Mental Health: Children and Young People

Lord Markham Excerpts

Thursday 23rd November 2023 Lords Chamber

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

I thank all noble Lords for their contributions to this debate. Before replying, I add my congratulations to the noble and learned Baroness, Lady Hale, on her maiden speech. I am sorry that no one was able to add to the Yorkshire hat trick and, speaking as a Brighton boy, I cannot get much further away than that. I found the reasons for the delay fascinating; it was an education for me, as I did not quite realise her involvement in so many things. For me, it was well worth the wait, and it is a personal honour to be able to reply after such a distinguished and accomplished speaker. I invite her, along with all other speakers, to join—as the noble Baroness, Lady Wheeler, mentioned—the round table that I have organised with the Minister, Maria Caulfield, where we can follow up some of the themes brought out today in more detail. I would be delighted if the noble and learned Baroness were able to add her experience to that round table.

I also thank the noble Earl, Lord Russell, for enabling us to have this debate. He has heartfelt and personal reasons for the debate; as many noble Lords will know, I have my own personal experience and reasons. As the noble Lord, Lord Allan, said, it is normal. I had the misfortune of going to a funeral last week of one of my school friends, whose brother had mental health issues. As we were talking on the way down in the car, we were updating each other on all our families, and we realised that every single one of our families had one of their children or someone in the household with mental health issues.

Is the reason for that Covid, as the noble Lord, Lord Laming, mentioned? Is it some of the online reasons, as mentioned by the noble Baroness, Lady Hollins, and the noble Lord, Lord Allan? Is it gambling? I have to say to the right reverend Prelate the Bishop of St Albans that the gambling aspect of it all was something that I had not probably thought through enough, but I found that fascinating as well. Is it the cost of living, as mentioned by the noble Baroness, Lady Tyler? Is it the increase in the number of ghost children—I apologise for using that phrase, but it is the easiest way to sum it up—as mentioned by the noble Lords, Lord Storey and Lord Laming? Is it eating disorders?

I always like these debates to result in substantive action rather than being a talking shop, so that really led me to take away an action point. I was proud to be titled the Minister of Follow-through by the noble Lord, Lord Allan, yesterday, so I will follow that up. I would like to see whether we have done any research, through the NIHR, to really understand what factors and causes are behind what is a massive increase in the number of young people requiring mental health support, as the noble Earl, Lord Russell, says and we all acknowledge. I have seen various figures; the one I was cited was that it had gone from one in nine to one in six. Whichever way you look at it, it is a massive increase. We really need to understand those reasons, because it is often only when you understand the causes that you can look at how to address them. I will do some personal work, but if the research is not there I propose—and I will speak to people about this—that this is something that the NIHR should do, because it is vital that we understand those reasons. As all noble Lords have said, prevention is of course key to this.

Obviously, I hope that many of the reasons are transitory—maybe many were caused by Covid so we are seeing a big jump up now but will see a reduction afterwards. But the reason for needing to understand it is that it goes to the long-term funding we might need. If they are not just transitory reasons, and this is now the new normal, so to speak, then we need to do exactly as the noble Lord, Lord Allan, said, and think about a whole provision of child services in the mental health space, in the same way we do in the physical health space. I think we all agree that we need to do that to a degree regardless, but it is the level of that. That goes again to the points made by the noble Baronesses, Lady Wheeler and Lady Tyler, about the long-term workforce plan and understanding how many mental health staff we need to make sure we are training and equipping. Specifically, while I mention that, I will write to noble Lords on the mental health dashboard and when that is being updated.

I think we are absolutely united on the need for early detection in all this. The noble Baroness, Lady Hollins, gave the example of Emma, in the autism space, but we have all said it in various guises. We have made good progress on mental health provision and identification in schools, which has gone up from about a quarter to over a third of schools, with a target of over 50% in the next year to 18 months. However, I think we all agree that we need to go further and that it needs to be 100% of schools.

Also on early detection, I have been interested in some of the pilots in Bradford, which are starting to look at children’s school results and how they respond to the SATs and other things to see whether that could be an early indicator of some of the issues. I recently saw a fantastic example in the Boston children’s hospital, where they look at how children play online, digitally, on their iPads. With dyslexia, for example, the problem is often that it is only when children are five or six and have been taught to read that such things show up, but there they have started to see how children of two or three interact through pattern recognition, with blocks and other games devised for that. They look at their playing patterns to see whether those can be good early indicators.

I have personal experience of this. I am fortunate that my wife was an early years special needs schoolteacher, and she was able to identify very early on and make sure that our son had that early support. I firmly believe that that stood him in good stead in later life. So early detection starts with the parents. If I had not been so fortunate, 25 years ago, to have a wife who understood these sorts of things, I would not have known. As the noble Baroness, Lady Hollins, said, it starts with parenting programmes and making sure that the early support hubs are a good way into that. I echo and support our commitment to early detection.

You also need early support, as all speakers have said. The ICSs are the right place to do that because they look system-wide. As we know, schools are also a vital part of this, and the £2.3 billion of funding that we put into this space is designed specifically for 350,000 extra places for young people in the community—and I think we all agree that the community is the right place. Obviously, in the next debate, tabled by the noble Baroness, Lady Hollins, we will talk about some of the issues around in-patient treatment, but I think we all absolutely agree about the need for community treatment. My understanding is that these early support hubs are very much like mental health drop-in centres, as the noble Lord, Lord Allan, mentioned, and that is what they are designed to do. As the noble Baroness, Lady Tyler, said, the innovation programme looks promising, but we need to make sure that this is rolled out. ICB early support hubs are very much part of the first line of defence, for want of a better phrase. To me, the 350,000 extra spaces and the funding we are trying to put in are a very important part of that.

As the right reverend Prelate the Bishop of St Albans said, we have set up gambling clinics to try to address this from some of those angles. However—and this goes back to the research—we need to look at some of the wider angles. My noble friend Lord Evans was just saying that AFC Wimbledon has tried to get football clubs to remove the sponsorship of gambling companies, which a load of Premier League clubs have. Straightaway, that normalises gambling from a very young age. Those are some of the wider society solutions that we need to look at in all of this.

We have 70 eating disorder teams, and we need to look at whether we need to expand that, given what we know about the issues involved in a lot of eating disorders. This all comes back to the long-term workforce plan, which many Members mentioned, and making sure that we have the support there.

A couple of noble Lords mentioned the Major Conditions Strategy. My understanding is that it is not supposed to be seen as an either/or. It is about trying to understand that, because a lot of people have more than one major condition, instead of us approaching things as silos we have to look at a whole-person solution, and so we would look at their mental health as much as their physical health. I accept the perception that any major conditions strategy generally focuses more on the elderly, so I will take back that we need to make sure that it is not delivered in that way and does not prevent the sorts of things we need to do for young people.

The noble Baroness, Lady Tyler, asked about CAMHS. A lot of the funding I was speaking about and the 350,000 extra spaces are all about trying to make sure that we meet that four-week target. It is recognised that the sooner you can get people mental health support, the better; that is obviously even more important for a young person in that context. I will look into the points raised about support into adulthood, to make sure that that handover happens properly.

I hope I have given a flavour of what we are trying to do. As the noble Earl, Lord Russell, said right at the beginning, it starts with recognising that there has been a fundamental change. That needs to be reflected in our response. As I was saying earlier, I am attempting to try and understand what is behind that so we can get to some of the root causes.

I encourage all speakers to join the round table with the Minister, so I will invite people to that. I know I am never able to respond to all the points in my speech, so I will write to all the speakers, covering all the points raised in the questions. I thank the noble and learned Baroness, Lady Hale, for making her maiden speech, the noble Earl, Lord Russell, in particular for his words, and all noble Lords for their contributions. I have learned a lot from the debate and thoroughly enjoyed it.

My understanding is that we are going straight into the next debate, so I hope noble Lords will excuse me for taking a quick bathroom break beforehand.