Special Educational Needs and Children’s Mental Health Services

Yvonne Fovargue Excerpts

Wednesday 9th February 2022 Westminster Hall

[Yvonne Fovargue (in the Chair)]

Before we begin, I remind hon. Members to observe social distancing and to wear masks.

[Laura Farris (Newbury) (Con)]

I beg to move,

That this House has considered special educational needs and children’s mental health services.

It is a pleasure to serve under your chairwomanship, Ms Fovargue. It is timely to be holding this debate in Children’s Mental Health Week. Today I want to focus on one aspect of mental health—specifically, the conditions that fall under the wider banner of special educational needs.

The difficulty that families in West Berkshire experience in seeking a diagnosis has been raised with me since I was first elected, but it was not until I conducted a constituency-wide survey last summer that I understood the extent of its prevalence and urgency. For many people in West Berkshire, accessing CAMHS—child and adolescent mental health services—for diagnosis of a potential learning difficulty is an extraordinary uphill battle. Waiting times regularly exceed two years for an autism diagnosis and can be substantially longer. I know that this problem also exists in other parts of the country.

When I was preparing for this debate, I asked affected families to get in touch with me, and was overwhelmed by responses, which came from everyone from mums and dads through to headteachers and GPs. The Minister whom I expected to respond to the debate, the Minister for Care and Mental Health, my hon. Friend the Member for Chichester (Gillian Keegan), is not in her place, but I had a word with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), in advance. The issue as it affects West Berkshire is less about a lack of funding—the Berkshire West clinical commissioning group has received additional investment for this—and more about accountability and the adequacy of the service. I have had too many letters and emails to refer to them all, but I would like to tell hon. Members about three of my constituents, whose stories capture the issue more widely.

The first is Steffi Whelan, who told me about her 11-year-old son. He has been waiting more than two years for a CAMHS appointment. His problems began seriously in year 4. What began as outbursts of screaming in class evolved into something more disruptive. Sometimes he would tear up work or behave in a way that was completely unsustainable for the teacher. In time, he was moved from that primary school to another, and his parents have been told that he will not be emotionally able to move on to an ordinary secondary school. He is now nearing the end of year 6, and despite all of that, the family are still waiting for their first appointment.

Melanie Fenemore told me about her nine-year-old son, Archie, who was strongly suspected to have autism. Melanie was first referred to CAMHS in October 2018. She filled out a load of complicated forms, and in January 2019 was told that her son was on the waiting list and to expect a 20-month delay. In fact, she waited 27 months before he was seen in April last year. At the time of the assessment, the view was formed that he probably did not have autism spectrum disorder but had something more equivalent to attention deficit hyperactivity disorder, and he was referred to the ADHD team. Again, Melanie was sent a bunch of forms, which she described as “pretty much identical” to the previous ones, and her son was sent back to the bottom of a waiting list. The family have been told to expect a 36-month wait. If that projection is correct, Archie will have been on a waiting list for six years, from the age of six to 12, by the time he receives his first appointment. During this time, Archie’s mum tells me, he has

“expressed a desire not to be alive.”

He has a tendency towards violence, born out of frustration. She says:

“I am sometimes at the receiving end of Archie’s violent outbursts which hurt more as he gets older.”

The Buller family’s young daughter, Daisy, has been waiting more than two years for an autism diagnosis. By the time her mum contacted me last July, her daughter was self-harming and barely attending school, even though she was in the crucial year 10. Her mum wrote to me:

“This is 5 years since we first started struggling and we are no closer to helping my daughter. Simply one question Laura, in today’s age, how is this Ok.”

One headteacher of a primary school described the waiting times as “absolutely awful”, with another saying that the situation has got worse in recent years. Valiant efforts are made by West Berkshire Council to offer support through its Emotional Health Academy, but that is not a substitute for a clear diagnosis. A head at a primary told me that until they get a CAMHS diagnosis,

“The child may be excluded or at risk of exclusion, their anxiety will often worsen and they don’t attend school, the school can try but it cannot put in the support that it is required until there is an Educational Health Care Plan in place and CAMHS diagnoses are critical to this.”

The headteacher of Kennet School in Thatcham said,

“While schools will have an indication of what a pupils needs may be, a diagnosis through CAMHS leads to targeted work and accessing additional services to further support the child and their family. A huge part of a SEND diagnosis is the support”.

It enables the young person to

“understand themselves. Where a diagnosis is not yet given, this delays the essential step for the young person, causing more erratic behaviours and often fall-out at home as well as at school.”

The short point is that a timely CAMHS diagnosis is often crucial for life chances. It hardly needs to be said that a child who is repeatedly excluded can easily end up in a pupil referral unit. People with neurodiverse conditions are significantly over-represented in the prison estate and the youth estate. Their employment opportunities are often compromised, anyway—it is said that only one in five people with autism sustain full-time employment—and in teenagers there is a significant correlation with depression and self-harm. Timely diagnosis and the correct support is crucial for addressing that.

I want to focus on the Government response so that my speech does not sound like a barrage of criticism. I know that the Government attach significant importance to improving outcomes for those who are neurodiverse. The SEND review, to be published soon, is a testament to that, as is the work being done to ensure that children with autism will have a designated key worker within the next year or so. Hundreds of millions of pounds of additional funding was made available for CAMHS in the spending review, and I have to concede that West Berkshire is one of the first 25 areas that will pilot the schools-based mental health support teams.

I said at the start of my speech that Berkshire West CAMHS received significant investment from the Government last year—£1.6 million in April 2021. In fact, when I spoke to the service a few months ago, it said that funding was no longer the problem. The money will enable it to recruit another 27 members of staff that it so badly needs, although so far it has managed to recruit only 12.

Despite a detailed local transformation plan published last September, in which some laudable ambitions were set out, including a goal of reducing waiting times for diagnoses to just a year by next month, when I spoke to Berkshire West CAMHS, it conceded that there is in fact no fixed deadline for reaching that target, so it is not really a target at all; it is nothing more than a general ambition. There is no consequence if the service fails to reduce waiting times. I regret to say that that is not good enough.

The overall impression of Berkshire West’s child and adolescent mental health service is that there is a serious lack of urgency or accountability. Dr James Cave, the well-respected medical director of the Downland Practice in my constituency, wrote to me:

“I think it is important that you understand the depths of despair GPs feel about the local CAMHS service. Remote, unresponsive, closed, uncommunicative sums them up. It feels as if they are always looking for a way NOT to have to see a child. They demand detailed referral forms from us…and then find reasons not to see a child. If they do accept a referral the wait is forever and then often the intervention is a fixed predetermined intervention that does not take”

into account

“the needs of a child.”

I am not seeking to humiliate anyone, but families in West Berkshire are being failed, and it is my role and my responsibility to fight for them.

The Health Secretary has said time and again that the Health and Care Bill currently making its way through the House will deliver better accountability. Speaking in the debate in July, he stated:

“The third theme of the Bill is greater accountability.”—[Official Report, 14 July 2021; Vol. 699, c. 430.]

He said that people have the right to expect “clear lines of accountability” for how every priority is delivered. So my plea—a cri de coeur—from the many families in West Berkshire is that the Department demands better accountability from CAMHS in West Berkshire and across the country. We want details of how that £1.6 million will be spent, and firm commitments to reduce waiting lists, with consequences if managers fail to deliver.

The issue is not confined to West Berkshire, but it is stark within it, and I therefore speak today for the families that I represent and all those families across the country who are experiencing the same struggle.

[Yvonne Fovargue (in the Chair)]

As there is considerable interest in the debate, I will set a formal time limit of four minutes for speeches.

[Olivia Blake (Sheffield, Hallam) (Lab)]

I thank the hon. Member for Newbury (Laura Farris) for securing this important debate. I was not expecting to be called quite so early.

I will focus my remarks on my own personal experience of having ADHD, dyslexia and dyspraxia, none of which were recognised during my schooling. I want to highlight this because it is a journey of things going wrong and children not being fully supported.

By the age of 12, the average child with ADHD has received 20,000 more negative comments about their behaviour than their peers. “Lazy,” “distracted,” “too chatty,” “fidgety,” “failing to meet potential,” “disorganised” and “in disarray”: those were all comments that were levelled at me as a child, and they stick in my brain to this day and make me consider all my actions daily. This has led to huge feelings of anxiety and depression—a feeling that I am always doing something wrong. My ADHD was diagnosed only last year, and I have only just started taking medication, which has been life-changing.

There are two sides to the coin on this issue. When children and young people are supported at home and in school with the love and understanding that they deserve and need, they can flourish, as I feel I have flourished. I thank my family for the support that they showed me throughout my education to enable me to get to where I am today.

However, I meet too many children whose stories are still the same: their needs are not recognised or are not severe enough to merit critical help, and they are stuck in the middle, reaching their potential in some subjects and failing in others. They also feel that they are not listened to, that they cannot access support and that there is something critically wrong with them. They internalise negative comments about themselves, which is really damaging in the long term.

There are also lots of huge positives to being neurodivergent. Neurodivergent people are more likely to be entrepreneurs, and to take the risk of setting up businesses. However, the dark side is that they are more likely to try illicit drugs and to get involved in crime. There really are bright and dark sides. To any young person who is struggling at school, I say: “Don’t worry. There is always something else for you to strive towards. You just need to find what you are good at, and you will relish that opportunity.” No one should be held back because they have a diagnosis of ADHD, autism, dyslexia or dyspraxia. All children should be supported to get the best out of themselves.

However, far too often our education system is one-size-fits-all. I am really proud to chair the all-party parliamentary group for special educational needs and disabilities. It is so important that we change the classroom and home environment for these children, so that their behaviours are understood, and they can fully experience school and get to where they need to be.

So many things have gone wrong during the pandemic. Some children with autism have flourished through online learning, but others have found themselves isolated from their friends, peers, teachers and support. Several organisations are yet to start providing the therapeutic interventions that they are meant to provide under children’s education, health and care plans, and this is causing huge disruption to the ability of those children to thrive. Three quarters of disabled children have seen progress in managing their conditions and overall development regress in the pandemic. This is urgent and critical. Those who receive a diagnosis of dyslexia should also be screened for ADHD or other neurodivergent conditions, because the crossover is huge. We are letting our young people down by not helping them to get the tools they need to understand themselves—first and foremost—and how they fit in with the world.

I hope that the Minister will think more about how we can intervene as early as possible to avoid young people becoming incredibly depressed and anxious about just who they are—because they are round pegs trying to fit into square holes. It is critical that we support young people to thrive and give back to our society and economy by being the great pioneers and entrepreneurs that we all want to see.

I also have the privilege of having someone with autism in my family—

[Yvonne Fovargue (in the Chair)]

Order. I call Aaron Bell.