventions that we can make on a therapeutic level. From the evidence, it looks like working with children from birth to the age of two, working with families, and working with parents is the most effective intervention we can possibly make. I urge the Minister to be bold in terms of what we will do in that Green Paper. If we can do only one or two things from that Green Paper, we should focus on the really important one, which is shifting resources to genuinely effective early intervention based on evidence. Everything else we have talked about, such as mental health first aid and so on, has a role to play in this debate, but it will not solve the problem we are trying to confront. We will solve this problem by focusing a lot more resources in a laser-like way on early intervention—even before school. That is the critical part of this debate. The one bold move for the Government would be to focus their attention on that. Then we might be able to make significant progress.

Other hon. Members have mentioned CAMHS. If we were designing a child and adolescent mental health service today, we would not design it in the way it currently operates. We have had several reviews of CAMHS over the last decade. Other hon. Members have mentioned Future in Mind, the CQC has just done its review and there have been other reviews. We know that CAMHS is currently not fit for purpose. That is not to say that people working in CAMHS are not doing an excellent job in delivering the services they do, but we need a more integrated service. We need to move away from the tiering approach, which means we concentrate on tier four—that is children with the most severe mental illness. If we can get rid of this metaphor of tiering and focus on access to the appropriate level of care required by a child or young person in a place appropriate to them and deal with it across the spectrum, and integrate it with initiatives that are being taken in schools and the initiatives I have been talking about in relation to early intervention, we can make significant progress.

We have come a long way. People use the word “crisis,” which I am always very wary of using. It is not as if this crisis started today. The debate about children and young people’s mental health has been going on since about 1962 when Enoch Powell, then the Public Health Minister, made the decision that we would no longer put people in asylums but would move towards a community model. That was in 1961 or 1962. We are only now beginning to have a real debate about how we really tackle some of the underlying issues that we face in society in terms of the mental health of children and young people. We are much better at talking about it, but the debate actually is only just beginning and the Government have an opportunity to take some really bold steps, which would have a lasting legacy.