Children’s Wellbeing and Mental Health: Schools

Madeleine Moon Excerpts

Tuesday 10th January 2017 Westminster Hall

[Norman Lamb]

I thank the hon. Lady for that intervention and pay tribute to the tremendous campaigning work that she does on mental health. Her point highlights the gap between the rhetoric, which is often well intentioned, and the reality. There is now a much greater focus on prevention in the Government’s argument, but what too often happens with a system under impossible strain is that the preventive services are cut first because there is a desperate need to prop up acute services within the system. She makes an important point.

Let me address the issue of stigma in schools. Stigma can exacerbate mental health conditions and prevent people from speaking out and seeking help. In October 2016 the YMCA launched a nationwide campaign aimed at tackling the stigma associated with mental health difficulties and to help to encourage young people to speak out. It found that more than one in three young people with mental health difficulties had felt the negative impact of stigma. School is where most young people experience stigma, and more than half of those who have experienced stigma said it came from their own friends. There is often a lack of understanding among young people—teenagers—about what mental health really is. That is why it is so important that we get this on the curriculum so that every teenager learns about their mental, as well as physical, health and wellbeing, and about how they can become more robust in coping with the challenges they face.

The impact of stigma is profound and pervasive, affecting many areas of a young person’s life. Young people reported that the stigma affected their confidence and made them less likely to talk about their experiences or to seek professional help. I can remember the moment when our eldest son said to me, “Why I am the only person who is going mad?” I just thought that here is a teenager feeling that and having stored it up inside himself, having not been able to talk about it for a long time. We can just imagine the strain of trying to cope with that on top of all the normal pressures of being a teenager. We have to do far more to combat stigma if we are to improve young people’s experiences.

I want to mention “Future in mind”, which is the blueprint we published in March 2015 just before the coalition Government came to an end. It was widely welcomed across the sector. We involved educationalists, academics, practitioners and young people, in particular, in the work we did. Central to the recommendations was the role of schools, and among the recommendations was the proposal that there should be a specific individual responsible for mental health in every school to provide a link to the expertise and support available, to discuss concerns with an individual child or young person and to identify issues and make effective referrals.

There should be someone taking responsibility but also a named contact point in specialist mental health services—too often we find that schools do not have the faintest idea who to contact when a child needs support—and also joint training. The hon. Member for Upper Bann (David Simpson) made the point about the training of teachers. If we can get teachers working alongside specialist mental health workers in schools, everybody will benefit.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Will the right hon. Gentleman also pay tribute to the work of the Samaritans? It has a scheme called DEAL—developing emotional awareness and listening—which it is rolling out across Wales in particular. There is a resource pack available for teachers if they want to take it into schools, or the Samaritans will send volunteers into schools to undertake, separate from the school system, talks and raise awareness for young people. That is the sort of low-cost—not expecting lots of money to be involved—involvement of people and organisations such as the Samaritans, with their specialist knowledge and awareness, that is extremely helpful in reaching young people.

[Norman Lamb]

I pay tribute to the hon. Lady for the incredibly valuable work that she has done, particularly on suicide. I join her in paying tribute to the work of the Samaritans and the army of volunteers who give up their own time to save people’s lives. The sort of initiative that she described is incredibly important. Do the Government remain committed to implementing “Future in mind”? There is a danger in Government that we just replace one initiative with another. There is a very good plan there, which has all the right principles, and the important thing is just to do it and make sure that the money—I will come to that in a moment—actually gets through to where it is required.

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[Mrs Madeleine Moon (Bridgend) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Nuttall. I thank the right hon. Member for North Norfolk (Norman Lamb) for the opportunity to have this debate. As chair of the all-party parliamentary group on suicide and self-harm prevention, one thing of which I am very aware is that change only comes when there are champions, at the local and national levels. He has certainly been a champion in this House for mental health. When he was a Minister, it was always a delight to speak to him, because I knew I was talking to somebody who understood the problem, and I pay tribute to that.

I welcome the publication of the latest national suicide prevention strategy—I am particularly pleased by its recognition of the work of the all-party group—but one of the big problems is that there is no new money for local action plans. If we do not start on a local basis, we will not get the change that all of us want.

The all-party group works only with academics; on the whole, the people who come to speak to us come from an academic background. Their work is fully researched, and the way forward is understood. Just before Christmas, two researchers from the National Centre for Social Research, Sally McManus and Caroline Turley, addressed the all-party group. They discussed the findings of the recently published adult psychiatric morbidity survey, which examined trends in mental health and well-being since 2000.

It was extremely depressing. One of the first things that they mentioned was self-harm. The all-party group considers both suicide and self-harm prevention, because self-harm is often an early indicator that someone is suffering from mental health problems. If we ignore it, we just build up problems for the future. Self-harm among 16 to 24-year-olds has doubled since 2000. One in four women and girls aged 16 to 24 have self-harmed, rising to one in three among over-18s. In 2000, one in 15 young women between 16 and 24 reported having self-harmed. By 2015, that figure was one in five.

Young women are twice as likely as young men to self-harm. They do so for a number of reasons, but it is often to relieve tension, anxiety and depression. For them, it is a coping mechanism. Triggers vary from one individual to the next, but bullying via social media, low self-esteem and anxiety are often cited. Some care must be taken in considering those figures, as the rise might be due to increased willingness to report, but the increase is borne out by other studies. Clearly, that level of distress cannot be ignored.

Of the 16 to 35-year-olds surveyed, one in 10 asked for help but did not receive it. Someone aged 16 to 18 with anxiety and depression has only a one-in-five chance of accessing help. The older someone is, the more likely they are to receive help. Some 37% of those who reported having self-harmed had received medical or psychological help, leaving two thirds who had no help. If an individual presents at hospital after an incident of self-harm, they will not necessarily receive the help that they need.

The highest rate of access to help was among 35 to 54-year-old white British women. If young people come from a black or ethnic minority background, their access to mental health support decreases. That is incredible and totally unacceptable. Findings published recently in The BMJ, drawn from the multi-centre study of self-harm, 2000 to 2012, considered hospital admissions for self-harm and concluded that despite NICE guidelines, only a little over half were offered a psychosocial assessment.

Sadly, another issue that we must consider is that all too often the criminal justice system picks up the failures of the mental health services. Too many young people are sidelined into youth offending teams and ultimately into young offenders prisons. Staff at those young offenders prisons have told me that some of the most tragic cases that they deal with are of young people with mental health problems who are being criminalised at an early age. That has to stop.

The Department of Health is diverting its failures to the Home Office and to the Ministry of Justice. I cite as an example a young girl in my constituency who, very sadly, has quite severe mental health problems. Over the years, she has appeared in front of the police and the courts more than 140 times. She has served numerous prison sentences; she is in and out of prison all the time. The police and the probation service recognise that her problems are linked to mental health. She has been involved in the mental health system since she was a very young child, but now that she is a young adult, she is being sent back and forth in the criminal justice system and is not receiving the mental health support that she needs. She is now out again; she has already tried to take her own life by jumping from a bridge and has broken her ankles. The likelihood is that she will be back in prison before we know what we are doing.

I agree that we need to start early. The work in schools is essential. Young people need to know what is normal—“I’m going through adolescence, my hormones are all over the place; what is normal and what is actually a problem that needs dealing with?” We need to look at NICE guidelines on psychosocial assessments, which need to be in place more often. The Department of Health informed me in response to a parliamentary question that it does not keep records on where a psychosocial assessment has been offered, but that would give us an idea of how often we are failing.

Another important thing that needs to happen is a triage system. For a GP’s letter to a consultant asking for an appointment to just sit on a secretary’s desk until the secretary has done that assessment is nonsense. Dr Robert Colgate has set up a triage system for mental health that allows direct access to a consultant, so that help and support are available to GPs, mental health nurses and psychiatric social workers straight away and medication, help and appointments can be given straight away.

This has gone on too long. We know what the problem is, and it needs money and investment. Let us make sure that we start from today.

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[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

It is a pleasure to serve under your chairmanship, Mr Nuttall. I thank the right hon. Member for North Norfolk (Norman Lamb), his colleagues and the Children’s Society for initiating this debate. As ever, I pay tribute to his continuing personal commitment to improving mental health services, not only as my predecessor but also through chairing the commission on children and young people’s mental health for the Education Policy Institute. That work has been extremely valuable to us.

The right hon. Gentleman is quite right to say that today’s debate is both timely and hugely important. As many colleagues have demonstrated in their comments, we know the distress that mental health problems cause to individuals and those who care for them. Some 10% of children have a diagnosable disorder—700,000 in the UK—and they are twice as likely to leave school with no qualifications, four times more likely to become drug dependent and 20 times more likely to end up in prison. He could not have put it better. There is a compelling moral, as well as social and economic, case for change. We know that if we can get our children and young people the help and support they need early on, when problems first arise, we can make sure that the problems do not become entrenched. That is why the Prime Minister was clear in her determination to improve mental health services and tackle the burning injustice of those with mental ill health having a shorter life expectancy.

As has been discussed, the measures announced by the Prime Minister particularly tackle children and young people’s mental wellbeing and build on the substantial work already in train to implement “Future in mind”. We will continue that work, so that we can go further and faster in intervening earlier more often. In driving those reforms forward, one of the challenges we still face—the right hon. Member for North Norfolk identified this when he was a Minister—is the “fog” when trying to identify and pinpoint the best treatment and support for those with mental health problems. We need to base policies on the most robust evidence possible, so that we can be sure that we are providing the care that people need at the right time and in the right way.

That is why the Department for Education is conducting a large-scale school survey on the activities and approaches used in schools to support children and young people’s mental health in order to find out what works best, and why the Prime Minister requested that the Care Quality Commission undertake an in-depth thematic review—the first of its kind. That is also why we are carrying out a prevalence survey on children and young people’s mental health—the first since 2004, which was before YouTube, Twitter or Snapchat. The survey will look at issues such as cyber-bullying and the impact of social media for the first time, and it is on course to report in 2018. It will fill an important gap in our understanding.

As the right hon. Member for North Norfolk knows, I believe very strongly that transparency in mental health services has lagged behind that in acute services. At a national level, data on children and young people’s mental health services were included in the new mental health services data set for the first time in January. It is still early days, but as collection improves, new metrics to monitor delivery are becoming available. We know from experience in acute services that that does improve accountability, standards and safety for patients. I will respond in detail to the comments of the shadow Minister, the hon. Member for Worsley and Eccles South (Barbara Keeley) about her letter—I do not have time to do that properly right now—but we are looking at how we can drive accountability, eradicate all shadow of confusion from clinical commissioning groups about how they should be reporting, and make sure that we get that data set exactly right. As recommended by the taskforce, we will publish a 10-year research strategy to ensure that the evidence-gathering is sustained. A new policy research unit for mental health will be established in 2017 to make sure that the research continues to become a reality.

While all the evidence-gathering is going on, we cannot stand still. That is why we will press ahead with the implementation of “Future in mind”. As the right hon. Member for North Norfolk said, some areas are performing well and improving, some need to get the message about why this is important, and others are coming from such a low base that they are still working on capacity building, so we are not seeing evidence of improvement yet, but we are clear that we are ambitious not only to deliver “Future in mind” but to go further upstream and intervene earlier to prevent problems. The evidence base that we are building will come together to support the publication of the Green Paper, with increasing focus on preventive activity across all delivery partners. The Prime Minister committed initially to a new focus on schools, colleges and local NHS services working more closely together to provide dedicated children and young people’s mental health services. We are supporting schools and the NHS to develop work by evaluating models and approaches and exploring the impact that closer working can have. We will initially support that by funding the provision of mental health first aid training for teachers in secondary schools—we know that that works. That is our start. I am going to do the training in the next few weeks, to see exactly why it works.

As we know, the Prime Minister also launched a refreshed programme of activity on peer support in schools and online to help young people, through providing access to well-trained mentors, as well as comprehensive support structures to help identify issues and prevent them from escalating.

[Mrs Moon]

I urge the Minister to make sure that the Government look at best practice across the devolved Administrations. It is not a case of reinventing the wheel; let us look at what works elsewhere and incorporate that.

[Nicola Blackwood]

Absolutely. We are also looking at increasing support for schools by finding the evidence of what is proven to work in their approaches to mental wellbeing. That will be achieved by a programme of randomised control trials of promising preventive programmes across the country. As the hon. Lady also mentioned, the refreshed suicide strategy has a particular focus on self-harm, which is causing so many problems in schools.

To make the measures work and to see the progress that we so desperately need, we have to work closely with colleagues across Government. As colleagues have said, schools and colleges have an important role to play in supporting children and young people’s mental health. That role is not only laid out in statutory safeguarding guidance but is one of the four areas of Ofsted judgment in the new common inspection framework.

Colleagues are right: if we are to expect schools to play this role, we must give them the right training and resources. In 22 pilot areas, which include 255 schools across the country, NHS England has been trialling a single point of contact in schools. That programme has tested improvements in joint working between school settings and specialist mental health services—particularly improvements in local knowledge and identification of mental health issues—and it aims to develop and maintain effective local referral routes to specialist services to ensure that children and young people have timely access to specialist support where required. It is also testing the idea of a lead contact in schools and specialist mental health services and examining how different areas choose to put that into practice. The work is being independently evaluated by Ecorys, and the final report will be available in the spring. The question is whether that system is more effective than having an individual counsellor in every school. We are looking at that.

Other support available includes Government-funded PSHE Association guidance, and lesson plans on how to teach mental health across all four key stages. A range of training on how to recognise specific mental health issues is available to all professionals who work with young people through the MindEd website; our analytics have shown that teachers are the largest single group of registered users on the MindEd tool. As the shadow Minister said, mental health and wellbeing is an evolving and vital area of education, and we need to make sure that it is fit for children growing up in modern Britain, so the DFE is looking again at the case for further action on PSHE and sex education provision, with particular regard to improving quality and accessibility. I am sure that it will keep the House updated on that.

The right hon. Member for North Norfolk is absolutely right that school counselling can turn around a child’s whole life trajectory, so schools are encouraged to provide counselling services, and the DFE has produced guidance on good school-based counselling as part of a whole-school approach to wellbeing. It has also published advice on behaviour and mental health, which provides teachers with information, and with tools to help them identify pupils who need help and to give effective early support in understanding when a referral to a specialist mental health service may be necessary. An advisory group, including sector experts and young people, looked at what good peer support for mental health and wellbeing looks like and considered how to encourage good practice in schools, community groups and online. There is much greater recognition that the earlier we pick up these things, the better it is for young people and their mental health.

The “Children and Young People’s Mental Health: Time to Deliver” report from the right hon. Member for North Norfolk found that we are making progress in many areas of the country, but not nearly enough to be complacent. I agree completely with that. We are restless in our ambition not only to drive delivery of “Future in mind” in all areas, but to go further and deliver upstream interventions to prevent problems, rather than waiting until the need for treatment. I hope that I have convinced the right hon. Gentleman that this is an area to which we are fully committed, and that we will continue to drive forward with his agenda.

Question put and agreed to.

Resolved,

That this House has considered the matter of supporting children’s wellbeing and mental health in a school environment.