Mental Health: Children and Young People

Lord Brooke of Alverthorpe Excerpts

Wednesday 30th January 2019 Lords Chamber

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I too thank the noble Baroness, Lady Tyler of Enfield, for this debate on access to NHS treatments for children and young people with mental health problems. Doctors on the front line have long complained about the dire situation and inadequate resources. This in itself is a massive issue. It is placing ever-increasing demands on already stretched services.

Let us put ourselves in the shoes of a child encountering these services, possibly for the first time, at hospital A&E units. A child experiencing a mental health crisis out of hours—perhaps a looked-after child having difficulty adjusting to their new surroundings or having an argument with a parent—and brought to A&E by their guardian as the only safe place to seek assistance often has real difficulties. Self-harm is often a coping mechanism to which they turn in this kind of situation. It is not an unusual occurrence and once the child has, in many cases reluctantly, been brought to A&E they will often have to wait for hours to see a member of the psychiatry liaison team, which is already stretched to full capacity seeing the adults they are more properly equipped to manage. In most cases the healthcare professional will not have the expertise to manage the situation with the child given that most psychiatry liaison staff are not trained in child mental health. NICE guidelines recommend that they then have to admit the child overnight until the appropriate team member can come to the A&E.

Imagine then that this is a Friday night and the team member will not be available until Monday morning. I am advised that this is not a rare event and often happens in A&E. Staff are dissatisfied, A&E departments are dissatisfied, as are the children and their parents. Where are we going with all this without the appropriate resources to address the growing number of children with mental health problems turning up at A&E?

Again considering this same child, once the assessment hurdle has been surmounted the challenge remains of accessing the necessary service required. With an increase in referrals of 26% over the past five years this has stretched resources to the limits. Worryingly, however, parents questioned for a recent YoungMinds survey reported that this intervening period between the first referral and acceptance on to the clinician’s caseload can be a risky time, with 75% reporting that their children’s mental health had deteriorated further while waiting for the services to be given to them. In fact, the longer they were left to wait the more likely it was, the parents said, that the mental health of their child would deteriorate even further. There are many cases where people had waited up to six months and some had waited up to a year.

As many as three-quarters of those surveyed reported that they were not signposted to any other service during the time they were waiting for the appointment, so during this period the child’s mental health will almost invariably deteriorate, possibly leading to self-harming, dropping out of school or having suicidal thoughts which they might act on. The parents’ mental health may also be impacted on with the stress that they suffer during this period. What may begin as a seemingly relatively minor mental health crisis—perhaps an argument with parents or something like that—has the capacity to escalate into an issue which becomes pervasive in all aspects of the patient’s life or, worse still, lead to something worrying, such as thoughts about suicide and ill health later in life.

This lack of signposting further compounds GPs’ fears about a patient’s interaction with mental health services. They feel that there is little else that can be offered. However, we now have of course the new 24-hours-a-day crisis hotline, which through phoning 111 can triage children and young people. Let us hope that this will make a significant change.

Yes, we have more money coming in, which is welcome—the Government are moving in the right direction—but we need to know when the training is going to start to find the extra staff needed. Perhaps the Minister will address that issue.