Mental Health Education in Schools

Robert Halfon Excerpts

Monday 6th November 2017 Westminster Hall

[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.

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[James Morris]

I definitely agree with my right hon. Friend on that. As I said, the family is the crucible. The issue is often very complex, and the relationship between the family and the school is a critical part of what we are discussing because, again, families can be a place where therapy is very effective, and can be a very effective way of helping the child and making them resilient, so I very much agree with my right hon. Friend’s point.

[Robert Halfon]

Could I add just one qualification? Children with mental health difficulties may be experiencing significant family breakdown and may not be able to have the family involved, and therefore the school is literally the one place that can really help the child. That goes back to what my right hon. Friend the Member for Mid Sussex (Sir Nicholas Soames) and others said about teacher training and a young person being able to go to someone in the school who can actually look after that student.

[James Morris]

I thank my right hon. Friend for that intervention. I totally agree: clearly, it will not be possible to involve the family in all cases. I have seen examples in my constituency, particularly in the primary school environment, in which headteachers and teachers have taken really interesting and creative decisions to replicate the family environment for children who have not been brought up in a stable family environment and have not entered primary school in a properly socialised way. They have replicated the family environment and tried to create those kinds of structures because they have been absent, so I completely agree with my right hon. Friend on that.

Other hon. Members have talked about CAMHS and I want to make a few comments about early intervention. If you look at the spectrum of what we are talking about, it could be argued that by the time children get to school any mental distress and difficulties they suffer from will have been baked in for many years. There has been a debate about early intervention and mental health for years; it is what I would call a policy no-brainer. Everybody agrees we should intervene earlier. Everybody agrees that in principle that is a good thing. Yet we are still debating about whether we are doing it sufficiently well and how it should be done. The truth is that we should shift resources to where the evidence points us.

The evidence points to the joint Green Paper on children’s health and education, and adolescent mental health, which other hon. Members have mentioned. The evidence suggests that interventions at an early age, sometimes pre-primary school, are the most effective interventions that we can make on a therapeutic level. From the evidence, it looks like working with children from birth to the age of two, working with families, and working with parents is the most effective intervention we can possibly make. I urge the Minister to be bold in terms of what we will do in that Green Paper. If we can do only one or two things from that Green Paper, we should focus on the really important one, which is shifting resources to genuinely effective early intervention based on evidence. Everything else we have talked about, such as mental health first aid and so on, has a role to play in this debate, but it will not solve the problem we are trying to confront. We will solve this problem by focusing a lot more resources in a laser-like way on early intervention—even before school. That is the critical part of this debate. The one bold move for the Government would be to focus their attention on that. Then we might be able to make significant progress.

Other hon. Members have mentioned CAMHS. If we were designing a child and adolescent mental health service today, we would not design it in the way it currently operates. We have had several reviews of CAMHS over the last decade. Other hon. Members have mentioned Future in Mind, the CQC has just done its review and there have been other reviews. We know that CAMHS is currently not fit for purpose. That is not to say that people working in CAMHS are not doing an excellent job in delivering the services they do, but we need a more integrated service. We need to move away from the tiering approach, which means we concentrate on tier four—that is children with the most severe mental illness. If we can get rid of this metaphor of tiering and focus on access to the appropriate level of care required by a child or young person in a place appropriate to them and deal with it across the spectrum, and integrate it with initiatives that are being taken in schools and the initiatives I have been talking about in relation to early intervention, we can make significant progress.

We have come a long way. People use the word “crisis,” which I am always very wary of using. It is not as if this crisis started today. The debate about children and young people’s mental health has been going on since about 1962 when Enoch Powell, then the Public Health Minister, made the decision that we would no longer put people in asylums but would move towards a community model. That was in 1961 or 1962. We are only now beginning to have a real debate about how we really tackle some of the underlying issues that we face in society in terms of the mental health of children and young people. We are much better at talking about it, but the debate actually is only just beginning and the Government have an opportunity to take some really bold steps, which would have a lasting legacy.

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[The Minister for School Standards (Nick Gibb)]

It is a pleasure to serve under your chairmanship, Mr Wilson. I congratulate the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) on introducing the debate and on her excellent informative and powerful speech. I congratulate HeaducationUK and the Shaw Mind Foundation for securing more than 100,000 signatures—the first time a mental health charity has achieved that level of support on the petition website. I also congratulate other hon. Members and my right hon. and hon. Friends on their informed and powerful contributions to what has been a consensual and broadly united debate about some important and far-reaching issues.

The mental health of our children is a key priority for the Government. We want all children to have the opportunity to fulfil their potential and to develop into confident and happy members of society. In our manifesto, the Prime Minister set out a commitment to publish a Green Paper on children and young people’s mental health by the end of the year. The Department of Health and the Department for Education have been working together on the Green Paper to achieve a step change in the way we support the improvement of children and young people’s mental health.

I assure my hon. Friend the Member for Halesowen and Rowley Regis (James Morris), who I congratulate on a moving speech, that the Green Paper will be bold. It will look at the roles of health and education in supporting the mental health of children and young people, how we can prevent mental illness from occurring and how we ensure that children and young people receive the right treatment in the right place at the right time. I confirm to hon. Members that evidence and recommendations from the joint report of the Education and Health Committees have informed the proposals in the Green Paper. I thank all members of those Committees for their work in producing that report.

A child’s attainment at school is linked to their mental health and wellbeing. We are determined to improve both by ensuring that children with mental health issues are given all the support required to allow them to focus on their education. Schools can play a key role in how they teach about the importance of mental health and in the prevention and identification of concerns. The hon. Member for Newcastle upon Tyne North raised the issue of exam stress. Good teaching is one of the most important factors in helping pupils to achieve. Academic success is important and good headteachers know that positive wellbeing is necessary to support that achievement. Schools should encourage pupils to work hard, but not at the expense of their wellbeing. We have removed incentives for things that add to stress, such as the culture of multiple exam resits. We are helping schools to spot mental health problems through programmes such as mental health first aid training, and through resources such as the MindEd website, funded jointly by the Department of Health and the Department for Education, which has resources and information on mental health for adults working with children and young people.

We recognise that, as been said a number of times in the debate, teachers are not mental health professionals. When more serious problems occur, schools and colleges should expect the pupil to have additional support from elsewhere, including professionals working in specialist children and young people’s mental health services, voluntary organisations and local GP practices. To help with that, the Department ran pilots to look at how joint working between health and education could be improved by having single points of contact in schools and in mental health services. The evaluation found that the pilots led to increased satisfaction with working relationships, improved knowledge and awareness of mental health issues among school leads, and improved timeliness and appropriateness of referrals.

My right hon. Friend the Member for Harlow (Robert Halfon) asked about the future of the pilots. We are extending them to up to 1,200 more schools and colleges in 20 additional clinical commissioning group areas. Our survey, “Supporting mental health in schools and colleges”, found that 73% of schools and colleges provide specific lessons to help to promote positive mental health and that 64% of schools and colleges report that the promotion of young people’s mental health and wellbeing is integrated in the school day.

[Robert Halfon]

Is the Minister referring to the pilots of 1,200 schools that were announced by the former Children’s Minister, Mr Timpson, when he gave evidence to the Select Committees, or is it another tranche of 1,200 schools on top of that?

[Nick Gibb]

It is the same point that Ed Timpson made at that Committee, but it is important for this debate that we are extending those pilots to 1,200 more schools and colleges in 20 additional clinical commissioning group areas.

As well as the role of the wider teaching staff, many schools have staff with more specific roles in relation to mental health. Around half of schools and colleges have a dedicated lead for mental health; more than two thirds of schools have a designated member of staff responsible for linking with specialist mental health services; and 87% of institutions reported that they had a plan or policy in place for supporting pupils with identified mental health needs.

Evidence shows that a whole-school approach, established with a commitment from senior leadership and supported by external expertise, is essential to a school’s success in tackling mental health. A whole-school approach involves the work of all staff and students, with clear links to school policies, for example on behaviour, and a culture and atmosphere that promote good mental health. Tom Bennett’s review of behaviour in schools found that a consistently applied whole-school policy, with clear systems of rewards and sanctions, was key to securing good behaviour. He argued for the importance of a whole-school culture that is effectively communicated to all staff and pupils and stated that the best behaviour policies balance a culture of discipline with strong pastoral support. The combination of clear boundaries and known sanctions for poor behaviour with a caring atmosphere is fundamental to promoting good behaviour and wellbeing for all pupils.

My right hon. Friend the Member for Harlow suggested a study of the impact of social media on children’s mental health. We are working closely with the Department for Digital, Culture, Media and Sport on the internet safety strategy, which includes working on online safety with experts, social media companies, tech firms, charities, mental health practitioners and young people. I am sure that that work will highlight gaps in the evidence, as he suggested.

My right hon. Friend also asked when we would next publish a survey on children’s mental health. The Department of Health has commissioned a new survey that will examine the prevalence of mental health and wellbeing problems among children and young people nationally. The new prevalence survey will enable us to make comparisons with the prevalence recorded in the 2004 survey and will be published in 2018.

A number of hon. Members asked about Ofsted’s role in helping to deliver these objectives in our schools. Under the current inspection framework, inspectors reach a graded judgment on pupils’ personal development, behaviour and welfare and consider their spiritual, moral, social and cultural development. We will work with Ofsted on any implications that arise from mandatory relationships education and relationships and sex education.

My hon. Friend the Member for Telford (Lucy Allan) raised the important issue of mental health and children in care. The forthcoming Green Paper will consider how to improve support for vulnerable children and young people, including children in care. This includes ways of improving access to support, better joint working among services and improved training for professionals. An expert working group has been established to look at ways of improving support and care for children and young people in care; it will report shortly and we will fully consider all its recommendations. We will pilot new approaches that draw on the group’s findings to improve the quality of mental health assessments for looked-after children.