Mental Health and Wellbeing in Schools

Layla Moran Excerpts

Tuesday 4th December 2018 Westminster Hall

[Layla Moran (Oxford West and Abingdon) (LD)]

I beg to move,

That this House has considered mental health and wellbeing in schools.

It is a pleasure to serve under your chairmanship, Mr Stringer. I am delighted to have secured today’s debate on mental health and wellbeing in schools. I am sure that many hon. Members will know that I am a former teacher. My interest in this subject comes from the link between mental health and wellbeing and learning. I will come later to all sorts of issues surrounding children’s mental health and the lack of services out there, but I hope that today’s debate will focus on how this issue affects children, and indeed teachers, in schools.

Schools are not just places where we help students and children to learn resilience and the skills that they need to build themselves up so that they become adults who can cope with all sorts of pressures that are thrown at them; schools themselves can influence the mental health of children. Some of the debate so far has focused too much on the outside influences on children coming into school. Today I will focus on aspects of the current schooling system that exacerbate that problem.

Let us look at the scale of the issue. The National Society for the Prevention of Cruelty to Children says that the number of schools seeking help from mental health services is up by more than a third in the last three years. The number of referrals to NHS child and adolescent mental health services by schools seeking professional help for a student was 34,757 in 2017-18. That is the equivalent of 183 every school day. To say that this is anything other than a crisis would be wrong. We are facing a crisis of mental health issues in our schools.

The National Education Union further found that 49% of education staff said that secondary school pupils had been suicidal as a result of the stress that they were under, and more than half of professionals surveyed said that funding for support for pupils’ mental health in schools was inadequate.

[Stephanie Peacock (Barnsley East) (Lab)]

I congratulate the hon. Lady on securing this important debate. In my constituency of Barnsley East the local clinical commissioning group has been working with schools to try to embed support in a project called “MindSpace”. Does she agree that projects such as MindSpace that get trained counsellors into school, to be there every day, need more funding?

[Layla Moran]

I thank the hon. Lady for her contribution. Funding is part of it, but a number of interventions are taking place in schools, and they have to be critically evaluated. We have to look at the evidence to see whether they work. To my knowledge, only one—the Bounce Forward intervention programme—has been shown to have had a positive impact. I am not saying that the intervention that she mentioned does not, but we need to be careful that what we are doing in schools works. It is incumbent on the Government to ensure that that critical evaluation happens.

[Mr Jim Cunningham (Coventry South) (Lab)]

I congratulate the hon. Lady on securing this timely debate. Just before the 2010 general election, I introduced a Bill, which I discussed with the then education Ministers, that provided for somebody with medical knowledge, for want of a better term, to be available who would be able to spot mental illness, or other illnesses. In a way, that would have helped teachers as much as parents to do what would probably be called early intervention. Unfortunately, a general election came along, and the rest is history. Had that Bill passed, it could have been a great starting point.

[Layla Moran]

I thank the hon. Gentleman for his intervention. He makes an important point, and I will get to what the Government are suggesting in a moment. I also add a note of caution: I do not think that we should over-medicalise being an adolescent. There is a grave difference between that and ensuring that there are proper services for those on the acute end of the spectrum.

Coming back to funding cuts, one of the best bits of being a teacher in my day was having time to get know the students, and develop a level of trust with them, very often after a class was finished, or during an after-school club. Those are the kinds of things that are going. There is pressure on teachers, with cuts to the number of teaching assistants and a narrowing of the curriculum. Teachers have to teach more lessons and do more prep, meaning that they have less and less time for that critical pastoral support. What are the Government doing to measure how pastoral support in schools—the time that teachers have to spend with students—is changing?

It would be remiss in a debate such as today’s not to talk about teachers. Mental health in schools is not confined to the children; there is a crisis among teachers as well. A report by the charity Education Support Partnership, including a survey of 1,250 education professionals, showed that a huge majority—75%—of the UK’s education professionals had suffered from either mental or physical health issues in the last two years due to work. Some 50% of those who took part in the study said that they had experienced depression, anxiety or panic attacks due to work, and the charity has warned that unless urgent action is taken over rising mental health problems, there will be a severe retention and recruitment crisis. We already know that that is one of the issues that our schools are facing, and it exacerbates all the issues that I was describing regarding pastoral care.

The impact of Ofsted on the mental health of teaching professionals also needs addressing. The way in which Ofsted operates under its current inspection framework drives the wrong kinds of behaviour in schools. I believe, and the Liberal Democrats have now made this party policy, that the brand of Ofsted is so broken in the teaching profession that it needs scrapping and replacing with another inspectorate that does that job. Critically, the job of school improvement must be separated.

I sit on the Public Accounts Committee, and in a recent hearing we heard how school improvement is being lost amid academies’ governance structures and the lack of services provided at local authority level. Representatives from the Department for Education could not definitely say that it was their job, and neither could those from Ofsted. The Liberal Democrats believe that it is time to have an arm’s-length body that focuses on school improvement for all schools, no matter their governance structure, and a separate inspectorate that does that specific job.

Further to that, we need to change the framework for school inspections. It should not just be about numbers. I am the school governor at a primary school. I sit on the performance and standards committee of that school, and it is all about numbers. We are reducing children to single numbers; we look at their progress but do not allow teachers the time to look at broader issues. We believe that we should have an inspectorate that looks closely at wellbeing in schools and measures that part of what a school delivers as critically as attainment and progress. Having said that, I welcome much of what Amanda Spielman is doing in terms of drawing together the issues in education, particularly where she has spoken about the narrowing of the curriculum and off-rolling. That role is vital, so I do not want that to be lost in today’s debate.

Another thing that I want to bring up is league tables. Early in my career, during my first couple of years of teaching, in the early 2000s, I was a fresh-faced, brand-new physics teacher and I absolutely adored my job. I went into a school where I lost my faith in the profession very early on. We were teaching GCSEs and all the science students had been put up on a wall and colour coded. This was when we had A to F grade. The reds were the ones who were never going to get to the C boundary, and the greens were the ones who looked as if they were going to pass. We were told in no uncertain terms that we had to focus on the middle group, who were coloured yellow. That did not make any sense to me. I thought that I should be able to focus on those who needed it the most. When I asked why, I was told, “League tables.”

What can the Government do about league tables? I am not saying that we should get rid of any of the data; we should publish it. However, on the DFE website one of the first things that people can do is click on performance tables data. They are then encouraged to compare schools in their local area. Comparing schools is not a bad thing; parents need to have the right information. However, it should not just be about numbers; there needs to be a full sense of what the school offers, including its extra-curricular stuff and its ability to deal with wellbeing and mental health issues. That is not what people get; they either get performance tables data, or a link to the school’s Ofsted report, which, as I just mentioned, is inadequate in that form. The Liberal Democrats have therefore said that we would stop the Government doing that, even if we cannot stop the press doing it. In Ofsted’s annual report, which was published today, Amanda Spielman noted that, shamefully, thousands of children are being let down by off-rolling. The off-rolling epidemic in schools is a direct result of schools’ desire to push up numbers. It is about numbers, not about the children, and that cannot be right.

The Government are fostering a culture of senseless competition among schools, in which results from a single set of narrowly focused high-stakes exams are the be-all and end-all. That is not good enough. Amanda Spielman wrote to the Public Accounts Committee in October about the narrowing of the curriculum:

“Where we do have clearer evidence of a decline in the quality of education are in the narrowing of the curriculum in schools and an endemic pattern of prioritising data and performance results, ahead of the real substance of education…schools must work to make sure that pupils leave school with the qualifications and examination results that set them up for future success…However, our research has found evidence that an overly data-driven accountability system is narrowing what pupils are able to study and learn.”

My worry is that rather than encouraging children to flourish at every turn in their lives—which can often be one step forward and two steps back; that is how life works—we have a curriculum that encourages multiple levels of failure. It starts with baseline testing as soon as children get into schools, moves on to SATs and continues with exam after exam. Every young person whom I have asked about high-stakes testing tells me that it has got worse and worse.

I was an experienced teacher before I came into Parliament, but I am still one of the youngest MPs. We have to remember that the school system that we MPs went through is not the same as the system that students are going through now. There is much more high-stakes testing in the curriculum now, and we have to stop it, so the Liberal Democrats have committed to getting rid of SATs. We are not saying that data is not important, but we can collect it in other ways. For the record, as a physics teacher I loved exams—they were great—but they do not have to be so high-stakes. They can be part of learning well; they do not have to be the be-all and end-all. I am seriously concerned.

[Andrea Jenkyns (Morley and Outwood) (Con)]

I thank the hon. Lady for securing this debate. I, too, have worked in education, so I understand the challenges that our young people face. Does she agree that the Government are making a step in the right direction by ensuring that young people will be prioritised with school-based mental health support available in every part of the UK?

[Layla Moran]

I will come on to the Government’s proposals in a moment, but yes, I do call that a step in the right direction.

To come back to the thrust of the debate, what does my speech so far have to do with mental health? Lisa, a mum of three children in my constituency, writes:

“I had a chat with my 6-year old’s teacher about the amount of homework they get. Her response was that parents needed to see the SATS papers the children would have to sit in May. They would then understand how much work the children needed to do to reach the expected standard. The problem with the ‘expected standard’ is that it only looks at certain aspects of the curriculum and then puts children into boxes”.

If they do not meet that expected standard, they can only interpret that they have failed. Lisa goes on to say that

“putting children in boxes which suit a government body is, in my humble belief, creating mental health issues at a very early age.”

I would like our debate to focus on that toxic culture.

Let me move on to what the Government have announced. We now have a plan, at least, which I would call a step in the right direction, although it is not sufficient. We are looking at having health professionals in schools—a massive workforce of thousands. My question, which was shared with some scepticism during the Public Accounts Committee inquiry, is where those professionals will come from. The professionals whose roles we are looking to create are the same people we cannot get for nursing or midwifery, because it is the same type of person who might want to do the job.

I am seriously concerned that we are creating a parallel system, while the problem could have been solved by having school nurses in the first place. To return to the subject of funding cuts, school nurses were a valuable part of schools’ wider pastoral care. Many schools have lost their school nurses, which is a crying shame.

[Andrea Jenkyns]

Does the hon. Lady agree that mental health should be treated in schools with the same importance as physical health and that it should be central to the Government’s health agenda? I agree with what she says about nurses; we need to ensure that that is central to future policy.

[Layla Moran]

I completely agree. In fact, I would argue that if mental health is the Cinderella service in the NHS, children’s mental health is the Cinderella of the Cinderella service. That is brought into stark relief by child and adolescent mental health services across the country, although I will focus on Oxfordshire. My postbag is full of letters from parents who are desperate to get their children to CAMHS for all sorts of reasons. We have to remember that CAMHS is there for the most acute mental health needs; it does not cover the mild to moderate needs that so desperately need solving in school at an early, preventive stage. In Oxfordshire, children can wait for a referral for up to two years; extraordinarily, they are then often pushed back.

The Education Policy Institute reports that the number of referrals to specialist children’s mental health services has increased by 26% over the past five years, although the school population has increased by 3%. Something is clearly going on, whether it is lack of early intervention in schools or increased pressure.

[Stephanie Peacock]

Does the hon. Lady agree that it is quite concerning that people need to be in absolute crisis even to get a referral? Often young people need to be suicidal before they can get a referral. That is absolutely shocking. Surely earlier intervention would be much better.

[Layla Moran]

I completely agree. It is especially shocking with respect to issues such as depression and eating disorders. Parents seek referrals, but when—after a waiting time of six months at the very least—they see a professional, they are told, “I’m sorry, but your daughter’s not sick enough.” They despair, because they do not know what to do any more. We need a much more joined-up service. A lot of these things are picked up in schools, so schools have a part to play.

There is a lack of resources for CAMHS across the country, and unfortunately the new commissioning service is not going to solve it. The funding problem for mental health services shows that we do not have parity of esteem between mental health and physical services; I know that the Government want it, but they cannot pretend that it has happened. If they say that children’s mental health is a priority within that, I ask people to look at the evidence given to the Public Accounts Committee’s inquiry into children’s mental health services and see for themselves that that is absolutely not the case. The Government know that there is not enough money for CAMHS.

The EPI study further points out that as many as a quarter of local authorities have phased out vital support services around schools, including school-based mental health services, family counselling and support for those living with domestic abuse. The median waiting time for treatment is 60 days, but I am well aware of many constituents who have had to wait as long as two years. That is extraordinary.

Last but not least, I want to discuss the impact of cuts, particularly on local government and on the support available in the wider community. As we know, schools never exist in a vacuum. As today’s Ofsted annual report points out, schools cannot fix everything, but for a lot of children they are often where the buck stops. Cuts elsewhere in the system, particularly in local government, have a massive impact.

I have secured quite a number of debates in Westminster Hall, but of all of them, this debate attracted the most responses when I tweeted about it. I would like to share one with hon. Members, from Vanessa Whitcombe, headteacher at Castle Manor Academy:

“Just emailing following your Facebook post regarding tomorrow’s debate. We are trying so hard to prioritise mental health and wellbeing in schools, applying for grants, paying for school nurse service as ours has been withdrawn, participating in Anna Freud school mental health award, peer mentoring programmes, reducing workload for teachers and putting in wellbeing support, and we are really proud of the small steps we are taking forward. But they are small, as they are against a backdrop of dwindling external services and decreasing budgets. External service provision and early help is only available at such a high threshold we feel like we are firefighting, and it is the most vulnerable children and families that are not accessing what they need. Amanda Spielman spoke wisely of the need for schools to be able to stick to their core business, and in our school we try to make sure that classroom teachers are able to do that as much as possible, but the surrounding investment that is needed to be put in to safeguarding, emotional support, educating parents, feeding students is not going to go away without more provision outside school.”

We have seen that for ourselves in Oxfordshire. Every single one of the children’s centres in my constituency was closed by the Conservative county council, and the more than 40 across Oxfordshire have fallen to just eight. We were able to help families in children’s centres, at an early stage, before there were problems. I have not even started to go on about youth services and youth provision and the issues there. All the wraparound services for young people have gone from the local community, and that leads to all sorts of issues. It is not just about social media—in fact, there is some evidence to show that a little bit of social media for teenagers is a good thing, although a lot is very definitely a bad thing. The debate often focuses too much on that point and less on the much more intractable issues that surround the child.

In conclusion, I believe that this is an issue of deep concern. Even on a day such as today, when the shenanigans of Parliament might make us forget that there are big issues in the country, this is one of the biggest issues we have, and I am concerned that the Government response is simply a sticking plaster. What they are not doing is looking at the core issues that are driving the problem. Unless they do that, they are always going to be playing catch-up; I am not convinced that the laudable aims in the White Paper are actually deliverable. We need to change the culture in schools. We need to stop the pressures on young people. I am grateful in advance for the contributions from other Members, because I am sure that I have missed many of those issues out of my speech.

It is time for change. I am so proud that my party has managed to take a massive step forward in our conference debates. The issue I had in my early years of teaching was under a Labour Government. That has happened again and has got much worse under a Conservative Government. I am not blaming anyone; we have reinforced bad practice across the political spectrum. It is time that we made it stop. This is our next generation and there is nothing more important than that.

--- Later in debate ---

[Dr Poulter]

Certainly, eating disorders are an area of great challenge. One of the difficulties is that very often young people present in great distress after their illness has taken hold for quite some time, and the prognosis can be less good in those situations. A lot of young people may have to travel many miles or even out of area to get the specialist care they need, and that does need to be addressed as a matter of urgency. I know that my right hon. Friend the Minister will be raising such issues with his counterparts in the Department of Health and Social Care, because a number of the answers to the challenges raised in this debate have greater priority, and there is greater understanding of what the challenges are in that Department rather than in his.

[Layla Moran]

Does the hon. Gentleman agree that it is not just about talking; it is active co-ordination between the two Departments that will solve this? If they end up working in silos, as we know Government Departments often do, none of this is going to work.

[Dr Poulter]

I completely agree, but it is also about breaking down the silos on the ground. It is all very well Government Departments coming together to work together and the silos being broken down—that did help between the Department of Health and the Department for Education on special educational needs under the coalition Government, but in reality the levers or mechanisms do not exist on the ground to deliver meaningful change for young people in the timely manner that was envisaged by the legislation passed in this House. We must make sure that whatever legislation is passed and whatever co-operation there is at Whitehall level translates into the right levers on the ground to deliver the co-ordinated and joined-up approach to more integrated care that young people need, across health, education, social services and other statutory services as may be required.

On the broader issue of child and adolescent mental health, a key challenge is the lack of workforce to deliver the care needed for young people. We know that the number of full-time mental health nurses has fallen by more than 6,000 between 2010 and March 2018, with a reduction of 1,832 learning disability nurses alone during that period. The number of CAMHS and learning disability consultant psychiatrists has slightly declined over the past decade. Many parts of the country, particularly outside London, are struggling to fill higher registrar training posts in CAMHS and learning disability psychiatry. That is a real problem, because without the workforce to deliver care we will not have the bodies on the ground to make a difference for young people.

Perhaps more concerning is the fact that the recent rhetoric on child and adolescent mental health still bears little resemblance to the reality facing many children and their families. Given the shrinking CAMHS and learning disability workforce, it is difficult to see how current levels of care can be maintained, let alone how the step change in mental healthcare provision for young people, which the hon. Member for Oxford West and Abingdon and I—and everybody taking part in this debate—would like to see, can take place.

The focus on healthcare apps and the talk of fines for social media companies are no substitute for having enough trained professionals on the ground to deliver frontline care to young people and their families. The NHS is far too often viewed through the prism of A&E. As a result, acute hospitals often receive a disproportionate level of funding compared with primary care and community services. In child and adolescent mental health services, as in other parts of the NHS, community services are often understaffed and poorly resourced. In fact, we are hearing about reductions in staff levels and not about the increase that the Government talk about as being desirable. My message to the Minister today is that we need more staff in child and adolescent mental health services, whether they are working in schools or in the community. Without those staff, all the media announcements and well-wishing announcements to improve in this area will come largely to nothing, and young people will still be struggling.

On the issue of fragmented commissioning, which the hon. Member for Oxford West and Abingdon raised, we see silos not just in Whitehall but on the ground. CAMHS, social services and education providers do not always work in a joined-up way. Although there can be some good initiatives at local level, and there are examples of good, co-operative working, there is nothing to compel the providers of different services to work in a joined-up way for the benefit of young people. Unless we get the commissioning of services right in providing better mental healthcare for young people, and actually compel joint working rather than just encourage it, we will not make a meaningful difference.

I know that the Minister will want to pick up some of these issues with his colleagues in the Department of Health and Social Care. Unless we have a joined-up approach that we can compel at local level, all the announcements on improvements in tackling young people’s mental health will come to very little. We will still be having these debates in this place in 10 years’ time—those young people will have lost 10 years of their life and will still be struggling.

I know that the Minister has a great commitment to all he has done on schools and in education. He has been a very good Minister, and I hope that he will redouble his efforts to get joined-up working and collaboration with the Department of Health and Social Care in addressing some of these problems.

--- Later in debate ---

[Layla Moran]

I thank the Minister for his response. I am sure that many people out there will be heartened to hear that students should not be feeling the stress of exams, but the fact is that they do. It is also a fact that the stress is definitely worse even than when I started teaching, which is well over 10 years ago. It is a shame that the Government will not take responsibility for the part that they have played in creating that culture.

I thank all Members for their contributions to the debate. I am sorry that there is not time to go through them all individually, but there was a range of expertise and the constituency stories that we heard were not only heartbreaking but heartening, because we know that there are people in this place who care.

I also put on the record my thanks to Oxfordshire Mind, the university’s Oxford Mindfulness Centre, Oxford Mental Health Campaigners for Change and a host of other national bodies that contacted me about the debate. Finally, I thank all members of the public who wrote in in such large numbers. I promise that the Liberal Democrats and I—in my role as the education spokesperson for my party—will continue to bang the drum for putting children’s mental health wellbeing at the heart of everything that we do in this place.

Motion lapsed (Standing Order No. 10(6)).