Mental Health Education in Schools DebateFull Debate: Read Full Debate
Robert HalfonMain Page: Robert Halfon (Conservative - Harlow)
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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.
Thank you for calling me to speak in this important debate, Mr Brady. It is a pleasure to follow my right hon. Friend the Member for Harlow (Robert Halfon), and I pay tribute to the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) for her inspiring opening to the debate.
We all agree that education is about preparing our young people for the future. Key to both success and survival in life is being able to build resilience and learning how to take care of our own wellbeing and mental health. Without doubt, that is the most vital tool in the armoury of any young person, as they will inevitably take on many challenges as they go through life. Schools have a critical role to play in promoting an understanding of self-care as it relates to exercise, diet, sleep, mindfulness and building strong social networks for support, as well as the negative role of alcohol and drugs in mental health and how to avoid the pernicious influence of social media and its effect on wellbeing. However, family, friends and healthcare workers also have a significant role to play.
I am pleased that today young people are far more likely to talk openly about mental health issues, whether in school, at home or with friends. There are real signs that the silence and stigma are being shattered, but there is much more work to do, and schools can play a vital part in that. I welcome the Prime Minister’s commitment to mental health training—I think it was referred to mental health first aid training. I was not entirely sure what that meant, but mental health awareness training is a goal we should seek to achieve. I would like every school to seek to promote mental health awareness and to give students pointers on where to go, and all teachers to have an understanding of how to spot signs of mental ill health.
I welcome the forthcoming Green Paper on children’s mental health, and I ask the Minister to consider an earlier Education Committee report, prior to the joint report between the Health and Education Committees that we have talked about. The earlier report was in the 2015-16 Session, when the Education Committee looked into the mental health of children in care. One of the points that emerged in that report was about navigating the system and getting access to support when a child might experience multiple placements in any one year. One of the blockages to accessing support was that without a stable placement, the child was not eligible to qualify for child and adolescent mental health services. I urge the Minister to commit to reading that report, because we took evidence from a large number of influential and knowledgeable people, and their recommendations and some of the proposals in the report were somehow put to one side at the end of the last Session. Please, please can the Minister read the report and confirm that the upcoming Green Paper will specifically include provision for children in care and the need for school-based counselling for looked-after children?
To re-emphasise that point, during the inquiry into the mental health care of children in care, one child told us:
“The state took us away from our parents, the Government are now our parents. Parents will do anything for you”—
parents will help their children to navigate the system—
“but the state doesn’t provide that.”
We have a special duty to those children in care, who do not have parents to fight the system for them and help them to get access.
About a year ago, we had a debate on that report in this Chamber. I urge the Minister to look back at what was said, because the excellent and much missed former Member for Crewe and Nantwich, then the Minister for Children and Families, had a great deal to say. He committed to a number of measures that I feel may also have slipped to the back of the shelf. I would love to see that work not going to waste but brought forward during the drafting of the Green Paper, so that the Committee’s work, the Minister’s commitment and the evidence of all the experts are not wasted. The then Children’s Minister said that there would be an expert working group to consider access to mental health care for children in care via school systems. That may have fallen by the wayside, or the expert working group may be well under way, and I would be grateful to know which it is. If the Minister cannot answer that today, I would be most grateful if he did so in due course.
I hesitate to sound any discordant note in this collaborative and helpful debate, where we all want to achieve the same thing, namely improving the mental health of children in school, but I have concerns, and will sound a note of caution, about the compulsory element for all schools. I recognise that there is patchy provision across the country, but to my mind it is the CAMHS provision that is so patchy. I am wary of imposing on teachers yet another burden that becomes a tick-box exercise, so they can say, “We’ve done this—end of. We’ve dealt with mental health care of children. We gave that half-hour lesson in the personal, social and health and economic education class and that’s finished. We don’t have to deal with it anymore.” Schools may want to signpost students, discuss wellbeing through informal drop-ins or school counselling sessions, or they may want to make it a formal part of PSHE, but that may not always deliver the results we all seek for our young people.
I also question whether a school should be responsible for identifying our young people’s mental health needs. As we have heard from many speakers today, teachers are not mental health professionals. They cannot replace the services of CAMHS and we should not ask them to do so. What role should we encourage families to take in helping young people to understand self-care and the pointers to where mental health support is required? We should all encourage young people to take care of their own mental health and wellbeing and, as they grow older, to accept some responsibility and accept that they can make a difference to their own mental health and seek out assistance and support where required.
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.
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.
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.
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.