Mental Health Education in Schools

Lisa Cameron Excerpts
Monday 6th November 2017

(3 years, 11 months ago)

Westminster Hall

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Department for Education
Phil Wilson Portrait Phil Wilson (in the Chair)
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Before we move on to the Front Benchers, the mover of the motion has indicated that she would like two or three minutes, if we get that far, at the end to wind up.

Lisa Cameron Portrait Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
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6 Nov 2017, 6:28 p.m.

It is an absolute pleasure to serve under your chairmanship, Mr Wilson. I especially want to thank the hon. Member for Newcastle upon Tyne North (Catherine McKinnell), who excellently set the scene about where we are and where we all hope to progress to. That is the issue: we have come some way, but we are still on a journey in terms of mental health services across people’s lifespan.

I thank the Petitions Committee and the members of the public for supporting a debate on mental health education in schools. It shows that it is extremely important to all: our community, our constituents, children, adults and parents. It is important to MPs, as we can see today. There has been such a great consensus—it is one of the debates that I have attended where there has been such a great consensus—and that is so important to see.

I must declare an interest in mental wellbeing as a psychologist, although I worked largely with adults. I am also a member of the British Psychological Society. I was saying earlier today at a conference on trauma counselling that I think now is a pivotal moment for mental health. We all know, and are in agreement, that something has to be done across the lifespan, and this is our opportune moment to take that forward.

The petition calls for mental health education to be made a mandatory part of primary and secondary school education. That is important. Across the UK and the devolved Governments, we cannot go on with this postcode lottery. It is happening everywhere—no one service is perfect—and we all have so much progress to make. We have all been trying to make sure that services are in place. I see from my own career how far things have come, but we cannot continue with the postcode lottery. It is not fair on people. It is not fair on parents or children. We must address young people’s mental health.

Only 70% of secondary schools and 52% of primary schools currently provide counselling. Research suggests that one in 10 children aged from five to 16 suffers from a diagnosable mental health disorder. It is so important that that is picked up at an early stage. As has been stated so eloquently in this debate, including through Members’ personal experiences, if we can identify and support such children at a key early stage, prevention and early intervention will be by the far most effective interventions. That is why it is so crucial for resourcing to be targeted at that level.

Seventy-five per cent. of children and young people experiencing a mental health problem are not accessing treatment. This is the tip of the iceberg, so much more resourcing is desperately needed. In ensuring that people can come forward and speak, and that they have awareness about mental health issues and can seek treatment, we must ensure that they can access resources for support and treatment at every stage. Ninety per cent. of teachers have reported increased rates of anxiety and depression among pupils over the last five years. Clearly, we need this debate and a consensus and, importantly, we need action.

Mental health first aid training for all teachers is a welcome step forward. It has been mooted that teachers are already overburdened and that adding to their stretched teaching lives might make things very difficult for them. However, I would suggest that they are overburdened because these issues are already prevalent. Children are experiencing them, so we must ensure that they are identified and that adequate care pathways are available. If teachers can have awareness training to pick up early symptoms, that early detection will be key for prognosis.

The Green Paper on children and young people’s mental health is expected later this year, and I am extremely keen to hear what the Minister can tell us about that today. I hope he will indicate the type of progress that might be made, because we are all keen, listening ears here today and right across the United Kingdom. We must share best practice and look at the pilots working in each area of the UK, and we must ensure that those are rolled out when evidence-based practice is making a real difference for children and young people.

The collaboration between education and health services must be improved. The care pathway is needed. As I have said, identifying the issue and enabling young people to speak about it is the first stage. However, many of them will then need to access adequate help at different levels of the care pathway. It is important that we focus on mental health at a school level, because if children can verbalise their issues and teachers can recognise them, we will start to make the progress required.

This is not so much about mental illness, but about teaching wellbeing and coping skills and skills for life. The earlier we can do that, the better—even at pre-school, which has been spoken about, that is key—because the earlier that modulating emotions, concentration and mindfulness can be taught, the greater success children will have going into their adulthood. They will have a greater ability to cope with the stressors that will come into their lives later and they will go on to experience fewer difficulties that require treatment. Addressing this issue is not only economically vital, but about skilling up our future generation to cope with mental wellbeing and to cope holistically with life.

There is a need to push for a statutory footing with clear guidance. I agree with the hon. Member for Halesowen and Rowley Regis (James Morris) that interventions need to be peer-to-peer based and child-friendly. Children use a variety of digital technologies that are well beyond my capability, but that is how they operate in today’s society. They listen to one other—in adolescence, they listen to one another much more than they do to parents and teachers—so we must use our knowledge to ensure that peers educate peers and that we tap into digital technology for a positive response. All too often, social media can have a negative impact on mental health, fostering a culture of bullying. Some children believe that they do not have as many friends online or that they do not measure up, but we can tap into the resources that children use and turn that around, ensuring that their mental wellbeing is a key part of those apps and social media.

Focusing on diagnostic testing and access to it is also key, particularly for autism, and I have tried to champion it throughout my time in this House, because it is badly needed. Parents continually come to us all saying that they are unable to access adequate services. We need a map of clinicians with the relevant training around the UK, so we can look at where the gaps are in autism diagnosis training. We then need to fill those gaps and make sure that, no matter where someone stays, if they require a diagnosis, it happens, so that parents can access the services required for their child.

The British Psychological Society is calling for access to applied psychologists to ensure the full assessment of complex cases. We have heard about the types of complex cases that should perhaps be prioritised, including looked-after and accommodated children who might have already experienced trauma and might be most at risk.

In conclusion, I will speak briefly about a couple of my constituents. The first wrote to me as a very concerned parent, desperate for support for her 10-year-old child who struggled for years with her mental health but who has been unable to access child and adolescent mental health services. I will take that case forward, but just how many more parents are struggling with those issues across the United Kingdom? We must all work together across all the nations to ensure that we fill those gaps.

Helen Mitchell is an excellent lady who has triumphed over adversity and runs the Trust Jack Foundation, a trust created in memory of her son who suffered mental illness and took his own life. She supports services for young children suffering mental illness, including art therapy, support groups and befriending. We must remember that it is not just skills but the community and health—all of us must work together to ensure that mental wellbeing is something we take forward positively for all.

Mike Kane Portrait Mike Kane (Wythenshawe and Sale East) (Lab)
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6 Nov 2017, 6:38 p.m.

It is a pleasure to serve under your chairmanship, Mr Wilson. I acknowledge the good work done by the Shaw Mind Foundation in securing the debate. For Adam Shaw, the foundation’s chairman and founder, after struggling for 30 years with his own mental health, which led him to the brink of suicide, this is a personal issue. It is vital that we listen to the voices of those such as Adam who have experienced mental ill health in their childhood. They are telling us that understanding our own mental health is a life skill, which should be part of our childhood education as much as reading and writing. The response from the public to Adam’s petition shows that that view is shared by many people in the UK. This debate has left us in no doubt that action needs to be taken now to safeguard our children’s mental health.

My hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) made an exceptional speech. It was a real tour de force, highlighting national and local policy and bringing in individual cases from her constituency. The 103,000 people who signed the petition so that it could be debated in Parliament today can be extraordinarily proud of her contribution.

Other contributors to this debate include the Chair of the Select Committee on Education, the right hon. Member for Harlow (Robert Halfon). I could not agree more that mental health requires a whole-school approach rather than just being pushed into PSHE lessons. As a former PSHE co-ordinator for a primary school in the borough of Trafford, which I represent, I know that mental health cannot be taught in the time given to that subject. More must be done.

The hon. Member for Telford (Lucy Allan), who is also a member of the Select Committee, spoke extraordinarily powerfully about the stigma that needs to be shattered; this debate is part of doing so. I join the right hon. Member for Mid Sussex (Sir Nicholas Soames) in congratulating the Duke of Cambridge and Prince Harry, who have raised the issue. He also spoke powerfully about the need for teacher training to incorporate mental health education in colleges and universities up and down the land.

The hon. Member for Halesowen and Rowley Regis (James Morris) gave an extraordinarily powerful personal testimony about his own mental health during his childhood. MPs being brave in that way in public life are beginning to shatter the stigma. The right hon. and learned Member for North East Hertfordshire (Sir Oliver Heald) also spoke eloquently about the good practice that he has seen between NHS councils and schools in his constituency. We need exemplars of good practice across the land.

My hon. Friend the Member for Vale of Clwyd (Chris Ruane), citing the World Health Organisation, said that mental health would be the defining issue of the 21st century and that there is a tsunami coming. He is a passionate advocate for mindfulness day in, day out in this place. We have had an extraordinarily good debate. As a former teacher, I know that schools are struggling to deal with an upsurge in mental health needs among pupils.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), in an excellent speech, brought her clinical prowess and expertise to this Chamber. As she pointed out, statistics show that one in 10 children have mental health issues. That is three children in every classroom of 30. One in five adolescents experience a mental health problem in any given year. A recent survey by the union NASUWT involving more than 2,000 teachers and school leaders further underlined the scale of the problem: 98% said that they had come into contact with pupils whom they believed were experiencing mental health problems, and 46% said that they had never received any training on children’s mental health or on recognising the signs of possible mental health problems in children.

We know that half of people with mental health problems as adults present symptoms by age 14, and 75% do so by age 18. Shockingly, suicide is the most common cause of death for boys between the ages of five and 19. Data from a recently published Government study showed that one in four girls are clinically depressed by the time they turn 14, and hospital admissions for self-harm are up by two-thirds; the number of girls hospitalised for cutting themselves has quadrupled over the past decade.

I also want to point to research on the LGBT community. Stonewall found that more than four in five young people who identify as trans have self-harmed; that is an incredible statistic. Three in five lesbian, gay and bi young people who are not trans have self-harmed. Shockingly, more than two in five trans young people have attempted to take their own life. For that community, mental illness rates are huge.

The number of young people aged under 18 attending accident and emergency for a psychiatric condition more than doubled between 2010 and 2015, yet just 8% of the mental health budget is spent on children, although children represent 20% of the population. Referrals to CAMHS, as has been mentioned, increased by 64% between 2012-13 and 2014-15, but more than a quarter of children and young people referred were not allocated a service. Perhaps most damningly, Public Health England estimates that only 25% of children and young people who need treatment for a mental health problem can access it.

Following the groundswell of evidence of mental ill health in our children and young people and the system’s abject failure to deal with it, the Prime Minister announced in January, to a fanfare, a package of measures aimed at transforming mental health support in schools, workplaces and communities. As my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) pointed out following the Prime Minister’s announcement, that will not deal properly with the burning injustice faced by children and young people with mental ill health.

I am afraid that this Government talk a good game on mental health, but in reality, they have continued to underfund services. The Government’s proposals do nothing to improve waiting times for treatment for children and young people, and they put pressure on schools to take on extra work on mental health, at a time when they are having to cut budgets. The Minister and I have been no strangers to discussing budget cuts in this Chamber over the past six months.

The evaluation of the mental health services and schools link pilots published in February underlined the lack of available resources to deliver the Government’s offer universally across all schools. Headteachers are telling us that real-terms cuts of £2.8 billion to school budgets threaten existing in-school care. On top of that, funding for child and adolescent mental health services fell by almost £50 million between 2009-10 and 2012-13. The Government also cut £600 million from mental health budgets between 2010 and 2015, and the number of mental health nurses in our country has decreased by 6,000 since 2010. Our Government continually expect our teachers, schools and health services to do more for less.

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Nick Gibb Portrait Nick Gibb
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6 Nov 2017, 6:57 p.m.

It is the same point that Ed Timpson made at that Committee, but it is important for this debate that we are extending those pilots to 1,200 more schools and colleges in 20 additional clinical commissioning group areas.

As well as the role of the wider teaching staff, many schools have staff with more specific roles in relation to mental health. Around half of schools and colleges have a dedicated lead for mental health; more than two thirds of schools have a designated member of staff responsible for linking with specialist mental health services; and 87% of institutions reported that they had a plan or policy in place for supporting pupils with identified mental health needs.

Evidence shows that a whole-school approach, established with a commitment from senior leadership and supported by external expertise, is essential to a school’s success in tackling mental health. A whole-school approach involves the work of all staff and students, with clear links to school policies, for example on behaviour, and a culture and atmosphere that promote good mental health. Tom Bennett’s review of behaviour in schools found that a consistently applied whole-school policy, with clear systems of rewards and sanctions, was key to securing good behaviour. He argued for the importance of a whole-school culture that is effectively communicated to all staff and pupils and stated that the best behaviour policies balance a culture of discipline with strong pastoral support. The combination of clear boundaries and known sanctions for poor behaviour with a caring atmosphere is fundamental to promoting good behaviour and wellbeing for all pupils.

My right hon. Friend the Member for Harlow suggested a study of the impact of social media on children’s mental health. We are working closely with the Department for Digital, Culture, Media and Sport on the internet safety strategy, which includes working on online safety with experts, social media companies, tech firms, charities, mental health practitioners and young people. I am sure that that work will highlight gaps in the evidence, as he suggested.

My right hon. Friend also asked when we would next publish a survey on children’s mental health. The Department of Health has commissioned a new survey that will examine the prevalence of mental health and wellbeing problems among children and young people nationally. The new prevalence survey will enable us to make comparisons with the prevalence recorded in the 2004 survey and will be published in 2018.

A number of hon. Members asked about Ofsted’s role in helping to deliver these objectives in our schools. Under the current inspection framework, inspectors reach a graded judgment on pupils’ personal development, behaviour and welfare and consider their spiritual, moral, social and cultural development. We will work with Ofsted on any implications that arise from mandatory relationships education and relationships and sex education.

My hon. Friend the Member for Telford (Lucy Allan) raised the important issue of mental health and children in care. The forthcoming Green Paper will consider how to improve support for vulnerable children and young people, including children in care. This includes ways of improving access to support, better joint working among services and improved training for professionals. An expert working group has been established to look at ways of improving support and care for children and young people in care; it will report shortly and we will fully consider all its recommendations. We will pilot new approaches that draw on the group’s findings to improve the quality of mental health assessments for looked-after children.

Lisa Cameron Portrait Dr Cameron
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6 Nov 2017, 7:03 p.m.

Will the report also consider transition from child services to adult services? Transition is a crucial time: young people who may previously have received services often fall through the gaps and do not get the continuation of care that they need.

Nick Gibb Portrait Nick Gibb
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6 Nov 2017, 7:03 p.m.

The hon. Lady raises an important point that will be considered in the Green Paper that we will publish shortly.

My right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) raised peer-to-peer counselling. One of the pilots that we have just launched relates to peer-to-peer support for children and young people with mental health. We are working with the Anna Freud Centre on it, and have just invited interested schools and colleges to apply. The programme is being independently evaluated so that we can share its findings with other schools and colleges when the pilot ends in 2019.

We want to provide all young people with a curriculum that ensures that they are prepared for adult life in modern Britain. Most schools already use their curriculum and school day to support pupil wellbeing, for example through the personal, social and health and economic education curriculum and a range of extracurricular activities. Good schools establish an ethos, curriculum and behaviour policy that teaches children about the importance of healthy, respectful and caring relationships. The Government want to ensure that all children receive a high-quality education in that respect. The Children and Social Work Act 2017 requires the Secretary of State for Education to impose a statutory duty on all primary schools to teach relationships education and on all secondary schools to teach relationships and sex education. The Act also gives the Government the power, which we will consider carefully, to make PSHE a compulsory subject in all schools.

A thorough engagement process will be undertaken to determine what schools should teach with respect to these subjects. We will say more about that process shortly; we announced today that Ian Bauckham, an experienced headteacher, will lead that work. We are also carefully considering what support schools may need to adapt to changes and improve provision. I can confirm that relationships education will focus on teaching pupils about different types of relationships and the difference between healthy and unhealthy relationships, both online and offline, which will help pupils to understand their own and others’ relationships and their impact on mental health and wellbeing. That knowledge will support pupils to make good decisions and keep themselves safe and happy.

When considering how to teach these issues in schools, we need to look at what the evidence says. To help with this, the Department is undertaking a programme of randomised controlled trials to assess the effectiveness of school-based interventions to support children and young people’s mental health and wellbeing. We are also exploring, through pilots, how pupils can support each other with their mental wellbeing. The aim of these trials is to determine whether approaches such as mindfulness are effective and to make information available to any school that might be considering offering such interventions. Of course, it is equally important that we identify approaches that are not effective.

My right hon. Friend the Member for Mid Sussex (Sir Nicholas Soames) asked about teacher training. Our randomised controlled trials include two international mental health programmes—Youth Aware of Mental Health, and the mental health and high school curriculum guide—and programmes that link physical and mental health through exercise, activities and routines. Those evidence-based approaches will ensure that schools can provide the right support to children and young people.

The Prime Minister has committed to a range of other activities with regard to children and young people’s mental health. The “Supporting Mental Health in Schools and Colleges” survey showed that 90% of institutions offered at least some training to staff in supporting pupils’ mental health and wellbeing, and that in most cases that training was compulsory. To support school staff further, the Department of Health is funding a mental health first-aid training offer for every primary and secondary school in England. That training, which 1,000 schools should receive by the end of the year, will help teachers to identify and support pupils with mental health issues as early as possible.

The Government have also committed to tackling the effect that bullying can have on mental health. The Department for Education and the Government Equalities Office are providing £4.6 million of funding over two years to support 10 projects to help schools prevent and tackle bullying. These include projects that target the bullying of particular groups, such as those who have special educational needs and disabilities and those who are victims of hate-related bullying; a project to report bullying online; and projects specifically to prevent and respond to homophobic, biphobic and transphobic bullying in schools.

We are committed to supporting the positive mental health of teachers, in particular by alleviating the workload pressures that teachers tell us have an impact on their mental health and wellbeing. We have worked extensively with unions, teachers, headteachers and Ofsted to challenge practices, such as triple or dialogic marking, that create unnecessary workload. As a consequence of this work, we established three independent review groups to address the priorities emerging from our 2014 workload challenge: ineffective marking, use of planning and resources, and data management. Work is progressing to meet all the commitments set out in the action plan published alongside the 2016 teacher workload survey, and we remain open to other ways in which the mental health of wellbeing of teachers can be supported.

As I said, my right hon. Friend the Member for Mid Sussex raised the issue of teacher training. We have strengthened initial teacher training, ensuring that teacher standards include the requirement for trainees to understand mental health and wellbeing. The Department’s 2017 provision survey found that 90% of schools and colleges offered staff training on mental health.

I hope hon. Members are reassured that improving and protecting the mental health of young people remains a key priority for the Government. In 2015 we allocated £1.4 billion over five years for children and young people’s mental health.