Children’s Mental Health Week 2024

Debate between Wera Hobhouse and Tim Loughton

Tuesday 30th January 2024 Westminster Hall

[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.

Independent Review of Children’s Social Care

Debate between Wera Hobhouse and Tim Loughton

Thursday 24th November 2022 Commons Chamber

[Tim Loughton]

My hon. and learned Friend is so right. The adoption support fund was such an important part of the complex programme of getting adoption back on the front foot again. Too often, where adoptive placement was deemed to be best for a child, I am afraid there was too much, “Here’s the child, dump them with the family,” and then the local authority disappeared in the dust. Children who are going into adoption, in many cases with complex and traumatic problems underlying that decision, need a lot of support in the early years.

If we are to make an adoption work and prevent an adoption disruption, we need to put in the groundwork and do the leg work right at the beginning, to make sure that child gets the extra professional therapeutic work that might be required to make sure that family placement can work. The adoption support fund was a really important way of ensuring the resources to provide that professional expertise, so that the adoption stood a better chance. It is a false economy not to do that, because the amount of money the local authority saves is considerable if we can make an adoption work, so why not put in the resource at the beginning to make sure that the adoption is likely to work and that child can stay in a stable, loving family environment?

[Wera Hobhouse]

I know that I am blowing the trumpet for trauma-informed services, but does the hon. Member not agree that they are at the bottom of understanding most traumatised and difficult young people?

[Tim Loughton]

Yes, and we must understand that, too often, we are too keen to show the statistics that prove the underachievement of children who have been in the care system, be that in education or other outcomes. Why should we expect somebody who has been taken from their birth family, who has been deprived of the loving care of their birth parents because they are not able to give them that loving care, who has been abused as a child—who has perhaps been sexually abused as a child, as so many children are—and who has gone through such a traumatic upbringing, to be able to achieve as much as other children without getting that extra support? Whatever form those trauma services take, it is a no-brainer that we should provide them if we are serious about wanting those placements to work, be that a long-term foster care placement, a long-term home placement or, ultimately, an adoptive placement if that is the right place to go. It has to be horses for courses.

What we also did those 10 or 12 years ago is reduce the bureaucracy in the children’s social care system. When I took over as Children’s Minister, the manual for children’s social care, “Working together”, consisted of 756 pages, or something of that order. For the previous 10 years or so, since the death of Victoria Climbié, every time a high-profile safeguarding scandal happened and another child lost his or her life—often at the hands of his or her parents or carers—the Government rushed to legislate. It was a Labour Government at the time, but frankly, we were all guilty of going along with it: “The solution must surely be more legislation and more rules.” Ten years later, we had reached a stage where social workers were so saddled with regulations and rules that they were constantly looking over their shoulder, constantly referring to page 642 in the rulebook to see what they should be doing, rather than using the professional judgment and instincts that we train them for. Being a social worker is not an easy profession: one has to be a combination of a detective, a psychoanalyst, a forensic scientist and whatever else, because people who abuse their children are usually quite smart at covering it up.

The most important thing I said to social workers was, “I want to give you the confidence to make a mistake for genuine reasons”—hopefully not too often, but by using their professional judgment, rather than covering their back by saying, “Well, that’s how it said I was supposed to act in this case on page 602 of the manual.” That was the problem. We tore apart that manual—it was reduced to something like 70 pages—and said to social workers, “You’ve been trained as a social worker. We trust you: you have the nous. You need to go out and get the experience. You need to judge something on having face-to-face time with a vulnerable child or that child’s parents and to make a value judgment on whether you think that child needs to be taken into care, to have some support while staying with the birth family, or whatever. You make that judgment— occasionally, you will make it wrong, but you will make the wrong judgment for the right reasons. That will give you more experience to make sure you make it right the next time.”

Women’s Mental Health

Debate between Wera Hobhouse and Tim Loughton

Thursday 3rd October 2019 Commons Chamber

[Wera Hobhouse]

I could not agree more. We need a strategy. More than half of women who experience mental ill health have a history of abuse, meaning that their conditions are rooted in experiences of gender-based violence. In yesterday’s moving debate, we heard many harrowing examples of that. We have a long way to go if we are to change the whole culture around domestic violence and treat its consequences. When it comes to treatment, we must ensure that frontline mental health services for women are trauma-informed. There is a legal framework that we could use; it is called the Istanbul convention. We signed up to it back in 2012, but so far we have failed to bring it into domestic law.

One consequence is that we do not have enough rape crisis centres across the country. Earlier this year, Fern Champion, a survivor of sexual violence, came forward after being turned away by her local rape crisis centre. She launched a petition asking the Government to ratify the Istanbul convention, which has so far received 171,000 signatures. It is hard to suggest that we can do the groundwork to support women and their mental health challenges effectively when there are fewer than 100 rape crisis centres across England and Wales. This is simply not good enough if we are to support women effectively and prevent them from developing serious mental health problems after suffering abuse. Ratifying the Istanbul convention would mean that the UK was upholding international standards on survivors’ rights.

Earlier this year, I tabled a Bill that would guarantee mothers a health check-up six weeks after giving birth. Depression before, during and after birth is a serious condition that is unrecognised and untreated for nearly half of new mothers who suffer from depression. Statistics suggest that mothers are afraid to speak up, and 47% of new mothers get less than three minutes to discuss their mental health with a healthcare professional. Conversations about the reality of motherhood and perinatal depression are still few and far between. This is a huge problem—and not just for the mother; undiagnosed mental health problems in mothers have serious consequences for the newborn child and their development.

I have been campaigning for better treatment of eating disorders. Eating disorders disproportionately affect women, although they do not discriminate. Women in the LGBTQ community are particularly susceptible.

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

I am absolutely in accord with the hon. Lady. Before she gets off the subject of perinatal illness, she will agree, I am sure, that it is a shocking statistic that in the UK, suicide is the leading cause of direct maternal deaths occurring within a year of the end of pregnancy. Perinatal mental illness can actually lead to a loss of life among mothers. We need to do so much better for them in those early mental health checks.

[Wera Hobhouse]

Absolutely. Post-natal depression is hidden, and the NCT’s “Hidden Half” campaign addresses that. Anyone who has been a parent knows that parenthood is not easy. Probably all mothers go through some form of depression, or feel really down after birth. I keep saying that if anybody had asked me how I felt, I would probably have said, “Oh God, I am not feeling particularly well.” The problem is in not addressing that early on, because these things can develop into something much more serious. That is why it is very important that there be a check-up six weeks after birth for women, not just for the newborn child.

--- Later in debate ---

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

I concur with every word of your comments, Madam Deputy Speaker, and the response to this debate, and the one we held yesterday on domestic abuse, has shown this Chamber in a much better light than that of a week or so ago. These are things we can agree on and that are of acute, everyday importance to our constituents.

As I have said previously, I have been in this House for 22 years and we never used to debate subjects such as this, and rarely held debates on children’s issues or many social issues. It is absolutely right that we hold such debates much more regularly these days, and they are enhanced by the personal, often emotional, harrowing and brave testimonies of hon. Members who bring such experience and richness to the debate. They show that we do have some understanding of the complex, complicated and challenging issues that face so many of our constituents every day.

I had not intended to speak in this debate, but I was moved by the contributions from my hon. Friend the Member for Southend West (Sir David Amess) and the hon. Member for Lewisham West and Penge (Ellie Reeves). I have a long-standing interest in this issue, and I declare an interest as chair of the all-party group for conception to age two—first 1001 days. That issue has growing traction and importance, and it should be mainstreamed. I also chair the charity Parent Infant Partnership, PIP UK, and co-chair the all-party group on mindfulness. If any hon. Members present have not attended a mindfulness course, I reiterate that they are available on Tuesday afternoons, usually at 5 o’clock in Committee Room 7. Given the stress of recent weeks, attendance has been noticeably higher and perhaps of more benefit than usual.

I am slightly daunted by speaking in this debate. Yesterday I said that I was daunted by speaking in the fantastic debate on domestic abuse, on the basis, first, that I am a man, and, secondly, that I am not from Wales. Today I am daunted, first because I am not a woman, and secondly because I am not from Essex, which seems to have a dominant geographical impact on the contributions that we have heard and will hear.

Next week we will celebrate Mental Health Awareness Week, and we will also relaunch the charity PIP UK. I have just written a letter to the Minister, and I very much welcome her and the huge amount of experience that she brings to her role from her health background. I am glad that perinatal mental health featured in the remarks of the hon. Members for Bath (Wera Hobhouse) and for Lewisham West and Penge, because that is where I think we can have the biggest impact on the mental health of future generations.

A few years ago, the Maternal Mental Health Alliance produced a valuable piece of work that estimated that perinatal mental health issues affect at least one in six women. Too often that happens in silence, which is why it is so important that the hon. Member for Lewisham West and Penge recounted how it happened to her—why would it not happen to somebody just because they happen to be an MP? The cost to the nation of perinatal mental health issues was estimated at £8.1 billion every year, which is probably an underestimate. We can add to that the cost of child neglect in this country, which is estimated at £15 billion and is often born out of problems with attachment in those early years, even before the child is born, and particularly if a woman is facing huge stresses and challenges, or domestic violence and so on. The statistic that I gave yesterday, which I still find hard to believe, is that a third of domestic violence cases start during pregnancy. The cost of getting this issue wrong is more than £23 billion a year. That is so much more than the more modest investment we could make to get this issue right and prevent those problems and the huge issues they create, financially but also socially—problems that are often lifelong for future generations.

We need better attached children, and attachment dysfunction has gone under the radar for so long. It is therefore essential—I am glad that the hon. Members for Bath and for Lewisham West and Penge mentioned this—that the vital six-week checks on new babies should also include the physical and mental health of new mums, particularly first-time mums. I make no apology for repeating that health visitors have been an important component in helping with those checks, and one great achievement of the coalition Government—I was also part of the shadow health team when we worked on this—was the substantial increase in health visitors. That was based on the Kraamzorg programme in Holland, which we went to see. It showed that if we work intensively with new parents in those early stages, we can prevent many problems from happening later on. Health visitors are such a good investment to ensure happy, healthy, stable new parents who are able to interact in a sensible, robust, proper and healthy way with their children, and that is in the best interests of kids and their parents.

[Wera Hobhouse]

The health visitors in the early weeks when I was first a mother, and subsequently, were wonderful and a real lifeline. We do need to continue with that, but the problem is that it is not systematic enough. Making sure that a mandatory six-week health check is done by a GP and a health professional is the way forward. Currently, the system is too haphazard and we need to have a much more watertight system to get help to every woman who needs it.

[Tim Loughton]

We need both. The health checks are NICE-recommended, but alas not mandatorily funded or instituted across the country. Frankly, all GPs need better training on mental health and mental illness prevention generally, and especially on perinatal mental health.

It was a huge success of the coalition Government that we recruited almost the 4,200 target for health visitors that was set back in 2010. We have lost as many as 30% of those now, since the responsibility for health visitors went from the NHS to local authorities. I am not saying whether that was the right move or not, but, given the cash constraints on local authorities, health visitors have turned out to be a soft target. That is a hugely false economy and certainly needs to be revisited as a priority by the health team.

The lifelong importance of early attachment should not be underestimated. It has been judged that for a 15 or 16-year-old suffering from depression—an all too common problem among teenage children in schools—there is around a 99% likelihood that his or her mother was suffering from depression or some other form of mental illness during or soon after pregnancy. The correlation is as close as that. Not getting it right during the conception to age two period will have an impact on many children for their childhood years and, for too many, continuing into their adult years too. Maternal mental health is very important, not just for the mother herself but for her children and the surrounding family.

Let us not underestimate the impact this has on fathers as well. I will be ruled out of order if I go too much into the subject of male mental health—although I hope we have a debate on male mental health too—but the impact of poor attachment between a mother and baby has significant impacts on fathers. It is important that they are also given every help and support to have that attachment to their children. Too often, children’s centres and other support mechanisms are mum-centric and we overlook the role of the father. The father has an important role to play in the life of the child and an important support role to play in the physical and mental health of his partner, the mother.

The Government have done an awful lot in recent years to raise the profile of the importance of mental health and flag up how we need to do much more. Importantly, they are also investing much more in mental health. We talk about the parity of esteem between mental health and physical health, and we all agree that that is necessary. Much has been done to reduce the stigma that was attached to mental illness just 20 years ago. It is good that so much more money is going into the area. We have a shortage of mental health practitioners and we need to make sure that we prioritise recruiting, training and getting them in service as soon as possible.

The criticism I have is that last year’s Green Paper on mental health included a lot about school-age children, which is important, but virtually nothing on pre-school-age children and perinatal mental health. Shifting the age profile forward and making it more about prevention and early detection—rather than dealing with the symptoms of a child who may already be damaged because their mother was damaged in their early years—is the way we have to go. We have to do much more in schools, but we need to do so much more before children get to school, by working with their mothers and fathers at an early stage.

Early Years Family Support

Debate between Wera Hobhouse and Tim Loughton

Tuesday 16th July 2019 Commons Chamber

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

It is a great privilege to follow the hon. Member for Warwick and Leamington (Matt Western). I, too, worship at the altar of my right hon. Friend the Member for South Northamptonshire (Andrea Leadsom). She is the great authority on this subject and I pay tribute to her. I also pay limited tribute to the hon. Member for Manchester Central (Lucy Powell), given I am no longer her favourite ex-Children’s Minister—but there we go. [Laughter.] You can go off people.

It is interesting that at the same time as we started this debate there was a debate in Westminster Hall on children’s mental health. In the many years I have been in this place, subjects such as children’s mental health rarely got on to the Order Paper. It is a sign of huge progress that it is now much more common for us to talk about them—and with a great deal of experience and consensus. It is long overdue. We are starting to appreciate the huge strategic importance of doing much more, much better, much earlier for our children. Some of us have been banging on about that for many years in this place, and it is great to see many other headbangers joining us. It is becoming almost common parlance.

[Wera Hobhouse]

rose—

[Lucy Powell]

rose—

[Tim Loughton]

Hold on a minute. I will give way first to the hon. Member for Bath (Wera Hobhouse) and then to the hon. Member for Manchester Central.

[Wera Hobhouse]

I thank the hon. Gentleman. Does he agree that the whole body of knowledge about adverse childhood experiences should be shared even more widely in the House, because it makes so much sense when we are discussing, for instance, the Prison Service or the probation service? Every service should be informed about trauma. Once we understand adverse childhood experiences, it all seems to make sense.

[Tim Loughton]

I think that the hon. Lady is right. I shall come on to the way in which it is all joined up. “Adverse childhood experience” has become more common parlance now. Essentially, it goes back to attachment and all the stuff that Bowlby was talking about, often as a lone voice, many decades ago. However, it is true that we can now relate it to many of the challenges that we see as individual MPs and the Government see, in relation to antisocial behaviour, mental health conditions, and all the issues that have been referred to my right hon. Friend the Member for South Northamptonshire and others.

I will now give way, very enthusiastically, to the hon. Member for Manchester Central.