Child and Adolescent Mental Health Services

Robert Flello Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Dr Wollaston]

I thank the Minister for that intervention. It is very welcome that we now have waiting time targets as a right for people with mental health problems, alongside those for people with physical health problems, but the challenge is not so much about the budget for children and young people’s mental health services, but what we take that from, because there are no areas of slack in the mental health budget, as he will know. I think that the mental health budget overall must achieve some parity. Again, if we look at prevention and the really small amounts of money, in relative terms, that are required to keep excellent voluntary services running in our communities, we see that it would be the greatest waste and tragedy to lose those vital services in our communities for the want of what are really quite small sums. When children, young people and voluntary services came to give evidence to our inquiry, we heard time and again that what they need is stable, long-term funding. They do not require a great deal of money, but they are currently limping from one short-term budget to another. Another issue raised was that if funding is available, it often gets directed to a new start-up project, not towards a project in the same community that may have proven value.

[Robert Flello (Stoke-on-Trent South) (Lab)]

The hon. Lady is no doubt aware that some of the small, really good charities will find that a bigger charity that is very good at filling in application forms will get the funding and then subcontract the work back to the small charity that was doing it before, having taken a cut of the funding as well.

[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.

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[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.

[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.

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[Robert Flello (Stoke-on-Trent South) (Lab)]

It is a pleasure to follow the hon. Member for Southport (John Pugh) and his contribution to the debate. He made extremely good points.

I should like to refer to an experience I had some 12 or so years ago of running an organisation in Birmingham called Malachi Community Trust, which worked with young people with emotional, behavioural and mental health issues. More often than not, it also worked with their families, including parents and their wider families, to resolve their issues. We worked with qualified cognitive behavioural therapists and teachers—they were primary age children—in the school setting. It is interesting but deeply saddening that so many items in this extremely good report take me straight back to some of the conversations of 12 or 14 years ago.

I want to give a brief outline in the unfortunately few minutes that are available of what Malachi did—it is still going strong. It used musical theatre to engage with young people and as a tool to identify their issues. It enabled processes to be set up to work with those children and young people who had more profound mental health issues. Pertinently for today’s debate, it acted to stabilise the situation for children who were on waiting lists to see CAMHS staff. Back then, there were three, four and five-month waits, or longer. Malachi was not the only group that did that work, although it was and still is particularly good—I have fond memories of what it did. Malachi and other organisations were very good at that stabilisation. They were good at holding those young people in a place where they were not deteriorating while waiting for CAMHS workers. My fear then, and sadly now, is that an awful lot of children—some of our most vulnerable citizens—are waiting for CAMHS workers and their conditions are deteriorating, and their needs are getting worse and not better, because of the waiting lists.

One of the big issues we identified was family breakdown. Parental conflict and family breakdown is a very strong factor in mental ill health in children. A statistic suggests that one in four young people in Stoke-on-Trent are affected by family breakdown and divorce. That means that approximately 15,500 children in Stoke-on-Trent alone will be affected by parental breakdown and divorce. That does not immediately mean that those children will have a mental health issue, but it is a factor that makes them more vulnerable. To pick up on some of the comments made by the hon. Member for Southport, children need the skills and the ability to have resilience, so that if there are factors that might tip them into having mental ill health issues, they have the resilience to address them. Sadly, for all too many of our children there is not the ability to build that resilience.

My hon. Friend the Member for Sheffield Central (Paul Blomfield) referred to local authorities. The ability to gain that resilience from services such as those offered by local authorities is not possible in Stoke-on-Trent, where local budgets have almost been wiped out for some children’s services. I seem to be constantly talking to people who used to work for the local authority in children’s services, but have now gone off to do other things because they can no longer be afforded. The main thrust of what I want to say is that more than 10 years ago there was a shortage of access to CAMHS. We do not seem to have gone anywhere with that. It seemed to get better, but it is now getting dramatically worse.

Healthwatch Stoke-on-Trent helpfully brought to my attention a list of issues that they are concerned about. When I say “they”, I mean children, young people and the adults supporting them. It makes deeply saddening reading. The first item on their list of what they want is a single point of access for real-time professional advice and guidance that can refer them to mental health services with the support they need when there is a crisis. This was again being talked about more than 10 years ago when I was attending meetings in what was still then, despite the fact it had been going for 10 years, a fledgling CAMHS. Nevertheless, even back then there was talk about having a single point of access. We have come full circle on the need for a single point of access.

Those children, young people and the adults supporting them talk about information, options and guidance to navigate the range of services and pathways available to them, and evidence-based interventions that are appropriate to them, with follow-up support as needed—the right service, first time. It is sad that here we are, so many years later, without that service—or, where a service has been developed, it has gone because of the cuts. The Government are now having to undertake a review to take us back to the probably better work being done in the period leading up to 2010.

These people want a greater use of technology and access to online support. Technology has come a long way in the past 10 years, and I welcome that good suggestion from the children and young people themselves. They would like more support from schools and direct interventions on school premises in the school day, such as counselling, peer mentors and quiet spaces. There are quiet spaces in some of the good schools that I am blessed to have in Stoke-on-Trent. For example, St Thomas More school has a specific arrangement and understanding that young people who feel that they need to go out and get their head together can use the space that has been made available. I am sure other schools do that as well, but that example was highlighted to me. Malachi was doing innovative work on support in schools 15 or 20 years ago. I made the point in an intervention on the hon. Member for Totnes (Dr Wollaston) that when Malachi lost bids to big national charities, those charities would then subcontract back to Malachi, because they knew they had an in with the schools and could provide the service.

Going back to the list, those children and young people and the adults supporting them want clearer step up, step down work given that their mental health needs change and fluctuate, as well as more early support from non-mental health practitioners and their peers and/or older mentors. Their final point is that they do not want to be stigmatised when seeking and accessing help, which is so important. In addition to those things that the children and young people want, they have asked for clear referral routes and pathways through services, so that they get the intervention they need quickly, without being referred to multiple services—often waiting some time for an assessment—before finding that the service is not the right one for them anyway: having waited three or four months to get into the system, they then find that it is not what they needed and they have to start all over again.

The children and young people have also asked to be involved in planning their own care, to be part of setting their own outcomes and goals, to be consulted when changes are made to service provision and for their parents to be given support so that they can support them. The parents themselves, the carers, have asked for there to be clear access to services—that comes up time and again—and parenting support in the community that is easily accessible and non-stigmatising. Going back to my Malachi days, one of the hugely important things we did was to work with the parents, supporting and helping them, enabling them to take on a lot of the work of maintaining and helping their own children.

There are a few more items on the list, but I am conscious that I will rapidly run out of time if I am not careful, so I want to move on to a few of the risk factors. Again, they are not new, but things that we have come across too often, and it is important to raise them in the context of Stoke-on-Trent. In a report on this, the first factor listed among those that will have an impact on children and young people’s mental health is—this comes up time and again—deprivation and poverty:

“The close association between mental disorder”—

as it is termed—

“and economic disadvantage was clearly illustrated by income analysis in the Mental Health of Children and Young People in Great Britain in 2004 survey”,

so this is not new evidence. That is a huge problem in places such as Stoke-on-Trent, where we still have such high levels of deprivation—indeed, they have been made worse recently.

I have mentioned parental conflict and breakdown, but there is also communication/speech and language delay. In Stoke-on-Trent there is a huge problem with language delay. Fantastic projects such as Stoke Speaks Out are addressing it, but if a child is having difficulty expressing their needs, how much more difficult will it be for that child—that young person—to be able to eloquently, or indeed adequately, put across what they want from the system that is trying to help them? Attainment in education is still an issue, despite the dramatic improvements that we saw in Stoke-on-Trent. Then there is housing and homelessness; and again, the poor standard of so much housing still in Stoke-on-Trent is a tragedy.

I want to make an observation about children in care and some of the organisations. The local authority in Stoke-on-Trent has seen a rise in the number of children in care in just a short period. From July 2010 to June 2013, there has been an increase of 38% in the number of children needing support in care in Stoke-on-Trent. That is a massive increase in the number of young people in the care system, which is a huge risk factor for mental ill health.

I close by observing a couple of things about Stoke-on-Trent. There is, as I have mentioned, Healthwatch Stoke-on-Trent and the good work it does. There are other organisations doing fantastic and excellent work, including Young Carers—part of North Staffs Carers Association. I have had the huge privilege on a number of occasions to meet the young people from Young Carers and hear about the amazing things that they—children—are called upon to do, quite often looking after their parents, and the huge impact that has on their mental health. Finally, there is another scheme, whose details I have unfortunately lost in the pile of papers in front of me. Home Start has been running in Stoke-on-Trent for about 30 years. Sadly, because the local authority is so strapped for cash and has had to cut its budget, after all that time and after helping thousands of families, Home Start is now closed. It is gone. It is another resource that is no longer there to help the people of Stoke-on-Trent.

That is the backdrop to the report by the hon. Member for Totnes and to what the Minister is doing with his investigation, both of which I welcome. It saddens me so much, however, that we seem to have gone nowhere in 10 years. Let us try to make sure that we do something about this in the coming months rather than in the years ahead.

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[Norman Lamb]

I agree. It is intolerable. One can only imagine the impact on the family having to travel such long distances. My hon. Friend and I had that discussion in Brecon with the family concerned. It is shocking that that practice continues. It must be a priority.

My hon. Friend the Member for Totnes said that the importance of early intervention is a central theme of the report. There is great scope for much more to be done on public mental health. It was revealed recently that a tiny proportion of public health budgets in localities is spent on public mental health, and yet we know—there is loads of evidence—that, if we invest in public mental health, we can achieve a significant return on it. I welcome the report.

The hon. Member for Sheffield Central (Paul Blomfield) talked about what young people had told him. It was great that they were given a voice directly in this place. I welcome his comments.

In a very thoughtful speech, as always, my hon. Friend the Member for Southport (John Pugh) talked about a continuum. Many of us are susceptible to poor mental health in certain circumstances. That makes the point about the importance of schools, which other hon. Members mentioned, in building resilience and keeping youngsters stronger so that they can cope with all the challenges they inevitably face these days.

The hon. Member for Stoke-on-Trent South (Robert Flello) talked about Malachi, an organisation he was involved with, and about the triggers that can cause mental ill health among youngsters. Family breakdown is one, but bereavement can have a significant impact, as can bullying at school, which another hon. Member mentioned.

[Robert Flello]

Will the Minister give way?

[Norman Lamb]

I am conscious that I need to get through quite a lot in the time available to me.

I thank my hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) for his kind comments. He was absolutely right about the potential for online access. The hon. Member for Windsor made a similar point. There is enormous potential. One platform is called Kooth. Good evidence is developing about the impact that online access can have. Given that so many youngsters with poor mental health get no support at all, we can do a lot to increase access, not as a replacement for other services, but as a complement. He, too, talked about the importance of the role of schools.

I worked in Parliament as a junior researcher in 1980, for a Labour MP. I shared an office with the secretary of the hon. Member for Coventry North West (Mr Robinson). He is still here 35 years later. He is clearly the great survivor. He referred to the most appalling wait of 44 weeks in Coventry, which is totally unacceptable. I do not know what is going wrong in that locality, but that is not matched in many other places. There may be particular problems that need to be faced. In a way, that makes the case I have been making throughout my time as Minister that the same access and waiting time standards for physical health should exist for mental health. That is the big discrimination against mental health, and it has existed for a very long time.