Mental Health of Children and Young Adults

Lord Farmer Excerpts

Thursday 16th May 2019 Lords Chamber

[Lord Farmer (Con)]

My Lords, I too congratulate the noble Baroness, Lady Royall, on securing this important debate. I will focus on the indispensability of family support, and particularly support for parents’ relationships with each other, if we are to address major contributing factors to children’s and young people’s poor mental health. Prevention should, whenever possible, be at the heart of any mental health strategy, whether from local or national government or from the NHS. Family relationship difficulties are also provoked by mental health problems in a child or young person. Whichever comes first, the family system, not just the person with the diagnosis, needs attention.

In a letter to the Times this week, I said that,

“The breakdown of family relationships creates a plethora of social policy challenges”.


Measures to strengthen families should be on the business plans of every department of government, as families which function well are major assets to their aims and objectives. This is particularly the case here. The NHS survey Mental Health of Children and Young People in England, 2017 found that family functioning was clearly correlated with mental health problems. Almost two-fifths of children from families functioning in the least healthy ways had a mental disorder, compared to one-12th of children in the families functioning most well. Robust surveys of mental health clinicians corroborate this. Family relationship problems were cited as the biggest presenting issue by mental health clinicians in a recent study of over 43,000 children in services.

Distressed children would agree. I commissioned research from a team led by Dr Samantha Callan, my parliamentary adviser, to inform the work of the Department for Education and the Department of Health and Social Care in developing the Green Paper on CAMHS. This included a focus group with young people with mental health problems who had experienced parental relationship breakdown. They highlighted that people in general are “not at all” aware of the effects of family breakdown on children and young people. They described teachers’ and other adults’ expectations that exposure to conflict or parental separation two or more years earlier would no longer impact them. This made it very hard to express ongoing pain from the lingering effects, including the difficulties in keeping in contact with the non-resident parent.

One participant said: “I see girls who don’t see their dads who try to get the attention and the affection from someone much older than them. It can have a bad long-term impact on you if you end up in bad relationships”. Another described their severe problems with anger management, linked to their father leaving unexpectedly more than a decade ago. Other negative effects were attributed to one parent not having recovered from the relationship breakdown. Conflict might have ceased, but children might still be coping with their parents’ depression, bitterness or other long-term ramifications of the split, which went unsupported. One said, “I have absolutely no complaints about the care I have received, but my mum didn’t get any help at all. I might not be sitting here if she had had the same level of support”.

The importance of good interparental relationships was recognised in the 2017 Green Paper, which said:

“Children who are exposed to persistent and unresolved parental conflict are at a greater risk of early emotional and behavioural problems, anti-social behaviour as an adolescent and later mental health problems as they transition into adulthood”.


To unpack the concept of persistent and unresolved conflict, this need not mean a violent home environment but one daily characterised by overt, hostile exchanges or cold, contemptuous indifference.

Apart from citing the DWP’s reducing parental conflict programme, the Government’s response to the Green Paper consultation made no proposals to support families and interparental relationships. Similarly, the NHS Long Term Plan merely acknowledges that a,

“stable and loving family life”

significantly influences young people’s health and life chances. Health services might argue that relationship and family support are someone else’s responsibility, but this ignores the fact that, in a phrase coined by researchers from UCL, good relationships are a health asset. Indeed, I cannot resist saying here that “The key to happiness”, according to today’s headlines from the Office for National Statistics, is to “Eat, drink — and be married”. Moreover, health budgets dwarf government funds earmarked for relationship support, so can my noble friend outline what the DHSC is doing to support family relationships?

I have a couple of recommendations. First, NHS organisations could invest directly in the provision of relationship support. Hackney child and adolescent mental health service employs a specialist to work directly with the couple while another member of the multidisciplinary team treats their child or young person who has been referred. The research found that this is rare, so to help build confidence that embedding couple counsellors in CAMHS teams is good use of scarce mental health funding, the DHSC should fund pilots of this model.

Secondly, early help for families is imperative to address the roots of mental illness and prevent children and young people developing such problems. Local councils, from Newcastle to the Isle of Wight, are making progress in repurposing children’s centres as “family hubs”, so that their expert early years services are preserved alongside services offering help for parents of children aged nought to 19. Health services and education, now both on the front line of help for children with mental health difficulties, are free and available to all, yet we cannot ignore any longer the uncomfortable truth that, without similarly accessible support for family relationships, they will fail to turn back the tide of mental illness in this and future generations.

Cannabis: Medicinal Uses

Lord Farmer Excerpts

Thursday 1st November 2018 Lords Chamber

Asked by

[Lord Farmer]

To ask Her Majesty’s Government whether they intend to respond to the concerns raised by the Faculty of Pain Medicine in their Faculty Position Statement on the Medicinal use of Cannabinoids in Pain Medicine, and their call for further research into the potential benefits of cannabis for medicinal uses.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy) (Con)]

My Lords, the Government acknowledge the valid concerns raised by the Faculty of Pain Medicine. Under the new regime, only specialist doctors will be able to prescribe cannabis products. Clinical guidance published yesterday is clear that these products will be considered only in a small number of conditions and where alternative treatments have not helped or have been discounted. The National Institute for Health Research has issued a call for proposals in order to enhance knowledge in this area.

[Lord Farmer (Con)]

I thank the Minister for that Answer. Bearing in mind the faculty’s overarching cautionary position, and the fact that according to the National Health Service website,

“Regular cannabis use increases your risk of developing a psychotic illness”,


what assurances can the Minister give us that Her Majesty’s Government will not allow the changes in prescribing cannabis for medicinal use to be a Trojan horse for the legalisation of cannabis for recreational use?

[Lord O’Shaughnessy]

I can absolutely reassure my noble friend by reiterating the position outlined by my right honourable friend the Home Secretary. He has been crystal clear that the Government have no plans whatever to legalise cannabis for recreational use. Indeed, the penalties for unauthorised supply, possession and production remain unchanged.

The Long-term Sustainability of the NHS and Adult Social Care

Lord Farmer Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord Farmer (Con)]

My Lords, I add my congratulations to those of others to the noble Lord, Lord Patel, and his committee on this report. I am particularly grateful that the committee took the opportunity to take a long, hard look at what the NHS is now and what we should be looking for in the future. I want to dwell on the report’s emphasis on prevention and to talk about how family breakdown and dysfunctional family relationships contribute to the long-term unsustainability of the health service and the social care system.

We must not allow nanny state concerns to perpetuate the wilful neglect of this issue by successive Governments, including the current Administration, on whose Benches I sit. We have had strategies to address disability, diabetes and dementia—all of which are laudable and necessary. After all, disability affects one in six adults; diabetes around one in 10 adults; and dementia one in six adults over 80 years old. Yet, despite almost one in two 15 year-olds having experienced the breakdown of their parents’ relationship, no UK Government have ever come close to developing a family strategy that acknowledges the repercussions of this and addresses the root causes.

The Select Committee report we are debating describes the short-sightedness of successive Governments and the culture of short-termism that seems to prevail in the NHS and adult social care. This sums up very well the policy approach over the last half century towards the growing trend of family breakdown, which drives need in both these areas. Moreover, the report highlights the false economy of neglecting public health, prevention and patient responsibility and gives short shrift to nanny state concerns.

The quality of people’s relationships, particularly in their childhood, is a significant determinant of health as studies on loneliness and the effects of adverse childhood experiences, among others, make clear. Research from the International Centre for Lifecourse Studies—the ICLS—at University College London measured cortisol levels in thousands of 60 year-old adults to see whether there are long-term effects of psychological stress in childhood. It found that people who had been separated for more than one year from their mother had higher cortisol levels, which indicates a less healthy stress response several decades later, and therefore an increased risk of disease and early death. Other ICLS research found that people who suffer stresses such as parental divorce in childhood are more likely to experience social and psychological problems later in their adult lives.

For children to flourish they need safe, stable and nurturing relationships, not just a good school place and a healthy diet. Nationwide, a million fathers have no meaningful contact with their children and, in some communities, father absence is the norm. This fuels the hunger for belonging, which leads many to join gangs and get caught up in the culture of violence, where life is cheap. Overstretched and understaffed accident and emergency departments then have to deal with high numbers of young men with stab and gunshot wounds.

Many other pressures on our health services can be traced directly back to broken and dysfunctional relationships. Prevention, in the form of family strengthening measures, should be available in every community. This and every previous Government have struggled to provide leadership in this area, yet they find themselves picking up the pieces at every turn. Curing is always more costly than preventing.

Many have gone beyond even being concerned about family breakdown. I met with a Minister this week whose official briefing included a graph showing that divorce levels had become stable and were even beginning to ease off. The implication was that “things aren’t so bad after all”. Yet this one simple set of descriptive statistics obscures the bigger picture: our high divorce rates are still almost at the top of the OECD league table and the growth area in parental splits is among those who are not married. Three-quarters of family breakdown among children under three involves unmarried parents. Three-fifths of parents who were closely involved but not living together when their children were born are no longer together by the time the children turn five, compared to fewer than one in 10 of parents who were married.

No Government have yet been courageous enough to put serious effort into communicating through policy and rhetoric that the best context for childbearing is within a committed relationship. A fear of stigmatising children born outside marriage has unintentionally penalised one generation after another by neglecting to encourage a culture where the norm is for parents, whether rich or poor, to be deeply intentional about bringing a child into the world and raising her together. Neutrality is not an option when the costs of family and relationship breakdown mount up inexorably in so many areas. These include, to touch on just a few: lower resilience among young people and greater susceptibility to them developing poor mental health; lower productivity, which leads to less cash for the NHS; fewer family members available to care for older relatives; and more people living alone in later life due to divorce, and therefore higher social care costs.

So often, and understandably, domestic abuse is a reason for reticence to talk about family stability. NHS Employers has estimated the cost to the NHS of repairing the physical damage to victims to be around £1.25 billion per annum, with the cost to mental health services related to domestic violence estimated at £176 million. A preventive approach is essential. People across the broad range of those impacted by domestic abuse need help to learn how to avoid or step out of unhealthy relationship patterns. That includes not just women victims but couples where abuse is mutual, couples who want the abuse to end but the relationship to be sustained, and male victims and female perpetrators.

On that point, I want to clarify some statistics I cited in the recent debate on domestic abuse led by the noble Baroness, Lady Lister. I mentioned SafeLives data showing that 95% of victims are women and 95% of perpetrators are men. This is based on the 4,500 people accessing independent domestic violence adviser services, and must be set alongside the Crime Survey for England and Wales. In the year to March 2017, the survey found that a little over one-third of victims of domestic abuse were men and slightly under two-thirds were women. For the purposes of this debate, health services—not the police—are often the first port of call. Indeed, the 2012-13 survey found that four out of five victims do not call the police.

The Government are beginning to take note of the damaging effect on children and young people’s mental health of frequent, intense and unresolved conflict between their parents, even when violence is not a factor. In a sample of over 42,000 children attending children and young people’s mental health services, family relationship difficulties were a presenting problem for over half—52%. Their Green Paper, Transforming Children and Young People’s Mental Health Provision, published last December, acknowledges this in its chapter on wider action to support children and young people:

“Children who are exposed to persistent and unresolved parental conflict are at a greater risk of early emotional and behavioural problems, anti-social behaviour as an adolescent and later mental health problems as they transition into adulthood”.


I have one question for the Minister, who is I know is also exercised about the negative effects of relationship breakdown on children. The consultation process asked no questions about this wider action. What is the Department of Health’s response to family breakdown?

Young Women: Self-Harm

Lord Farmer Excerpts

Thursday 16th November 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness picks up on a particular interest of mine. She may know that I was involved in setting up three primary schools. It is important to start these lessons early. In the end it comes down to behaviour policies and what is expected from children. Schools with fair and robust behaviour policies do not tend to see bullying. Those which are more lax do. First, it is about making sure that teachers have training and resources and the support they need from the leadership, governors and parents to crack down on it. Bullying now has moved into different domains, particularly online. I think it is very encouraging today—the noble Baroness may have seen it—that His Royal Highness the Duke of Cambridge is launching some actions on cyberbullying. Dealing with bullying is a big part of that and I agree with the noble Baroness about the importance of starting early.

[Lord Farmer (Con)]

My Lords, the Government’s own research, most notably that commissioned by the DWP from Professor Gordon Harold, conclusively showed a causal link between young people internalising problems, such as self-harm, and conflict and breakdown in their parents’ relationships. Will this evidence be acted on in the forthcoming Green Paper on children and young people’s mental health?

[Lord O'Shaughnessy]

I know this area is of great interest to my noble friend and he has done very good research on it. He is quite right to highlight the impact that, unfortunately, parental conflict and breakdown has on children. The Department for Work and Pensions, in a cross-government approach, is doing particular work on supporting parents. I also know that the best schools and community health services work to provide that kind of parenting support. There are a number of parenting programmes out there. I assure my noble friend that that evidence takes a proper place in the mental health strategy that we will be publishing for children and young people.

Child and Adolescent Mental Health Services

Lord Farmer Excerpts

Monday 30th October 2017 Lords Chamber

[Lord O'Shaughnessy]

Yes, I wholeheartedly agree with the most reverend Primate. We are making up for lost time, unfortunately, with children and young people’s mental health care and there is a lot to do. He will be pleased that the additional funding being provided is helping with the rollout of the children and young people’s IAPTs—the talking therapies. As I said, the intention of the extra funding is to be able to treat 70,000 more young people, on top of those who have already been treated, by 2021—so more young people are being seen. That will increase the 25% of the potential caseload currently dealt with to 35%. Obviously that is better but it is not the whole way.

[Lord Farmer (Con)]

My Lords, following on from that question, I ask what the Government are doing in relation to preventing children’s mental health problems by addressing parental conflict and family breakdown.

[Lord O'Shaughnessy]

That is an incredibly important point because good relationships are very influential on young people’s mental health, and the Green Paper will look at the role of family conflicts. My noble friend will be pleased to know that the Department for Work and Pensions is launching a programme to reduce parental conflict in conjunction with the Early Intervention Foundation. I hope that it will have some positive benefit in reducing parental conflict, which is, of course, one of the causes of mental illness.