Children’s Mental Health Week 2024

Wera Hobhouse Excerpts

Tuesday 30th January 2024 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

It is an honour to serve while you are in the Chair, Mr Pritchard. I congratulate the hon. Member for Tooting (Dr Allin-Khan) on introducing the subject in such a wide-ranging and compassionate way. I prepared only a few notes because I thought the debate would be over-subscribed, but I hope we will still fill the time. I might add a few things that I have not prepared.

I want to focus particularly on adverse childhood experiences. I have been the chair of the all-party parliamentary group for the prevention of adverse childhood experiences, which we now call the APPG for childhood trauma, for some years. Listening to and understanding the science of adverse childhood experiences has given me a real insight. I commend the WAVE Trust, which has also done a lot of work on attachment disorder and the importance of a child’s early attachment to their mother. The trust has been a fabulous supporter of the APPG for childhood trauma.

Our children are falling through the cracks. It is clear that our approach to childhood mental health is not working—I agree with the hon. Member for Tooting on that. As the chair of the APPG for childhood trauma, I will focus my attention on trauma in mental health.

Adverse childhood experiences, also known as ACEs, are the biggest drivers of poor mental health in children. They can be anything that threatens to overwhelm the child, including abuse and neglect. Being unable to process prolonged stress can alter a child’s normal brain function, which often stays with that person all their life. That is what we call trauma. A child’s brain helps them to survive in the moment, but it assumes that persistent stress or danger is normal and it therefore adapts to constant adrenalin. Because of that, those who experience childhood trauma are twice as likely to develop depression and three times as likely to develop anxiety disorders.

Very often, children’s behaviour at school is also affected. I asked a question in Education questions earlier this week about the Government’s behaviour policy, because ACEs are not even mentioned in it. If we do not talk about ACEs more—I use every opportunity to talk about them—gaps appear in the behaviour policy or guidelines to schools. The Department for Education does not even mention ACEs and childhood trauma; that needs to be corrected.

Many children carry their traumatic experience into later life. Someone’s chances of dropping out of school, being obese or even developing diseases such as strokes are higher the more ACEs they have experienced. The life expectancy of those with six or more ACEs is 20 years lower than that of peers with none. There is no limit for the reach of ACEs. That does not mean that people who suffer adverse childhood experiences are invariably condemned to a life of disadvantage, but it is so much more likely. We therefore have to focus on it.

Poverty is also an adverse childhood experience. That is why the connection between mental ill health and poverty is so important. We need to focus and see it for what it is.

[Sir Jeremy Quin (Horsham) (Con)]

The hon. Lady is making a fascinating speech, and I look forward to hearing more from her on a future occasion. She draws attention to how young people can get support and be recognised. In my constituency, we had a series of tragic events. Out of that, the NHS has provided i-Rock Horsham District, which is an opportunity for young people without a referral—without being told by a teacher, parent or doctor that this is the appropriate path—to present themselves for professional support. It will not be fully-fledged psychiatric support but it will have that triaging process, sometimes helping them with more basic issues or reassuring them, but often helping to pick up where they really need the kind of support my hon. Friend the Member for Penrith and The Border (Dr Hudson) and others have referred to. That is proving extremely effective in my constituency.

[Wera Hobhouse]

I could not agree more. I hope my speech will make everybody here realise that we need much more understanding about ACEs. Some countries have that understanding and roll out trauma-informed services across the board, including police, education, welfare and health. A better understanding of ACEs will lead to more specialism and more people understanding this area. Trauma-informed schools, for instance, would also mean that teachers pick things up and go deeper into the issues of childhood trauma. I was a secondary school teacher before I became a Member of Parliament, and I sometimes wish I had known about ACEs, given some of the behavioural challenges I faced, which would make someone think, “That is just a very difficult child.” If I had known more, I would probably have picked up the behaviour as that of a traumatised child, rather than that of somebody who was consistently causing trouble. We would therefore deal with children differently.

[George Freeman]

The hon. Lady is making a powerful case, and I am keen to hear as much of it as I can. To the point I was trying to make earlier, extreme poverty is one cause of childhood trauma, but there are many others. Like many people in this House—I put my own hand up—I experienced childhood trauma, but I was in a materially privileged family. Poverty can provide a lot of those drivers that the hon. Lady has talked about, but I was taken out of the arms of my father by the police at 11 months, and I was a child carer of an alcoholic parent. Poverty has a part to play, but does the hon. Lady agree that we need to make sure we frame this in the context of the real causes, some of which are not related to poverty but to other chronic problems, such as alcohol, addiction or domestic violence? If we view the matter simply through the prism of a poverty attack, we are in danger of missing out some of the causes that are really embedded in repeated patterns of trauma within families.

[Wera Hobhouse]

First of all, it is brave that the hon. Gentleman is sharing his experiences of trauma. I think we need more people to do that. He is also absolutely right that not all of this is directly linked to poverty. Poverty or extreme poverty is one ACE among many others, and these things can happen in any family. Those who are doing research into ACEs would always recognise that trauma is not just suffered in a particular type of household but across socioeconomic backgrounds. The hon. Gentleman will know how difficult it is to overcome the traumas of early childhood and deal with them.

I want to make some progress. I am sorry that I cannot expand on ACEs now, but I encourage everybody who is here to inform themselves about them and the research that the WAVE Trust has done into the subject, which is fascinating and ongoing. That research suggests that the adverse childhood experiences of abuse and neglect alone, which can happen in any family, cost the UK more than £15 billion a year. Clearly, the cost of preventing adverse childhood experiences is less than that of inaction.

Unnoticed and unaddressed, adverse childhood experiences can be a lifelong sentence. Childhood trauma does not end with the child and it gets transferred to the next generation—that is also something that the APPG for childhood trauma has researched further. Then, there is a spiral or a vicious circle of repeat trauma. If childhood trauma is not addressed, those who become parents will carry their adverse childhood experiences into the next generation, and their children may suffer trauma, too. We must end this cycle, and that starts with early intervention. One factor that can help to prevent childhood trauma is whether the child feels capable and deserving. A supportive and reliable adult presence is key, and we often hear about how teachers, for example, have helped a great deal because they, as an adult, have been in the room when home life has been very difficult.

As I have said, trauma-informed services across the board—in schools, the NHS, the police and our prisons—would have a transformative impact on the whole of our society. Social workers must be supported to recognise the effect of ACEs early in children’s lives. Early years practitioners can spot signs of trauma at the age at which it is most likely to be resolved. I hope to hear commitments from the Minister on implementing trauma-informed services. Examining how trauma affects minds allows us to gain an enriched understanding of behaviour, and I have mentioned how that would support teachers. Rounded insights and changes in approach lead to better care for children, and better care for children now will be felt for generations to come.

[Tim Loughton (East Worthing and Shoreham) (Con)]

I had not intended to speak, but there appears to be an opportunity to do so, and I am not one to pass it up, so I will make just a few comments. I declare my interests as per the Register of Members’ Financial Interests. Until recently, I was also for six years the chair of the trustees of the Parent-Infant Foundation, which did and continues to do very important work on infant mental health awareness, attachment and the provision of services.

I again congratulate the hon. Member for Tooting (Dr Allin-Khan) on securing this debate. It is a subject about which she knows much, and her passion shows through. I disagree with little of what she said, although her speech became a little partisan at some stages. This issue has besieged Governments over many years, but if one looks at the figures, most alarmingly, the incidence of mental illness among children has got particularly bad since the beginning of covid, and there are reasons for that that we should continue to be worried about. This is not a gradual progression; there has been a very serious downturn in recent years, which I will come back to.

I agree with all the comments that have been made about the disproportionate impact on children in the care system, children from black and minority ethnic backgrounds and those in poverty. However, as my hon. Friend the Member for Mid Norfolk (George Freeman) said, the issue is not exclusive to people from deprived backgrounds. In some projects run by the Parent-Infant Foundation around the country, we see parents from well-to-do city backgrounds who have serious attachment problems with their children. At times, we forget that mental illness spreads across the whole of society in different ways, and we need to be open to all of them.

[Wera Hobhouse]

Does the hon. Member not recognise that those from a less deprived background have better access to help than those from a poorer background?

[Tim Loughton]

There is something in that, and people from better-off backgrounds may have recourse to the private sector as well, but the point is that the illness impacts on everybody, although I certainly agree that the capacity to get early help for that illness is differentiated across families.

The impact of covid should not be underestimated. During covid, we saw the impact on new parents, particularly new single parents. One of the biggest impacts was the absence of health visitors able to go across the threshold of new parents’ homes, particularly on single parents having a child for the first time. There were the other horrors of covid going on, and people were detached from the normal family networks they might have, such as grandparents coming along to share their experience and give support. On top of that, they did not have a health visitor coming to visit them physically, because about three quarters of health visitors were diverted to the frontline of dealing with covid. It was only in the most deprived cases, where there were concerns, that health visitors physically got to go and visit.

On top of that, we had a decline in the numbers of health visitors, which reversed the position that the coalition Government produced, where we had an additional 4,200; quite rightly, that was a pledge by the Government, and it was actually delivered in the lifetime of one Government. Since then, numbers have declined again. I think there is absolutely a false economy.