Mental Health Education in Schools

Rachael Maskell Excerpts

Monday 6th November 2017 Westminster Hall

[Catherine McKinnell]

I absolutely agree with my hon. Friend, who is a passionate and successful campaigner on this issue.

[Rachael Maskell (York Central) (Lab/Co-op)]

Does my hon. Friend agree that, in light of the fact that mental health challenges start when people are young, it is crucial that schools have mental health practitioners who can support young people? Teachers are not health professionals, and therefore do not have the necessary skills. They have numerous other pressures to focus on, so is it not crucial that we have mental health practitioners in schools?

[Catherine McKinnell]

Yes—I will come on to some of the big challenges in this area. It is one thing for us to agree on the principles and on the fact that we want a much better focus on mental health in the education system, but it is another matter to ensure we make the tools and resources available to make that a reality for every child in this country. I will expand on that later.

--- Later in debate ---

[Catherine McKinnell]

My hon. Friend makes a powerful point. It is about not just shifting the life experience of an individual, but the knock-on effect of shifting the life experience of everyone around the individual and the whole community. We know that the lack of support and mental health education affects not only individual young people, perhaps for the rest of their life, but those around them. The potential returns from investing in our young people in that way are significant.

[Rachael Maskell]

Is it not crucial that we also understand the triggers, the causation, of mental health conditions in young people and where the stress factors fall, for example in the pressures of the exam system? Those issues should be addressed.

[Catherine McKinnell]

I agree with my hon. Friend. I will talk about that because it is one of the issues that young people raise with me time and time again: the amount of stress and pressure that they feel under from a worryingly young age.

--- Later in debate ---

[Catherine McKinnell]

The right hon. Gentleman raises a pertinent question and one that I would be keen for the Minister to answer when he responds. This is not just about the young people who we want to benefit from a whole-school, holistic approach to mental health education; it is about the ability of our teachers, support staff and the wider school to deliver that. It is partly a training issue but partly, and significantly, also a resource issue. I am pleased that the right hon. Gentleman raised that question and I would like to hear the Minister’s response.

The whole-school and universal approach to mental health is supported by the British Psychological Society and the Association of Educational Psychologists. The charity YoungMinds, which also campaigned on this issue, made the following recommendations to the Government in its recent report, “Wise Up: Prioritising Wellbeing in Schools”. It recommended that existing legislation should be updated

“to enshrine wellbeing as a fundamental priority of schools”

and that mental health and wellbeing should be established

“as a central part of school improvement, by strengthening the focus on wellbeing provision within the Ofsted framework”.

It also recommended that a wellbeing measurement framework should be developed, trialled and established by 2020, that an

“understanding of wellbeing, mental health and resilience”

is embedded in all teacher training, and that schools are provided with

“designated funding to resource wellbeing provision.”

That leads me to a number of key issues that I believe must be addressed alongside the provision of compulsory mental health education if we are serious about genuinely supporting children and young people on this issue.

[Rachael Maskell]

On funding, does my hon. Friend not agree that it is economically expedient to put this training in place? I know from talking to a head of a primary school in York that she was spending all her time trying to support the mental health challenges of the children in her school, as opposed to being the head of the school, as it is so time-consuming. Therefore, putting the expenditure, funding and investment—if I can call it that—into ensuring that we have a proper mental health programme will actually save resources.

[Catherine McKinnell]

My hon. Friend is absolutely right. It feels uncomfortable to talk about this in monetary terms, but ultimately an invest-to-save policy approach would make huge differences, because if teachers and young people are better supported in their mental health and wellbeing, that will relieve pressures in that school and further down the system, and into adulthood and beyond.

The Government should take seriously the recommendations that I outlined from YoungMinds, which all address putting targets in place and the funding necessary to meet them. I want all children across the country to have the best possible education, filled with rigour and challenge—one that will provide them with the right knowledge and skills to set them up for their adult lives, where they will face many challenges, including in the workplace. However, I know from my time on the Education Committee and from regular conversations with school students, parents and teachers across my constituency just how much pressure young people feel under as a result of ever-increasing demands for schools to deliver the right academic results. Indeed, a constituent recently contacted me about her son, who was prevented from studying certain subjects at A-level despite having achieved good B grades at GCSE. She commented:

“My son is resilient but this has knocked his confidence as he is effectively being told he is not good enough at the start of a really important two years of school.”

There are increasing concerns about the introduction of the English baccalaureate and its significant narrowing of the curriculum at many secondary schools, which reduces the opportunity for many pupils to excel, such is the pressure on schools to deliver results in a small number of Government-defined core subjects.

There is really disturbing pressure on primary age pupils as a result of significant recent changes to the curriculum, school performance measures and SATs. A recent Guardian survey found that some 82% of primary school leaders had seen an increase in mental health issues among primary age pupils around the time of exams, with effects including loss of eyelashes through stress, sobbing during tests, sleeplessness, anxiety, fear of academic failure, low self-esteem, panic attacks and depression. That is in primary schools. I find that a really disturbing picture. Although I am pleased that the Government have listened to some of the concerns across the sector and agreed to scrap key stage 1 tests by 2023, the impact of high-stakes assessments clearly remains for key stage 2 pupils.

It seems to me that there is little point in the Government mandating compulsory mental health education in our schools while they actively undermine pupils’ mental health in the way that I have outlined and that I have seen in the young people I have spoken to and heard from. Indeed, the joint report of the Education and Health Committees concluded:

“Achieving a balance between promoting academic attainment and well-being should not be regarded as a zero-sum activity. Greater well-being can equip pupils to achieve academically. If the pressure to promote academic excellence is detrimentally affecting pupils, it becomes self-defeating. Government and schools must be conscious of the stress and anxiety that they are placing on pupils and ensure that sufficient time is allowed for activities which develop life-long skills for well-being.”

I look forward to hearing how the Minister intends to ensure that this situation is rectified, as it is clearly in the Government’s gift to do so. Of course, a plethora of other issues contribute to the poor mental health of far too many children and young people. The Select Committees’ joint report touched on some of those, which include social media pressures, cyber-bullying, internet safety, sleep deprivation and body confidence.

I seriously urge the Government to recognise just how detrimental families’ economic situations can be for children and young people’s mental health. As part of its breathing space campaign, the Children’s Society powerfully highlighted that

“children in low-income families with multiple debts are more likely to suffer from mental health problems than equivalent families with fewer debts.”

It is estimated that in my constituency alone, some 3,348 children live in families with problem debt. Again, it is in the Government’s gift to do something about that.

Of course, one of the key ways to ensure that our schools deliver something is measurement of it by Ofsted. Reporting to the Education and Health Committees’ inquiry, the Association for Child and Adolescent Mental Health described Ofsted as the

“largest driving force in school practice”;

the Institute for Public Policy Research stated that the

“Ofsted framework has a very strong ability to influence school behaviour”;

and the Education Policy Institute commented that the

“benefit of having Ofsted look at wellbeing is that it is a signal to schools that it is part of their job, and it is not just about accountability measures and the academic side”.

However, IPPR research found that just one third of Ofsted reports made explicit reference to pupils’ mental health and wellbeing, even after personal development and wellbeing criteria were included in the Ofsted inspection framework. That is why the Select Committees’ joint report recommended:

“More must be done to ensure that mental health and well-being are given appropriate prominence in inspections and in contributing to the overall grade given to the school or college. The recently appointed Chief Inspector should, as a matter of priority, consider ways in which the inspection regime gives sufficient prominence to well-being.”

[Catherine McKinnell]

I thank my hon. Friend for both her kind comments and her intervention. We will go on repeating the same arguments and the same compelling case for change until the Government make the changes that we know are needed. I look forward to hearing the Minister’s responses to the specific concerns that I outlined in relation to the Select Committees’ joint report and to the concerns raised by my hon. Friend, from whom I hope we will hear more later.

It would be hugely remiss of me to lead a debate on this subject without touching on the increasing pressures on our education system. Although I firmly believe in the importance of mental health education in our schools, I am always reluctant to propose placing yet another requirement on teachers, who are hugely overworked and under-resourced, particularly given the ongoing financial crisis that many of our schools face.

Despite the Government’s recent announcement about additional funding, the reality is that 88% of our schools still face a real-terms budget cut by 2020. In my constituency, that means Walbottle Campus losing more than £460,000 in real terms between 2015-16 and 2019-20—the equivalent of 10 teachers or £321 per pupil. For Gosforth Academy, it equates to a total real-terms loss of almost £430,000 in the same period. Those are staggering sums, and I know how agonising that is for headteachers who are trying to balance the books. I mentioned earlier that at least one of my local headteachers had to cut the school counsellor to make the necessary savings.

There is little point in seeking to introduce compulsory mental health education at the same time as budget cuts are resulting in existing mental health support for students and families being axed—a situation that is reflected around the country, as the evidence given to the Education and Health Committees showed. There is also little point in introducing compulsory mental health education or a whole-school approach to mental health if it is not done properly, which is why the Select Committees’ joint report highlighted that doing so

“will have implications for staffing and training and the balance of provision and delivery of subjects across the curriculum to allow more time to focus on well-being and building resilience.”

Our report also emphasised:

“Teachers are not mental health professionals, but they are in many cases well placed to identify mental ill health and refer students to further assessment and support. Training school and college staff to recognise the warning signs of mental health ill health in their students is crucial. We encourage the Government to build on the inclusion of mental health training in initial teacher training and ensure current teachers also receive training as part of an entitlement to continuing professional development.”

I know that there is much support for that from hon. Members who have already contributed to this debate.

[Rachael Maskell]

I am grateful to my hon. Friend; she is being generous with her time. Is there not a risk that teachers may feel pressure that they may miss something if they have to refer people to the system, and therefore that they will be really concerned about over-referring or under-referring? That is why it is so important for mental health professionals to be available to support teachers and, more importantly, children.

[Catherine McKinnell]

My hon. Friend raises an important point. I wanted to come on to CAMHS, which my hon. Friend the Member for North Durham (Mr Jones) raised eloquently and powerfully. I support the introduction of mental health education in our schools, for that whole-school approach to be implemented, but I reiterate my concerns that teachers and schools must be adequately resourced and trained for that. School budget cuts, which are resulting in vital services being axed, must stop, and the Government must seriously look again at those issues that are causing young people’s mental health to be so adversely affected. I also feel strongly that in promoting greater mental health awareness and encouraging children and young people to speak out and seek that help, we must ensure that treatment and support is available for them when they need it. We all know that simply is not the case for far, far too many young people affected by mental health conditions at present.

In the Care Quality Commission’s recently published review of mental health services for children and young people commissioned by the Prime Minister, it found that

“whilst most specialist services provide good quality care, too many young people find it difficult to access services and so do not receive the care that they need when they need it. One young person told CQC that they waited 18 months to receive help. Using estimates from the London School of Economics, Public Health England reported that only 25% of children and young people with a diagnosable mental health condition accessed support. The Royal College of Psychiatrists has noted difficulties in finding specialist inpatient beds close to a young person’s home.

CQC has rated 39%—26 services—of specialist community child and adolescent mental health services…as requires improvement and 2%—1 service—as inadequate against CQC’s ‘responsive’ key question, which looks at whether people access care and treatment in a timely way.”

It went on to comment:

“The problem of gaining access to specialist help is contributed to and compounded by the fact that those who work with children and young people—in schools, GP practices and A&E…do not always have the skills or capacity to identify or support the mental health needs of children and young people. When concerns are identified, children and young people, and their families, often struggle to navigate the complicated and fractured system of services created by a lack of joined-up working. Many organisations are involved in planning, funding, commissioning, providing and overseeing support and care for young people with mental health problems. Poor collaboration and communication between these agencies can lead to fragmented care, create inefficiencies in the system, and impede efforts to improve the quality of care.”

That paints a deeply concerning picture, particularly in the light of the statistics I cited at the beginning of the debate. Indeed, the Children’s Commissioner, Anne Longfield, has stated that the CQC’s report makes for “sad reading.” She went on to comment:

“Like the CQC, I acknowledge there are efforts being made to change things and that the staff working in children’s mental health are doing a good job in difficult circumstances. That was never my concern. It is those not getting the care they need…that worries me most…fewer than a quarter of children needing mental health support received it last year. There are severe shortages throughout the system, with the majority of local NHS areas failing to meet NHS standards on improving services.

Yet the numbers we cite on delays, expenditures and percentages can only tell you so much. The reason my office has focused so hard on…mental health this year is that we also hear—day in, day out—from children themselves, their carers, teachers and health system professionals about just how desperate the need is out there.”

I reiterate my concerns about the risks of introducing compulsory mental health education and a whole-school approach to this issue if we do not ensure at the same time a dramatic improvement in the support and treatment available to children and young people when they encounter a mental health condition. We must not have situations in which children wait 18 months to receive support, so that we are not simply ensuring that that those children and young people will continue to be affected by those mental health issues throughout their lives, with all the long-term social, economic and personal costs associated with that.

I reiterate my absolute support for the issues the e-petition raises and the need to ensure that all children and young people receive good quality, age-appropriate mental health education throughout their schooling. I acknowledge that some progress has been made in this area: for example, the Education and Health Select Committees heard about the 2015-16 £3 million pilot between the Department for Education and NHS England to provide joint training to schools and CAMHS staff and to test how having single points of contact in both schools and CAMHS can improve referrals to specialist services. I also know from the Government’s response to the e-petition that they are developing a new Green Paper on children and young people’s mental health to be published later this year, with

“new proposals for both improving services and increasing focus on preventative activity.”

May I take this opportunity to press the Minister to ensure that the various concerns I and hon. Members have raised today—I am sure they will continue to be raised as the debate continues—are tackled as part of the Green Paper, if we are genuinely to address the wider issues for children and young people: the pressures they face as a result of issues in their school and home life; the severe financial pressures schools are now facing and the implications of that in their ability to provide mental health support; and of course the monumental pressure on CAMHS services, which has resulted in a system that is at breaking point? I also suggest to him that, instead of more pilots, promises or warm words about mental health, we take those urgent, necessary steps. We need Government action if we are to prevent the terrible statistics I have outlined throughout this speech, which are just getting worse.

Indeed, only yesterday it was reported that 12 mental health organisations, including the UK Council for Psychotherapy, the Mental Health Foundation and YoungMinds, have written to the Chancellor ahead of his Budget this month, saying:

“We cannot go on with such unambitious targets, or simply accept a situation where promises of extra funding don’t actually materialise at the front line. If the Government is actually to deliver parity of esteem, the Chancellor needs to invest in and ring-fence the mental health budget to ensure any money promised genuinely reaches those it is intended to help. The crisis is here, the crisis is now.”

I agree, and compulsory mental health education, if introduced, would be an important part of the jigsaw in tackling those issues, but only if it has the support it needs both financially and in Government action to make it a reality.

[Robert Halfon (Harlow) (Con)]

I am grateful for the opportunity to serve under your chairmanship, Mr Brady. I pay tribute to the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) for the thoughtful and non-partisan way in which she approached this issue. She has done work with the petitioners, many of whom are here today, and I pay tribute to them for raising awareness of this. I also thank my predecessor as Chair of the Education Committee, and the current Chair of the Health Committee, who produced the report that the hon. Lady described. This debate is important, because we await the Government’s Green Paper on children and young people’s mental health. As I understand it, it will hopefully come out very soon.

It is essential to address the mental health of children and young people for their life chances and wellbeing, and for them to be able to climb the educational ladder of opportunity. The hon. Lady and others have quoted statistics showing that half of mental illness in adult life starts at the age of 15. In her report on mental healthcare in England, the Children’s Commissioner she says that according to the

“Millennium Cohort Study…of over 10,000 children born in the year 2000…At age 7, about 7% of both boys and girls have a diagnosable mental health condition…At age 11, about 12% of both boys and girls have a diagnosable mental health condition…At age 14, about 12% of boys and 18% of girls have a diagnosable mental health condition.”

My constituency experience is that the problem is getting greater and greater.

[Rachael Maskell]

I appreciate the right hon. Gentleman providing those statistics for the debate, but there is a real issue about young people not getting diagnoses, so the incidence is actually far higher. Children in my constituency often wait years for a diagnosis.

[Robert Halfon]

I have recently had a Westminster Hall debate about the same problem as it affects the parents of children with autism, and I agree with the hon. Lady. I did not want to repeat in my speech some of the things that other hon. Members had already mentioned, but she is right.

It is important to educate children and young people about mental health. I mentioned that in the previous Parliament the Education and Health Committees looked into the issue, and reported on it just before the general election. Both Committees recognised that schools and colleges have a front-line role in promoting and protecting children’s and young people’s mental health and wellbeing, and they recognised the need for education and mental health services to work closely together. One of the Committees’ key recommendations was to promote the whole-school approach, which embeds the promotion of wellbeing throughout the culture of the school and the curriculum, rather than confining it to PHSE lessons. They recommended that Ofsted should take the approach to mental health and wellbeing into account when inspecting and reporting on a school. The Institute for Public Policy Research report said:

“The Ofsted framework has a very strong ability to influence school behaviour”.

The Association for Child and Adolescent Mental Health described it as the

“largest driving force in school practice”.

Dr Peter Hindley also said that, although he felt that too often the relevant aspect of the framework had not been implemented, nevertheless there was strong support for the idea that Ofsted should look at how mental health is dealt with in schools.

The need for strong partnerships between the education sector and mental health services is reflected in the report, and concerns were raised, as the hon. Member for Newcastle upon Tyne North and other Members mentioned, about the variation in the quality of links between schools and colleges and CAMHS. The Committee visited Regent High School in Camden where the Tavistock and Portman NHS Foundation Trust has been commissioned to run CAMHS. That partnership between education, health and the local authority was a great example of inter-agency co-operation.

When the excellent previous Minister for Children, Edward Timpson, appeared before the Health Committee, he said that the pilot would be extended to cover 1,200 more schools and that funding had been allocated for that next stage. In light of the kind of project that has been set up in Camden, will the Minister tell us the present position in relation to pilots, and what more is going to be done? The report by the Children’s Commissioner says that it is important it is to have such medical support inside the school:

“Schools should be an access point for early support for children with emerging problems such as short courses of therapy. Where possible, this should be provided within the school. The Green Paper should be clear that council and NHS budgets should help to fund these services.

Where children have more serious needs, schools should be a referral point into specialised services.”

Where there are issues that can exacerbate poor emotional wellbeing or mental health issues, we need to address the root of the problem. According to the Office for National Statistics, children who reported being bullied frequently were four times more likely to report symptoms of mental ill health. A third of children who said that they were unhappy with their appearance also reported symptoms of mental ill health, compared with one in 12 of children who were happy with their appearance. Children who spent more than three hours on social media on a school night were more than twice as likely to report symptoms of mental ill health as children who spent less time on such sites.

We need to ensure that we help children and young people to make sensible choices about social media. Our predecessor Committees recommended that schools should include education about social media in PSHE lessons, providing children with the skills and ability to make wise and better-informed choices about their use of social media. I ask the Minister and the Department for Education to conduct a serious study of the impact of social media—a separate issue from cyber-bullying, although that is very much part of it—on children’s mental health. Then we will be able to see proper data, and the impact of what is happening.

The Minister relentlessly pursues high standards, and there is a lot of sympathy for that, but the pursuit of high academic standards should not come at the expense of children’s mental health. Witnesses who gave evidence to previous Committees suggested that other subjects, such as art and creative activities, have been squeezed out, but that those things help in developing lifelong skills for improving wellbeing. Last week, as my fellow Select Committee Member, my hon. Friend the Member for Telford (Lucy Allan) pointed out, the Education Committee held a round table with teachers, who spoke movingly about the pressure on children, and the mental health problems that they faced in the classroom. One participant told us of the importance of time for physical exercise and social skills, and for wellbeing and mindfulness. Achieving a balance between promoting academic attainment and wellbeing should not be regarded as a zero-sum activity. Increased mental health treatment and wellbeing can equip pupils to achieve academically.

That is something that I know from my constituency experience. Last year, their Royal Highnesses the Duke and Duchess of Cambridge visited the Stewards Academy as part of the Heads Together campaign, which does a lot of work on mental health; it works with the mental health charity Place2Be, as well as fundraising for mental health services. The school was highly commended. Since it has placed an emphasis on looking after the mental health and wellbeing of its students its GCSE and other exam results have improved.

I welcome the Government’s intention to publish a Green Paper. The Committee and I look forward to examining it, and to seeing whether the recommendations of the previous Committees have been taken on board. Statistics from the prevalence survey have been quoted. My concern is that the previous prevalence survey was done in 2004. I understand that there is to be one next year, but the Minister and the Secretary of State are rightly mindful of the importance of data in making decisions, and it is incumbent on the Government to analyse the data on the mental health problems of children in schools and to examine whether such problems are increasing as, anecdotally, many of us have found is happening in our areas. There is a need to consider whether funding restraint has led to an increase in the number of children suffering from mental health difficulties. I should be grateful if the Minister told us when the next survey will be published.

I mentioned that it is a false dichotomy to have to choose between academic standards and students’ wellbeing. The Health Committee report noted that

“the Association of Directors of Public Health told us that ‘Children with higher levels of emotional, behavioural, social and school wellbeing have higher levels of academic achievement on average’”.

That is an important statement. I mentioned that it would be good to study the impact of funding pressures. I recognise that the Government have recently made welcome announcements about the national funding formula. However, the report of the Children’s Commissioner mentions a cost-benefit analysis in relation to resources for schools to deal with children’s mental health difficulties:

“The Department of Health estimate that a targeted therapeutic intervention delivered in a school costs about £229 but derives an average lifetime benefit of £7,252. This is cost-benefit ratio of 32:1.”

I think that that is a powerful statistic supporting the argument that if we put in resources we can make a difference and avoid huge cost pressures on the Exchequer later. Not only is it the right thing to do but it helps with funding.

Finally—I know other hon. Members want to speak—the aim of the Education Committee is to promote the educational ladder of opportunity and to look at the skills problems we face. The first rung of the educational ladder of opportunity is addressing social injustice, and there is a real problem of social injustice here. The Government have done good work, but problems for children and mental health seem to be endemic in our school system for a variety of reasons that were ably set out by the hon. Member for Newcastle upon Tyne North. I urge the Minister and the Department for Education to treat the matter of social injustice with as much importance as they do raising standards and improving quality in our education system—something that the Minister is an important proponent of and has done so much to achieve.