Young People’s Mental Health

Lisa Cameron Excerpts

Thursday 27th October 2016 Commons Chamber

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I thank the Youth Select Committee for an excellent and comprehensive report, compiled by our young parliamentarians with the backing of experienced evidence. It is extremely thorough, and a credit to them. I thank the Backbench Business Committee for scheduling this debate and the hon. Member for Dulwich and West Norwood (Helen Hayes) for leading it.

I must begin by declaring a professional interest, having worked for 20 years as a clinical psychologist in mental health. I continue to maintain my skills and engagement in line with the professional requirements of my registration. Just after the election, I had the great privilege of contributing to the evidence taken by the Youth Select Committee during its inquiry into child and adolescent mental health services.

Mental health is an extremely wide field, ranging from major mental illnesses such as psychosis to depression and anxiety, trauma, and eating and adjustment disorders. Childhood developmental disorders such as attention deficit hyperactivity disorder and autistic spectrum disorder are often also included in the sphere of mental health. I would welcome future debates on those important conditions too, because I feel that we shall not have time to do them justice today.

As a member of the all-party parliamentary group on autism, I have a particular interest in this field. I commend the recent report by Ambitious about Autism, which, worryingly for us all, highlights the fact that 80% of children with autism experience anxiety on every single day they attend school. For this crucial group, we must target our resources and make sure that early diagnosis and support are provided for the young child and for the whole family. More than half of mental ill health starts before the age of 14, and 75% before the age of 18. Early and effective intervention in and prevention of mental ill health during childhood are absolutely key in reducing morbidity. The quicker we intervene, the more effectively we intervene, and it is also more cost-effective for the NHS.

In 2014, the health improvement efficiency targets were adopted in Scotland and across the UK, meaning that patients should be seen, from referral to assessment, in 18 weeks, including in CAMHS services. The figure that I have researched suggests that in Scotland 84% of children and adolescents are now treated within this time, and we have set a benchmark of 90%. We have therefore come a long way in this regard, but we still have further to travel. There are now significantly increased referral rates. Although that may mean increased numbers of sufferers, it may also mean that stigma is reducing and people feel more able to present, so it is a mixed picture. However, mental health services in Scotland, and across the UK, are not the finished article. We should continually strive towards improvement, and that should always be guided by patient need and by research underpinning the most effective clinical practice.

As we have heard, mental health problems in childhood are extremely serious. At worst, they can destroy educational potential, or at least impede it, and impede relations with peers and within the family. They can also lead to suicide and self-harm. Difficulties must be assessed and recognised at an early stage. In Scotland, widespread staff training has been undertaken to try to ensure that we can pick up on mental health issues within this age group. We have rolled out cognitive behaviourial therapy, family therapy, interpersonal therapy and specialist interventions such as those for eating disorders, with a focus on seeing patients as close to home as possible. We must make continual progress on this.

There needs to be additional resourcing for tier 4 services for in-patients. For children and adolescents, in-patient treatment should be a last resort, because it takes children away from the family home and pathologises their difficulties. Best practice highlights intensive outreach approaches that enable children to be seen at home and treated in their natural environment, so maximising key family and peer supports. Children who need in-patient services may suffer psychosis, intractable eating disorders, severe obsessive compulsive disorders, and a variety of neurological conditions. There are currently 48 beds available in Scotland, and £8 million has been pledged to build a new unit in Dundee for children and adolescents with mental health problems. We must ensure that service provision meets needs. My clinical experience suggests a lack of available tier 4 beds in forensic and learning disability CAMHS, and that should also be addressed.

We need better communication channels between departments when children’s care is transferred between professionals, and importantly, as has been described, at key stages of development such as moving from adolescence to adult services. There requires to be a component of the training programme for general practitioners in primary care that identifies children’s mental health issues. I would include symptoms of autistic spectrum disorder and attention deficit hyperactivity disorder within that training. We need to shorten the time from presentation to referral, and picking up symptoms timeously assists greatly with this. As with diet and exercise, good mental health and well-being has to be normalised. These are all fundamental coping skills that impact on everyday aspects of our functioning and deserve to be slanted more towards health and well-being than diagnosis.

Access to mental health specialists in schools is merited, as well as mental health awareness and training, particularly training for staff in schools so that if someone is experiencing a mental health problem the staff can pick it up at a very early stage and help them to access services. Specialist training for teachers would be a positive step forward. Education for children is also crucial so that they can identify when they are struggling, identify what makes for good mental wellbeing and seek help when needed, and so that they can identify whether a peer is struggling. Young people like to be, and should be, fully involved in their care.

We need to modernise our approach to mental health services for children and adolescents. We must embrace IT and social media methods of communicating with young people, because in the modern world, it is often how they communicate. In previous debates I have mentioned a project in Scotland called SafeSpot, which is an application, website and school intervention to promote positive coping skills, safety planning and access to information about mental health services for young people. That is a good step forward. I am aware that recommendations for online standardised and approved resources would be a key step.

As has been mentioned, we must address bullying, particularly online bullying, which appears to be on the increase and which badly affects children’s lives. In fact, we must address bullying everywhere. Only this summer, when I was discussing mental health, I was informed by an MP who was a fellow member of a delegation that MPs have a high suicide rate—something that I was unaware of. We must lead by example. We must ensure that mental health and wellbeing are addressed in all aspects of life, and we must provide our own model.

There remains a lack of empirical data regarding effective interventions for young people with co-morbidity issues, by which I mean mental health difficulties coupled with learning difficulties or substance use. That has to be built on through research and treatment programmes. I would also like to touch on services for looked-after and accommodated children—particularly those who have violence risk needs or self-harm needs—who are some of the most severely disadvantaged in terms of services and the magnitude of difficulties that they present with. Further service provision for specialist groups and underpinning research are crucial, and I am extremely pleased that the First Minister will be pledging to support those groups.

Given that the weight of evidence for child and adolescent mental health services is in favour of psychological rather than pharmacological interventions for the majority of presentations, clear structures must be in place to support the delivery of effective evidence-based psychological therapies for children and adolescents. The number of child and adolescent mental health services psychology posts have doubled in Scotland, and I welcome that, but we need to continue and strengthen that progress. Uptake of such services has always tended to be poorer among people from socially disadvantaged backgrounds, and in such cases an assertive outreach approach may be required to ensure that some of the most vulnerable and disadvantaged children and families do not slip through the net.

To summarise, mental health services require parity of esteem and therefore considerable funding. I believe that this goes beyond party politics. It is crucial that we tackle it meaningfully in a cross-party manner, sharing best practice across the whole United Kingdom. We need real progress to reach children and adolescents and to help all our children achieve their full potential.