Mental Health of Children and Young Adults

Lord Layard Excerpts

Thursday 16th May 2019 Lords Chamber

[Lord Layard (Lab)]

My Lords, in her excellent speech my noble friend Lady Royall described the dismal state of access to treatment for young people with mental health problems—a point repeated by almost every speaker. The question is how to deal with it. I think that the way forward is quite clear, because the situation for children now is almost exactly the same as it was for adults in 2008. However, since then, the situation for adults has been improved radically through the programme for improving access to psychological therapy, otherwise known as IAPT. This includes a large programme for training therapists, plus new services rolled out across the country to deal with all but the most serious cases, who continue to use regular mental health services.

What we need to do for children now is exactly what has already been done for adults, and that is the approach that the Government agreed to in the Green Paper. That was an excellent document. It proposed creating a nationwide system of mental health support teams to do for children what IAPT has been doing for adults. The teams will take all those cases that fall below the very high CAMHS threshold, and typically they will do that in the friendly setting of a school. Therefore, this is a moment of great hope and I congratulate all those in the Department of Health and Social Care and in NHS England who have brought us to this point. However, I also want to raise three key issues in respect of which I think the programme could be significantly strengthened.

The first is training. At present, the training is mainly for handling only mild to moderate problems. However, unless the service can also handle moderate to severe cases, it will end up passing many children who start off in it upwards to CAMHS and the blockage in CAMHS will continue, just as happens now. Therefore, in these new support services we need a stream of “high-intensity” therapists, as they are known, working with young people in the same way as they work with adults in IAPT.

The other issue is conduct disorder, which is not adequately covered in the training of the support teams. It is as serious a problem as anxiety and depression. We have already trained 4,000 practitioners to deliver the group training of parents of children with conduct disorder but very few of them are being used. We should be using them.

The second issue that I want to raise is the management of the service. When adult IAPT started, it was helped enormously by an expert reference group, which included leading psychological therapists, who brought their experience to bear on the design of the service and, conversely, carried back to the profession their own excitement about what was happening. However, we do not have any such group for children, and many leading figures in the profession feel excluded from the process. That is a real pity, and I hope that the Minister can assure us that such a group will be created. I hope that she can also assure us that the more ambitious training scheme that I have mentioned can be put in motion.

The third issue is scale. The Government have allocated only £250 million to the support teams over the first three years. In current money, that is half the figure that was spent on adult IAPT in its first five years. This timorous approach means that, as has been mentioned, under a third of the country will be touched by the new children’s service in the first three years. Surely we should be more ambitious than that. In fact, I would like to suggest that we should be more ambitious about mental health overall. Since 2000, mental health has been the top priority of the NHS—that is what has always been said—but the share of NHS expenditure has remained exactly the same. That will change only if the NHS has a specific, separate, ring-fenced budget for mental health. This is an issue that we should all think about. I suggest that we need a budget for mental health growing at 6% a year in real terms compared with 3% for physical health.

Finally, I would like to ask two questions about schools. First, the Prime Minister has promised to enable schools to measure the well-being of their children. That is an excellent idea that will affect schools’ ability to help children and incentivise them to take well-being much more seriously as a goal alongside academic achievement. However, we have not heard what is going to happen as a result, and what I have heard has been worrying. Can the Minister tell us what, concretely, is going to happen with the Prime Minister’s promise?

My second question concerns life skills. This Government have been the first to make life skills compulsory. That is a huge and excellent step forward, but they have not said how much time as a minimum should be devoted to life skills. In some schools, it will be rather a small amount. Can the Minister assure us that some guidance will be given on the minimum amount of time to be spent on this? I suggest that it should be at least one lesson a week.

Therefore, things are moving forward, as many speakers have said. That is wonderful, but surely they need to move a lot faster.