Child and Adolescent Mental Health Services

Oliver Heald Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Dr Wollaston]

I absolutely agree. The other problem is that sometimes those larger national charities may have no local presence or understanding.

We need greater flexibility so that commissioners within health and local authorities are able to provide stable, long-term funding and to set the priorities for these new pots of money. It is always easy to announce new projects, but we must allow funding to be directed at existing services that have a fantastic proven track record. The value for money that we get from these services is extraordinary, as is the value that young people place on them. Young people have told me—this applies particularly to a rural constituency such as mine—that it is no good having a CAMHS service in a neighbouring town if they cannot get to it because there is no transport. That is why voluntary services are so particularly valued.

I was going to discuss our comments on schools, but my hon. Friend the Member for Brigg and Goole (Andrew Percy), as a former teacher, is far better placed to talk about that, so I will leave it to him to elaborate. I just want to touch on the new challenges that young people face with cyber-bullying, sexting, and image sharing. This is a 24-hour pressure; there is no safe haven for them in these circumstances. I welcome the fact that the taskforce will comment on not only the challenges but the opportunities that the internet may give us to assist young people.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

My hon. Friend is making some important remarks, as has her Committee. Somebody who suffers from a condition such as depression or anxiety, and has already been taught coping techniques, often finds it helpful to have a mentor. Perhaps apps, mobile phones or the like could reinforce those coping techniques at times when life seems difficult. That is an important part of the picture.

[Dr Wollaston]

I thank my hon. and learned Friend.

In using the internet, one of the challenges is how to know which of the sometimes thousands of resources that will pop up as a result of a search are valuable and to be trusted. It would be useful to have a mechanism for directing people to those that have the best evidence base behind them, and have been rated by young people as being the most helpful. While these kinds of resources may be welcomed by some people, they will not be the most appropriate for everybody. We need to have choice and a range of resources. That also applies to IAPT—improving access to psychological therapies. Cognitive behavioural therapy has an evidence base behind it, but it does not necessarily work for everybody. Those who do not find CBT helpful must have other avenues they can go down, including longer-term support where that is appropriate.

In closing, I draw the Minister’s attention to another area of early intervention—perhaps the earliest of all. Does he have any encouraging points to make on the provision of perinatal mental health services? I look forward to his response.

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[Sir Oliver Heald (North East Hertfordshire) (Con)]

In listening to the hon. Member for Stoke-on-Trent South (Robert Flello), I recognised some important themes that were also evident in the speech of the Select Committee Chairman, my hon. Friend the Member for Totnes (Dr Wollaston). Both touched on what we can do to help people with mental health problems through volunteering, mentoring and bringing services together so that we have a more substantial whole that will help to tackle the fragmentation between different services and make something more rational and more joined up.

I was a governor of a residential school for young people with emotional and behavioural difficulties in the 1980s—Shaftesbury House in Royston. It was an Inner London education authority school, which did extremely good work with some very troubled young people. At that time, however, there was a different understanding of mental health issues from what we saw a few years later in 2001 when I was my party’s spokesman on mental health. By that time, there was much greater recognition that deep-seated mental health problems start at ages much younger than adulthood. Previously, there was a feeling that some of these issues were emotional, behavioural and developmental, but they were not seen in their true context.

I thus slightly disagree with the hon. Member for Stoke-on-Trent South. I think our understanding of mental health issues and what they mean for children and adolescents has changed over the period that he spoke about—and certainly since 2001, we know far more about the onset of these illnesses and about how they should be treated. I agree with him, however, that we are seeing a great number of young people affected by these issues. The hon. Member for Southport (John Pugh) talked about the ups and downs of adolescence and whether there was such a thing as a normal period of adolescence.

I believe that issues such as family breakdown, drugs, social media, and domestic violence put considerable pressure on young people, and it gets to the point where some adolescents have a series of crises. They can be intermittent, but there is often a recognisable crisis for which help is needed. It is more than just highs and lows; it is something more serious. In those circumstances, the delays about which we have heard can be particularly acute.

Two young people contacted me recently to raise issues about how child and adolescent mental health is dealt with. They were both very unhappy with the current situation. I thank the Minister for meeting one of them—a young lady who has been through CAMHS —to talk through the issues. She was very appreciative of hearing about the taskforce that has been set up, and it does the Minister great credit that he was prepared to meet her and that he has accepted that there are problems in the system that need tackling. Delay is certainly one of them. Another is the amount of help available, and particularly whether there are sufficient numbers of trained staff—psychiatrists, community psychiatric nurses, therapists and so forth. We have never had the numbers we need, and I hope the taskforce will consider that issue.

The Hertfordshire Partnership Foundation Trust has a youth panel that is deliberately aimed at revealing concerns. The young lady who came to see the Minister had been on that youth panel. She had suffered from anxiety, bulimia and depression; she had been bullied, but got no proper response from her school. She waited nine months for CAMHS, and had still not been given an appointment when she attempted suicide. Even after she had been in hospital, she had to wait for six weeks. She had only five sessions of therapy in 20 months at a time when she was experiencing serious crises. Another young lady who has been in touch with me was taken into an in-care unit, and it was three weeks before she saw a psychiatrist, although she too had experienced a bad crisis.

[Grahame M. Morris]

I cannot disagree with what the hon. and learned Gentleman is saying or the examples that he is giving, but does he accept the general point that one of the problems when it comes to planning effective interventions is the lack of current and accurate prevalence data that would enable the relevant agencies to plan and commission services that meet local requirements?

[Sir Oliver Heald]

I agree. I am sorry that action to deal with that problem was cancelled some years ago, because such action is definitely needed.

I was talking about the young woman who was taken to an in-care unit. She said that the staff always seemed to be overworked, and she was given no opportunity to exercise. She felt that, although she had been placed in the unit, nothing was being done to address her condition. I think that a great deal needs to be done to improve child and adolescent mental health services.

On page 76 of its excellent report, the Select Committee refers to the Minister’s taskforce, and says that the “current fragmented commissioning arrangements” must change

“to allow rational and effective use of resources in this area, which incentivises early intervention.”

That is an extremely important point. On page 77, the Committee deals with education and GP services and makes another important point, namely that this is not just about specialist CAMHS, but about school-based counselling. It quotes Mick Cooper, professor of counselling psychology at the university of Roehampton, as saying:

“Due to its short waiting times, convenient location, and broad intake criteria, school-based counselling is perceived by many stakeholder groups as a highly accessible intervention. It is able to offer a wide range of young people professional therapeutic support in a direct and immediate way.”

I think it is time that we joined up those services, using schools as a platform. In my constituency, there is an initiative called the North Herts Emotional Health Support Service, which aims to make a start with that. It has estimated that one in 10 young people aged between five and 16 is likely to be affected by a

“clinically significant mental health problem”

at some point, and has calculated on that basis that 18,000 school-aged children in north Hertfordshire are affected, including about 6,000 with emotional disorders. It has looked at the schools in question, and says:

“Evidence suggests that vulnerable children, young people and their families find it easier to access services”

at a school. It has trained a team of mentors consisting of teaching assistants, teachers and volunteers, and has identified a

“bank of quality-assured local counsellors and…therapists”

who can provide the sort of art and drama therapy that was described by the hon. Member for Stoke-on-Trent South. It has two local lead therapists whose job is to oversee the training and supervising of the mentors. It speaks of the importance of “offering consultancy and training” and “co-ordinating”, and hopes to engage a “part-time administrator”. It has made considerable progress with that model, and, although it will need to be evaluated, I think that we should do something similar.

The service is harnessing the good will of people who volunteer, and there are people who will do that—when I was a mental health spokesman, I met people who volunteered to work for Rethink and MIND—but it also uses the skills of professionals to train the individuals concerned, under supervision. It is giving us a lot of coverage and an ability to help young people relatively cheaply. That is a consideration in these times. I therefore suggest to the Minister that looking at such initiatives and those described on that page of the report is a possible way forward.

Many young people spend a lot of their time using social media of course—thumbs clicking at great speed. This is not necessarily a bad thing. People with anxiety or depression or another mental health condition could find online services that could help them and they could reinforce the coping techniques that they have been taught. I hope the taskforce will look at that. I think it might be fruitful.

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[Grahame M. Morris (Easington) (Lab)]

I congratulate the hon. Member for Brigg and Goole (Andrew Percy), with whom I serve on the Health Committee, and the hon. Member for Totnes (Dr Wollaston), who so ably chairs the Committee. Although this report is the third report of the 2014-15 Session, I think it was the first report produced under the hon. Lady’s chairmanship, so it is quite an historic document. It is an important piece of work on a subject that has been neglected.

As time is short, I shall try to stick to a particular structure. I thank the Royal College of Paediatrics and Child Health for providing a briefing and for asking us to highlight some of its concerns about variations in services and funding for transition services and mental health care provision for prevention and early intervention. A number of right hon. and hon. Members have referred to those issues. I also want to make a few points from the perspective of local government. As we have heard and as the hon. Member for Brigg and Goole observed, this is an area of joint responsibility where local government, given the correct support and resourcing, can make a significant difference.

On the scale of the problem, it is a shocking statistic that 50% of mental illness in adult life, excluding dementia, starts before the age of 15, and 75% of mental illness starts before the age of 18. Apart from the mental health manifestations, there are often increased physical health problems associated with the deterioration in mental health. Disturbingly, since 1980, as others have mentioned, there has been no decline in the number of deaths caused by self-harm, suicide or assault, with more than 1,000 10 to 18-year-olds dying this way every year in the United Kingdom. The problem is particularly prevalent among boys.

An hon. Member spoke about the value of prevention and early intervention and alluded to a cost-benefit analysis, and he was absolutely right. Quite apart from the fact that it is the right thing to do, if we look at it purely in terms of the opportunity cost, we see that mental health problems that start in childhood and adolescence result in increased costs of between £11,000 and £59,000 per child annually, according to figures provided by the Royal College of Paediatrics and Child Health. Those are huge additional costs. With upstream interventions of the kind other Members have argued for, early identification of mental health difficulties should be established as a core capacity of all health, social care and educational professionals who work with children and young people, because the benefits would be considerable.

Another issue that has been talked about, and which I feel I must mention, is the provision of an evidence base on which to plan interventions. Indeed, the chief medical officer highlighted the lack of accurate prevalence data in evidence to the Committee. I fully understand that the Minister is carrying the can and making the arguments, but that survey had not been carried out for quite a few years. Although it has now been commissioned, my understanding is that the data will not be available for use until 2017. If we are to have a scientific or empirical basis on which to plan commissioning and resources, either in early years or in whichever tier is thought appropriate, we need an up-to-date and relevant evidence base of data.

[Sir Oliver Heald]

On the hon. Gentleman’s point about prevalence data, with which I agree, is not the real point that many of the contracts in mental health are block contracts, whereby a fixed amount of activity is purchased? If we do not know exactly what the prevalence really is, that is a bit of a shot in the dark.

[Grahame M. Morris]

I cannot disagree with that. I come from the perspective that we need to plan interventions on the basis of evidence, but how can we do that without current and relevant data on child and adolescent mental health? We certainly need that data. On the structure of the contracts, I am a firm believer in integration. There may well be issues with block contracts. The Health Committee received evidence from the south-west indicating that there are vast areas of the country where there is very little access to certain types of in-patient mental health provision, which is clearly unacceptable. One might have thought that a large block contract would make that less likely, but apparently that is not so. However, I am not an expert in commissioning; I am simply trying to identify the policy areas.

Having spent a number of years in local government, I have no doubt that local authorities wish to tackle some of the barriers that young people face in accessing mental health services. It is a complicated area, and we need to enable local areas—the hon. and learned Member for North East Hertfordshire (Sir Oliver Heald) just referred to larger block contracts—to commission better services, and perhaps that is better done on a more local level.