Child and Adolescent Mental Health Services

Paul Blomfield Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Paul Blomfield (Sheffield Central) (Lab)]

It is a pleasure to follow the hon. Member for Totnes (Dr Wollaston), whose very thoughtful and incisive speech drew on both her own rich experience and the Select Committee’s excellent report.

In the September recess each year, I organise a series of consultation meetings across my constituency. The one I enjoy most is that with young people. It is organised with a range of youth groups, such as Members of the Youth Parliament, and brings together a good number of young people aged from 18 to their early 20s. It is really sparky and lively, and they pull no punches in raising issues. When I ask them what are the top priorities that I, as their Member of Parliament, ought to take up on their behalf, it has been very striking just how high mental provision has come in the past couple of years. That would not have been the case when I was young.

The fact that young people themselves put such a high priority on mental health as an issue should send us a very clear warning signal. That does not only apply in Sheffield. Following ballots of tens of thousands of young people across the country, the Youth Parliament has made mental health one of its two priority campaigns this year. If it is so important for young people and they are pressing us on the issue, we should be deeply concerned.

In advance of today’s debate, I have been in contact with three of the groups I work with in Sheffield: CHILYPEP —the Children and Young People’s Empowerment Project; Young Healthwatch; and STAMP—Support, Think, Act, Motivate, Participate—which is a group of 14 to 25-year-olds who have come together with the specific objective of improving mental health support for other young people. They are concerned about the current state of provision, or what they would describe as the lack of provision, and they fear for the future and the impact of cuts on an already desperately inadequate service.

The groups have identified three key problems. The first is that reductions in funding are taking place at a time of increasing need. The second, which very much echoes the points made by the hon. Lady and the report, is about the lack of early intervention. The STAMP young people’s manifesto states:

“Act now, tomorrow could be too late!”

That indicates the severity of what we are talking about. The third is that young people are abandoned at 16.

[Mr Jim Cunningham (Coventry South) (Lab)]

On the issue of resources, budget cuts have been inflicted on local authorities, such as Coventry. Some of them have had to find about £3 million or £4 million, which is an extra burden. The Government hope that local authorities can somehow resolve that situation, and then they wonder why they have problems with young people.

[Paul Blomfield]

My hon. Friend makes a very important point. Such a matter is close to my heart in Sheffield, where funding from central Government will halve over the lifetime of this Parliament. That is putting an enormous strain on all the related services and support for young people that can play a broader role in alleviating some of the difficulties. In Sheffield, we are very conscious that our position is in sharp contrast to that in wealthier parts of the country.

The first point is about cuts at a time of increasing need. We know that budget cuts to front-line services are difficult and can be devastating at any time, but cuts to child and adolescent mental health services are being made at a time of increasing need. From 2011-12 to 2013-14, Sheffield CAMHS saw a 36% increase in referrals, and a 57% increase in initial appointments. If we are serious about reducing stigma, talking openly about mental health problems—we have made enormous advances in doing that—and having parity of esteem, we should welcome those referrals. However, that demand comes against the background of what has effectively been a 4% budget cut, disguised as a requirement to drive efficiency savings. That has had severe consequences for the level of support that young people are receiving. There has been a stark increase in waiting times.

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

It is certainly true that councils are faced with really tough decisions, given the 40% cuts to local government budgets. My understanding is that within the overall mental health budget of £14 billion, only £0.8 billion goes on child and adolescent mental health services. That seems to be a disproportionately small sum of money, given the scale of the problem.

[Paul Blomfield]

My hon. Friend makes a powerful point. It is a relatively small sum of money. Perhaps that indicates that a relatively small level of resource intervention could make a significant difference.

As I was saying, the consequence of the rising demand and falling resource in Sheffield is that some 18% of young people—almost one in five—wait over 13 weeks for treatment. The cuts not only impact on young people up to the age of 17, but have a knock-on effect on adult mental health services and on acute and emergency provision.

[Robert Flello]

Although demand is rising, there is still a current of demand that does not even present itself. There is a huge level of unmet demand, simply because people do not present themselves to systems such as CAMHS, but try to self-medicate or whatever.

--- Later in debate ---

[Paul Blomfield]

I am very grateful to my hon. Friend for that intervention. While on one level we have seen enormous progress in the openness with which we confront mental health issues and the willingness of people to come forward, we must be deeply conscious that there is still a wider problem of people who do not present. The absence of resource and the inability of the system to support people with needs when they do seek help sends out a powerful message, because young people are very well networked. Those who might be on the tipping point of coming forward to seek help will get the message from their friends, “What’s the point, because you have to wait so long?” That is an important point.

That brings me to the second point that young people raise with me, which is the importance of early intervention. Again, that was emphasised by the hon. Member for Totnes. In the words of STAMP:

“Act now, tomorrow could be too late!”

I want to share the harrowing words of one 18-year-old young woman who is involved in the STAMP project in Sheffield:

“Sometimes I think, do I have to kill myself to get help? I probably do. It happens all the time. People are desperate for help, the only way they can get it is if they are at harm, so people harm themselves or attempt suicide just to get put on another waiting list. It just shouldn't be like that.”

She is right; it clearly should not be like that. Nobody should have to reach crisis point before receiving the support and care that they need, and certainly not our young people.

At a time of increasing need, we need to look at how we can do more with less money. Early intervention is a way of doing that. The hon. Member for Totnes made that point powerfully.

[Robert Flello]

I appreciate my hon. Friend’s speech very much. He has put a thought in my mind about a point that the hon. Member for Totnes (Dr Wollaston) also raised about early intervention. Given that the cuts to other local authority front-line services have been worse than decimated in places such as Stoke-on-Trent, those services that would have been early intervention-type services—and, indeed, pre-early intervention services—are just not there any more.

[Paul Blomfield]

I thank my hon. Friend for making that powerful point. The situation in Stoke, Sheffield and Coventry underlines his point that there used to be a hinterland beyond the NHS of youth groups, activities and support networks, many of which were supported by local government funding in combination with funding that was often raised within communities. The withdrawal of that funding, as local authorities have increasingly had to focus on statutory services, has put many of those groups at a tipping point and left the support that is available very weak.

The third point that young people have made to me is about being abandoned at 16. Historically, CAMHS in Sheffield have worked with people up to the age of 16, leaving those beyond that age—before they turn 18 and become part of adult provision—to fall through a hole. Things looked a bit brighter for 16 and 17-year-olds when the clinical commissioning group committed just £300,000 a year to a service for them, although I am not sure why it did not include 18-year-olds as well. However, budgets are squeezed and it has since been announced that the funding will be cut by a third. That is another example of the budget pressures being experienced and it is happening within the NHS as opposed to local authorities, which we have discussed.

In effect, £200,000 allows the service to work with little more than 100 young people aged 16 to 17 in a given year. On funding relative to need, there are 12,627 young people aged 16 to 17 living in Sheffield and it is estimated that 10% of them have some sort of mental health challenge. That leaves more than 90% of those we could expect to need support with no service at all. We cannot keep talking about reducing stigma, eradicating stereotypes and parity of esteem between physical and mental health without funding services properly when people—especially young people—need that help. We have serious questions to answer on the challenges posed to us by the issues raised with me by young people in Sheffield and those raised by the Youth Parliament.

We know that, nationally, mental health problems account for 28% of morbidity, but only 13% of expenditure is committed to mental health. Where is the parity in that? I hope the Minister will address that when he responds to the debate. We need to put our money where our mouth is. I am pleased that Labour has committed to increasing the proportion of mental health spend on CAMHS, which is currently a tiny amount of 6% even though three quarters of adult mental illness begins before the age of 18.

[Norman Lamb]

I agree with the hon. Gentleman about the need to increase resource in children’s mental health services. Is the proposal he mentions designed to increase investment in mental health or to shift resource from adult mental health to children’s mental health?

[Paul Blomfield]

I am sure my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) on the Front Bench will come back to this issue. My understanding is that our proposal is both to increase the overall resource available in the NHS and to shift resource within the service towards supporting CAMHS.

We will also train NHS staff and teachers to spot problems sooner. We will expand talking therapies and work towards a 28-day waiting time standard for access to both adult and young people’s talking therapies. That is crucial, given what I have heard from young people. Moreover, as I said a moment ago, we will invest an additional £2.5 billion in the NHS to fund extra nurses, doctors and other health workers, to relieve pressure on the service. We owe it to our young people to respond to their calls and I am pleased to have had the opportunity to articulate some of their concerns.

[Several hon. Members]

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