Westminster Hall debate on Children’s Wellbeing and Mental Health: Schools - Jan 10

Norman Lamb (North Norfolk) (LD) 

I beg to move,

That this House has considered the matter of supporting children’s wellbeing and mental health in a school environment.

It is a pleasure to serve under your chairmanship, Mr Nuttall, I think for the first time. It is timely to be discussing the incredibly important issue of children’s mental health and wellbeing, particularly in the context of schools, given what the Prime Minister said yesterday. I welcome the fact that the Prime Minister of this country chose to make a speech that was significantly about mental health. That in itself is quite a novelty and should be acknowledged as such. She spoke powerfully about the “burning injustices” in society and focused particularly on those who suffer mental ill health.

My problem is that the response must match the scale of the injustice, and I think that the response has ultimately fallen short, but as a society we are on a journey and it is an important step that the Government are now saying the right things. I suspect that it is acknowledged by many Conservative Members that there is still a gap between the rhetoric and the reality for many people throughout the country, particularly families experiencing mental ill health, who sometimes have to wait horribly long for any access to treatment.

I will briefly describe my own family experience. This goes back to the last decade, which makes the point that the situation we are discussing is not the fault of any individual party or Government. When our oldest son required treatment and as a family we were fairly desperate, we were told that he would have to wait six months to start treatment, so we did what I guess any family would do and paid for treatment. Of course, very many people cannot do that. I do not want to live in a country in which people who have money can access great care, but those who do not are left waiting. That for me is the injustice that we must confront, but I welcome the fact that the Prime Minister has raised this incredibly important issue.

One in 10 children are estimated to have a diagnosable mental illness, and 75% of mental health problems in adulthood started before the age of 18, so there is both a moral and an economic case for dealing with mental ill health among children and teenagers, because by neglecting it we store up enormous problems for people later in life, at enormous cost to the state—that is the key point that we must recognise. However, despite the prevalence of illness among children and teenagers, three in four children and young people with a clinically significant mental illness are not in touch with appropriate mental health services, and sometimes it can take up to 10 years before the first symptoms are diagnosed and addressed.

I stress that I do not want to over-medicalise this problem; we do not want to drive everyone into treatment. What we want to do, of course, is prevent the need for that, so we must shift the system so that it focuses much more on preventing ill health and deterioration in health, and schools are necessarily central to that.

David Simpson (Upper Bann) (DUP) 

I am sure that the right hon. Gentleman will agree, in relation to mental health and schools, that it is important that young teachers are trained to recognise the difficulties that some children have, so that there can be early intervention to try to prevent the need for all the children to go into treatment.

Norman Lamb 

I am grateful to the hon. Gentleman for that intervention. I totally agree. As I will explain later, giving professionals the tools to manage the issues in front of them seems to me to be fundamental to a sensible approach.

There appears to be growing evidence of increasing mental health problems among young girls. In August 2016 a survey for the Department for Education found that rates of depression and anxiety have risen among teenage girls in England, although the rates appear to be more stable among boys. The survey found that 37% of girls reported feeling unhappy, worthless or unable to concentrate; that was more than twice the percentage for boys. According to the Children’s Society’s latest “Good Childhood” report, a gender gap has opened up between girls and boys in relation to both happiness with life as a whole and appearance. One in seven girls aged 10 to 15 felt unhappy with their lives as a whole, and the figure had gone up over a five-year period. We need to seek to understand that situation better in order to make the right response. I pay tribute to the Children’s Society, which has supported me in bringing this debate to Parliament. I also thank, as I should have done at the start, the MPs who joined me in applying for the debate.

There also appear to be problems among women between the ages of 16 and 24, according to a major report by NHS Digital. Reports of self-harm in that group trebled between 2007 and 2014, so something very serious is going on. Research is urgently needed to understand the causes of the trend. Social media appear to be part of the picture—there are concerns about sexting, cyber-bullying and so on.

We must also remember the issues that relate to boys and young men. Horrifically, suicide remains the biggest killer of men under the age of 45 in the UK, and the rate has been increasing in recent years. In 2014 the male suicide rate was three times higher than the female rate. I am pleased that the Government focused on suicide in yesterday’s announcements. Ultimately, there is nothing more serious or important than seeking to prevent lives from being lost in that horribly tragic way, with the impact that it has on families—my family, along with many others in this country, have gone through that experience—so we need to give it the greatest possible attention.

The overall lifetime costs associated with a moderate behavioural problem amount to £85,000 per child, and with a severe behavioural problem they are £260,000 per child. That is why it is so important to deal with these issues early, rather than allowing them to become entrenched.

The Children’s Society has highlighted school-based counselling, which can be highly effective for children experiencing emotional difficulties. It can be used as a preventive measure, an early intervention measure, a parallel support alongside specialist mental health services, and a tapering intervention when a case is closed by the specialist services to help a child or teenager through to recovery. Research shows that children perceive it as a highly accessible, non-stigmatising and effective form of early intervention.

Studies have also shown that attending school-based counselling services has a positive impact on studying and learning. In 2009 Professor Mick Cooper assessed the experiences of and outcomes for 10,000 children who had received counselling in UK secondary schools. More than 90% reported an improvement, which they attributed to counselling, and 90% of teachers reported that counselling had a positive impact on concentration, motivation and participation. So we end up achieving better academic attainment if we make the investment for those children who need it. It can be cost-effective, given the long-term cost to the economy of problems that continue into adulthood; some studies have indicated that the long-term savings can be in the region of £3 saved for every £1 invested, and data from Wales indicate that the average cost of school-based counselling is significantly lower than the specialist treatment children get if that is the only alternative. So we save money by giving children access to school-based counselling rather than delaying intervention and referring the child to a distant service, probably with a long waiting time, which is also far more stigmatising.

The British Association for Counselling and Psychotherapy has estimated that the overall cost of statutory provision of school-based counselling across all of England’s state-funded secondary schools would be in the region of £90 million per year. On the basis that 60% of schools are already delivering it, the additional delivery would cost around £36 million. I suggest that that investment is well worth making given the improved preventive care.

Luciana Berger (Liverpool, Wavertree) (Lab/Co-op) 

I am grateful to the right hon. Gentleman for giving way and apologise for being a few minutes late for the start of his important speech. I am sure that he, like me, will have had the privilege of visiting a number of schools, not only in his own constituency but across the country, that are really committed to their students’ mental health and have invested in school-based counselling. Does he share my concern that in this past year we have already seen cuts to those services within schools because they have seen their budgets reduced and they are having to incur the additional costs of pensions, for example? The prospect for the years ahead is to see some schools that fund counsellors five days a week going down to three, or three days down to one, and some having to scrap the provision altogether because they simply do not have the resources to make this very important service available in their schools.

Norman Lamb 

I thank the hon. Lady for that intervention and pay tribute to the tremendous campaigning work that she does on mental health. Her point highlights the gap between the rhetoric, which is often well intentioned, and the reality. There is now a much greater focus on prevention in the Government’s argument, but what too often happens with a system under impossible strain is that the preventive services are cut first because there is a desperate need to prop up acute services within the system. She makes an important point.

Let me address the issue of stigma in schools. Stigma can exacerbate mental health conditions and prevent people from speaking out and seeking help. In October 2016 the YMCA launched a nationwide campaign aimed at tackling the stigma associated with mental health difficulties and to help to encourage young people to speak out. It found that more than one in three young people with mental health difficulties had felt the negative impact of stigma. School is where most young people experience stigma, and more than half of those who have experienced stigma said it came from their own friends. There is often a lack of understanding among young people—teenagers—about what mental health really is. That is why it is so important that we get this on the curriculum so that every teenager learns about their mental, as well as physical, health and wellbeing, and about how they can become more robust in coping with the challenges they face.

The impact of stigma is profound and pervasive, affecting many areas of a young person’s life. Young people reported that the stigma affected their confidence and made them less likely to talk about their experiences or to seek professional help. I can remember the moment when our eldest son said to me, “Why I am the only person who is going mad?” I just thought that here is a teenager feeling that and having stored it up inside himself, having not been able to talk about it for a long time. We can just imagine the strain of trying to cope with that on top of all the normal pressures of being a teenager. We have to do far more to combat stigma if we are to improve young people’s experiences.

I want to mention “Future in mind”, which is the blueprint we published in March 2015 just before the coalition Government came to an end. It was widely welcomed across the sector. We involved educationalists, academics, practitioners and young people, in particular, in the work we did. Central to the recommendations was the role of schools, and among the recommendations was the proposal that there should be a specific individual responsible for mental health in every school to provide a link to the expertise and support available, to discuss concerns with an individual child or young person and to identify issues and make effective referrals.

There should be someone taking responsibility but also a named contact point in specialist mental health services—too often we find that schools do not have the faintest idea who to contact when a child needs support—and also joint training. The hon. Member for Upper Bann (David Simpson) made the point about the training of teachers. If we can get teachers working alongside specialist mental health workers in schools, everybody will benefit.

Mrs Madeleine Moon (Bridgend) (Lab) 

Will the right hon. Gentleman also pay tribute to the work of the Samaritans? It has a scheme called DEAL—developing emotional awareness and listening—which it is rolling out across Wales in particular. There is a resource pack available for teachers if they want to take it into schools, or the Samaritans will send volunteers into schools to undertake, separate from the school system, talks and raise awareness for young people. That is the sort of low-cost—not expecting lots of money to be involved—involvement of people and organisations such as the Samaritans, with their specialist knowledge and awareness, that is extremely helpful in reaching young people.

Norman Lamb 

I pay tribute to the hon. Lady for the incredibly valuable work that she has done, particularly on suicide. I join her in paying tribute to the work of the Samaritans and the army of volunteers who give up their own time to save people’s lives. The sort of initiative that she described is incredibly important. Do the Government remain committed to implementing “Future in mind”? There is a danger in Government that we just replace one initiative with another. There is a very good plan there, which has all the right principles, and the important thing is just to do it and make sure that the money—I will come to that in a moment—actually gets through to where it is required.

Luciana Berger 

I am grateful to the right hon. Gentleman for kindly giving way again. May I echo his very important points? “Future in mind”, the report for which he was responsible, was released in March 2015. We are nearly two years down the line and, despite the fact that the “Five Year Forward View” explicitly stated that it accepted the recommendations of the “Future in mind” report, we are yet to see the vast majority of them implemented. I echo what he said and urge the Government to address that very important point in their response.

Norman Lamb 

I thank the hon. Lady for that intervention. Given that I was responsible for that report, I feel very strongly about its absolute importance. I chaired a commission for the Education Policy Institute that reported last November, and we were pleased that the Secretary of State for Health came to speak at the launch, which I thought was important in itself. We looked at what has happened since “Future in mind” and in some parts of the country they are doing great work, but in others very little is happening. Very little has changed, with the bulk of the money still going to the acute end of the spectrum and not being reinvested in preventive care.

Critically, in many areas of the country, as the YoungMinds survey showed, 50% of clinical commissioning groups are not spending all the money—the additional investment secured in the coalition Government’s last Budget. They are not spending the full allocation on children’s mental health. I think that is scandalous. It amounts to theft of money solemnly pledged by the Government for children’s mental health, yet in many areas it is being diverted to prop up local acute hospitals. We cannot tolerate that. The Government have to find ways of ensuring that all that money is spent as intended. I know that the Government plan to have greater transparency, with Ofsted-style ratings for CCGs, but frankly there needs to be more than that. When a CCG is under financial stress, it is just too easy to shave a bit off children’s mental health to spend it where the public are clamouring for action, because ambulances are stacked up outside the A&E department.

In the first year after “Future in mind”, the system that we designed meant that local areas would get the money only if they produced a transformation plan to show how the money would be spent on changing the system to focus more on prevention. My proposition to the Government—the EPI commission report said this—is that every year the money should be tied to a commitment from the CCG that every penny of it is spent on children’s mental health. The CCG must also demonstrate that it has stuck with the plan from the previous year and that it has a plan to continue the change in the subsequent year. Unless we use the money to drive change in local areas, it will not happen because the system is under so much strain.

The other point argued for by the Education Policy Institute commission was that the Prime Minister should launch her own Prime Minister’s challenge on children’s mental health, as the former Prime Minister did on dementia, because that sort of prime ministerial stamp of importance for this subject would be incredibly valuable. Yesterday was a start, but I challenge the Prime Minister to go further and launch a formal challenge of that sort.

My final point—I am conscious that other Members wish to contribute to the debate—relates to the importance of ensuring that when a child needs specialist treatment, they get it on time. This goes to what I regard as a discrimination within the NHS, because anyone who has a physical health problem benefits from a maximum waiting time. Whatever their issue is, they know that a standard maximum waiting time applies nationally. It is accepted that those standards are under strain, but at least they exist, and I know that they drive the system, from the Secretary of State’s office downwards, in looking at every individual hospital’s performance across the country.

On mental health, however, apart from the two maximum waiting time standards that we introduced in the last two years, there are no other maximum waiting time standards. There is no standard for children. Families across the country can be left waiting, sometimes for months, to get any treatment at all, and when they get referred too often they have to clear high thresholds. In other words, someone has to prove that they are really sick before they get any help at all. That dysfunctional and irrational approach completely contradicts the principle of early intervention.

When you have a child aged 15—as I did, a girl—who had an eating disorder and was turned away from treatment because her body mass index was not low enough, and who then got admitted as a crisis case two months later because the problem had been neglected, you are left in a state of despair. We need to ensure that children with mental health problems have the same right to timely, evidence-based treatment as anyone with a physical health problem does, and that they should be treated close to home rather than being shunted sometimes hundreds of miles away.

These are the burning injustices that exist for many families across the country who cannot pay to opt out of the system. We have a duty and a responsibility—the Government, in particular, have a duty—to ensure that those children get the treatment they need on a timely basis.

Mr David Nuttall (in the Chair) 

Five Members wish to speak in the debate and I intend to call the Front-Bench spokesmen at 10.30 am, so if Members could keep their remarks, including interventions, to about seven minutes each, I calculate that we should get everyone in and share the time equally.

Rebecca Pow (Taunton Deane) (Con) 

I am delighted to serve under your chairmanship, Mr Nuttall. I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this debate, which is so important and timely, and I am pleased to be able to speak in it. I noticed last week that the debate was going to take place and I started to prepare my comments then, but of course, in the light of the Prime Minister’s excellent and welcome speech yesterday, I have had to change them somewhat.

I think it is pretty much agreed across the House that we need to put more emphasis on mental health, putting it on a par with physical health, as we have heard. We also need to do much more work on removing the stigma that seems to be attached to mental ill health, especially among young people. Another universally agreed principle is that prevention, or at least early intervention, is much better than cure. Obviously, that is where the school environment can really come into its own, and where I truly believe we need to focus a lot more effort.

To be positive for a moment, many Members from across the House have worked on bringing to the Government’s attention the fact that we needed a fairer funding formula for our schools. I am delighted that that is happening, and particularly that rural areas, such as mine in Somerset, will receive a much fairer share of funding per student. Although that will not solve mental health problems, it will alleviate the situation for many schools. They will have slightly more money to go around, which may mean that they have money to pay for consultants, advisers and specialist services, should they need them, for mental health. That is just one small thing, but if there is better education across the board, that has to be better for children growing up.

We know that a vast amount of mental health problems begin at school age, with 50% of lifetime diagnosable illnesses beginning at the age of 14, so it makes perfect sense to start dealing with those at that young age. I want to point out some positive initiatives that we could learn from and that perhaps should be copied on a wider scale. One is community engagement and involving young people in activities so that they really feel part of something. To give an example, I was very proud to go to the recent Somerset elections to the Youth Parliament in my constituency, where I was really taken by the assuredness of the students. Not only were they having great fun, but how well they conducted themselves, and how interested they were in life! I got talking to the chap who runs that—Jeff Brown from Somerset County Council—who said, “You should see the state that some of these children come to me in, when they are quite young—about age 11—and how this involvement, engagement and working together has really changed and helped them.” He also said that many of them had mental health issues, so if we could encourage children to get involved in such areas, it would be very helpful. Obviously, that means that we have to keep giving funding to organisations such as the Youth Parliament.

Another area that I am especially interested in, given my gardening and environmental background, is schools that are running gardening and outdoor projects to involve children in activities out of the classroom. I recently went to North Town Primary School in Taunton Deane; it has an excellent, innovative gardening set-up for a primary school. It is really involving children and giving them an outside interest—especially those who, perhaps, are not so academic—in growing and in watching the seasons change, watching nature and watching wildlife. The Royal Horticultural Society has many statistics to prove that that has a really beneficial impact on people’s mental health, and anything that any schools can do to get involved in such projects is worth while and to be encouraged.

Similarly, the Somerset Wildlife Trust, of which I am a vice-president—I am very proud to work with it—does an awful lot of work with local primary and secondary schools, enabling children to connect more with nature and the outside. According to national wildlife trusts’ statistics, 93% of schools said that outdoor learning improves people’s social skills, and 90% of children said that they feel happier and healthier when they are doing these activities outside. Interestingly, 79% of teachers in the surveys that they did said that outdoor learning had a real impact on their teaching practice, so I think there are real lessons to be learned there. Those are all excellent examples of what has already been done.

When I met the people from YoungMinds, they stressed the importance of placing wellbeing and all the activities that I have mentioned alongside academic learning. Again, I welcome what the Prime Minister said, and I was especially pleased to see that a review will be done of child and adolescent mental health services; I hope that it will begin swiftly.

Now for my negative bit: in the south-west, young people’s mental health is a significant issue. I am sure that all Members could give examples; I have many from my casework. People come to me with heart-rending stories exactly like the one that the right hon. Member for North Norfolk told about his daughter. I could list handfuls of people who are affected, including my children’s school friends, my son’s sports mates—guys with aspirations—and neighbours’ children. It is absolutely shocking how many people we can think of offhand. It is not only awful for the child; it puts so much pressure on families, especially if they must go long distances for treatment. It is awful for the child and awful for the parents, but it is also difficult for other siblings to carry on a normal life, and for parents to bring up all their children. I do not know if the right hon. Member for North Norfolk has other children, but I know that the impact makes things difficult for siblings. This is a serious issue, and this House and the Minister need to deal with it.

I welcome the introduction of mental health first aid training in schools, but will the Minister liaise with the Department for Education on an issue relating to the budget cuts for sixth-form colleges? In Taunton Deane, we have an outstanding sixth-form college called Richard Huish College, which has just been shortlisted to be The Times Educational Supplement’s sixth-form college of the year. I wish the college well in that, but when I spoke to its principal, he told me that the school had had to cut all its enrichment courses: sport, drama, music. He was at pains to stress that we need to send the message that we should not expect children to excel only at academic things such as maths and English. Obviously, those are important, but there are other ways for children to show that they are good at something, and for us to celebrate what they do. He pointed out that it is often the children who do not get such opportunities, or who think that they are not good at anything, who fall into a trap and start on a downward spiral. That is how we end up with a spike in mental illness. I urge the Minister to go along to the Department for Education and see whether we can have a bit of joined-up thinking.

I am delighted by the renewed focus on children’s mental health, especially as children spend a third of their time in school. Much good is already being done, as I have pointed out, and I would like to see some of those models copied, especially the ones relating to outdoor activities, the environment and even sport. Some schools run a daily mile; I believe that started in Scotland. Pupils go outside at a set time every day with their schoolteachers, in whatever they are wearing, and run a mile. They might get a bit sweaty, which I believe the girls do not like terribly—

David Rutley (Macclesfield) (Con) 

My daughter does.

Rebecca Pow 

—although my hon. Friend’s daughter does. What a terrific idea. If everybody does it, nobody worries about what they look like. It is simple and cheap; it does not cost a penny. I will also throw in that on Radio 4 this morning, we heard about shared family meals. There is so much benefit in things like that.

To conclude, I stress that the long-term benefits of addressing mental health issues at an early age will be to everybody’s advantage. I applaud the Government for what they are doing, but it is just the start—the building blocks or foundations on which I hope we will build a better future, in which we do not have to debate this issue.

Mrs Madeleine Moon (Bridgend) (Lab) 

It is a pleasure to serve under your chairmanship, Mr Nuttall. I thank the right hon. Member for North Norfolk (Norman Lamb) for the opportunity to have this debate. As chair of the all-party parliamentary group on suicide and self-harm prevention, one thing of which I am very aware is that change only comes when there are champions, at the local and national levels. He has certainly been a champion in this House for mental health. When he was a Minister, it was always a delight to speak to him, because I knew I was talking to somebody who understood the problem, and I pay tribute to that.

I welcome the publication of the latest national suicide prevention strategy—I am particularly pleased by its recognition of the work of the all-party group—but one of the big problems is that there is no new money for local action plans. If we do not start on a local basis, we will not get the change that all of us want.

The all-party group works only with academics; on the whole, the people who come to speak to us come from an academic background. Their work is fully researched, and the way forward is understood. Just before Christmas, two researchers from the National Centre for Social Research, Sally McManus and Caroline Turley, addressed the all-party group. They discussed the findings of the recently published adult psychiatric morbidity survey, which examined trends in mental health and well-being since 2000.

It was extremely depressing. One of the first things that they mentioned was self-harm. The all-party group considers both suicide and self-harm prevention, because self-harm is often an early indicator that someone is suffering from mental health problems. If we ignore it, we just build up problems for the future. Self-harm among 16 to 24-year-olds has doubled since 2000. One in four women and girls aged 16 to 24 have self-harmed, rising to one in three among over-18s. In 2000, one in 15 young women between 16 and 24 reported having self-harmed. By 2015, that figure was one in five.

Young women are twice as likely as young men to self-harm. They do so for a number of reasons, but it is often to relieve tension, anxiety and depression. For them, it is a coping mechanism. Triggers vary from one individual to the next, but bullying via social media, low self-esteem and anxiety are often cited. Some care must be taken in considering those figures, as the rise might be due to increased willingness to report, but the increase is borne out by other studies. Clearly, that level of distress cannot be ignored.

Of the 16 to 35-year-olds surveyed, one in 10 asked for help but did not receive it. Someone aged 16 to 18 with anxiety and depression has only a one-in-five chance of accessing help. The older someone is, the more likely they are to receive help. Some 37% of those who reported having self-harmed had received medical or psychological help, leaving two thirds who had no help. If an individual presents at hospital after an incident of self-harm, they will not necessarily receive the help that they need.

The highest rate of access to help was among 35 to 54-year-old white British women. If young people come from a black or ethnic minority background, their access to mental health support decreases. That is incredible and totally unacceptable. Findings published recently in The BMJ, drawn from the multi-centre study of self-harm, 2000 to 2012, considered hospital admissions for self-harm and concluded that despite NICE guidelines, only a little over half were offered a psychosocial assessment.

Sadly, another issue that we must consider is that all too often the criminal justice system picks up the failures of the mental health services. Too many young people are sidelined into youth offending teams and ultimately into young offenders prisons. Staff at those young offenders prisons have told me that some of the most tragic cases that they deal with are of young people with mental health problems who are being criminalised at an early age. That has to stop.

The Department of Health is diverting its failures to the Home Office and to the Ministry of Justice. I cite as an example a young girl in my constituency who, very sadly, has quite severe mental health problems. Over the years, she has appeared in front of the police and the courts more than 140 times. She has served numerous prison sentences; she is in and out of prison all the time. The police and the probation service recognise that her problems are linked to mental health. She has been involved in the mental health system since she was a very young child, but now that she is a young adult, she is being sent back and forth in the criminal justice system and is not receiving the mental health support that she needs. She is now out again; she has already tried to take her own life by jumping from a bridge and has broken her ankles. The likelihood is that she will be back in prison before we know what we are doing.

I agree that we need to start early. The work in schools is essential. Young people need to know what is normal—“I’m going through adolescence, my hormones are all over the place; what is normal and what is actually a problem that needs dealing with?” We need to look at NICE guidelines on psychosocial assessments, which need to be in place more often. The Department of Health informed me in response to a parliamentary question that it does not keep records on where a psychosocial assessment has been offered, but that would give us an idea of how often we are failing.

Another important thing that needs to happen is a triage system. For a GP’s letter to a consultant asking for an appointment to just sit on a secretary’s desk until the secretary has done that assessment is nonsense. Dr Robert Colgate has set up a triage system for mental health that allows direct access to a consultant, so that help and support are available to GPs, mental health nurses and psychiatric social workers straight away and medication, help and appointments can be given straight away.

This has gone on too long. We know what the problem is, and it needs money and investment. Let us make sure that we start from today.

Jo Churchill (Bury St Edmunds) (Con) 

It is a pleasure to serve under you chairmanship, Mr Nuttall. I thank the right hon. Member for North Norfolk (Norman Lamb), with whom I share a mental health trust, which we are both glad to see is out of special measures. I congratulate the staff on that, but there is much more work to do. I concur with other Members who have said that prevention is better than cure. There could be no more opportune time for this debate, which comes a day after the Prime Minister highlighted mental health, and particularly children’s mental health, as a problem. We have been talking the talk, not walking the walk, for quite long enough.

Why have I chosen to speak today? Mental health is one of my top three surgery priorities. Week after week, in surgery after surgery, I see families whose lives are breaking down because of waiting times. Very often, it is not only the child at the centre. Often Mum has given up work, so there is an economic impact; Dad has stopped doing overtime, so there is a further economic impact; and the siblings do not quite get the activities that they used to, because everybody is focused on the child who has the problem at that time.

I have four children; the last left school last year. Like my hon. Friend the Member for Taunton Deane (Rebecca Pow), I have been somewhat horrified over the past 10 years, as they have travelled through their teenage years, to see how their contemporaries have struggled with mental health and to see the help that has been available for them. As a governor some 10 years ago, the fact that some of my children would be sent hundreds of miles away, when we know that closeness to the family gives better outcomes in the long term, filled me with horror. We really need to drill down into the issue of tier 4 beds and the local availability of child and adolescent mental health services.

As governors and teachers, we instigated sessions with parents on eating disorders and resilience. The World Health Organisation’s whole-school approach is the right one, but we actually need a whole-system approach of teacher training, actual connectivity and knowing where the services are. School-based counselling is excellent, but as the right hon. Member for North Norfolk said, we need to ensure that the funds are there at the right time. Like my hon. Friend the Member for Taunton Deane, I welcome fairer funding, but the fairer funding formula for Suffolk still leaves us short of the national average, so for us it will make a slight difference but not enough. Suffolk’s population is rural, and delivering issues rurally causes problems. It is much harder for us, with a sparse population in which more than 40% are scattered around, to deliver those scattered services.

Why do only 25% to 40% of children and young people currently receive input? Some 50% of lifelong mental health illnesses develop before the age of 14, and 75% before the age of 25. Young people with mental health problems use other coping strategies: self-harm is one that is familiar to me, unfortunately, and they are four times more likely to turn to alcohol. All these are destructive. They are 20 times more likely to go to prison, as we have heard. Tragically, they are six times more likely to die before the age of 30.

One in seven adults has a common mental disorder. If we capture these problems earlier on, we will be doing ourselves and the country a great service, saving people’s lives and building resilience within their families. I was glad to hear the Prime Minister placing importance on mental health, but at the schools and colleges I go to, particularly my sixth-form college, the pastoral care teams reckon they spend up to 70% of their time on mental health issues. I have talked to teachers in the primary sector, who are seeing issues earlier and earlier. We need that teacher training and we need that funding.

How do we improve? We must build resilience, both personally and emotionally. We must focus on young women, who are three times more likely to experience common mental disorders than young men. However, our young men have less ability to express themselves and we see greater suicide numbers in young men, so we need a comprehensive approach. I encourage schools to reach out. Like my hon. Friend the Member for Taunton Deane, I support volunteering and using green spaces. The Green Light Trust does a great deal locally; Westgate Community Primary School does the daily mile. Exercise and sport improve outcomes, because children are within a team—research backs that up. Reducing the hours children spend in front of a screen, ensuring they eat together—all these things are part of resilience building.

When things go wrong, we do not want to medicalise, but we do not want to wait. People need services locally, and we need our children not to be sent all over the country. We have to look at the provision of funding and the allocation of resources. The lack of the family unit locally undermines short and long-term recovery.

I pay tribute to the fantastic work of the Prince’s Trust, of the Duke and Duchess of Cambridge and of Heads Together, which aims to destigmatise and shine a light on the area. That is to be welcomed. I will not give the statistics about body image and coping with work for young people, because we have already heard them, but we need to understand where the money goes. When I spoke to my local mental health trust recently, I discovered that some £363,000 went to eating disorders, but that there was no more money for any additional services. That worries me.

I ask the Minister the following questions. Young people’s mental health needs prioritising. How do we scrutinise those who commission those services? I welcome the £67 million investment in digital connectivity, but many of my constituents do not have access, and there is a broader issue with telecare and prescriptions. How are we locking into the Department for Culture, Media and Sport and the Department for Communities and Local Government to ensure that the fourth utility is there? Will she assure me that rural areas will be fairly treated? As in everything, we sit in the lower quartile both for education and for health, and that is not a good combination. How can we ensure that cuts in community care and local government support, which often give support services the money they are looking for, are considered effectively? Many trained professionals have moved out from children’s services into adult services. We need to capture that skill and bring it back.

It was my birthday when “Future in mind” was announced. I want to understand how we will properly evaluate whether the money that was announced yesterday—most welcomely—and the money announced in “Future in mind” is being spent where we need it to be spent, so that we can understand what is working. I was also glad to hear the Secretary of State for Health announce that sustainability and transformation plans will not be passed without mental health being high on the agenda.

Many have said that the journey to better mental health starts with a conversation, so I hope that this is our conversation and that by 2020 there will be shorter waiting times and talking therapies in every region, and particularly for my young people.

Liz Saville Roberts (Dwyfor Meirionnydd) (PC) 

It is an honour to serve under you as Chair, Mr Nuttall, and I thank the right hon. Member for North Norfolk (Norman Lamb) for securing this timely debate, which he opened excellently.

Mental health in schools is devolved to Wales and provision there is often used as an example of good practice. Today I would like to draw Members’ attention to certain areas of good performance in supporting children’s mental health services in Welsh schools, particularly in Gwynedd, the county in which my constituency is located and that I served as portfolio leader for education between 2008 and 2012. There is always room for improvement and there are still areas of concern, some of which infringe upon non-devolved competencies and impact heavily on the wellbeing of children and young people.

I will just point out that student union presidents at Grwp Llandrillo Menai, the three-college further education institution for north-west Wales, are so troubled by the prevalence of mental health issues among 16 to 19-year-olds that they have chosen Mind as this year’s cross-college union charity. The Children’s Society’s “Good Childhood” report for 2016 highlights the issues affecting children’s wellbeing, as well as the connections between wellbeing and mental health. It calls for the introduction of statutory provision of emotional wellbeing and mental health support within schools in England, to act as a point of early help and to provide referral to specialist services if necessary.

Although they were conveniently timed during a row surrounding the “humanitarian crisis” in health, I am sure that we all welcome yesterday’s announcements about reform of mental healthcare, particularly the pledge to offer mental health first aid training in schools. The Government are making the right noises, but the detail is yet to be communicated. The real-terms increase in health spending is unlikely to meet the requirements created by health inflation over the coming years, so it is by no means a silver bullet solution, and of course it has implications for the Barnett consequentials that Wales receives.

As I have said, counselling provision in schools is already on a statutory footing in Wales. During the Plaid Cymru and Labour “One Wales” Government of 2008, the goal was set of ensuring that every secondary school child could access counselling as needed. In addition, in our first few months as an Opposition party last year we secured a landmark budget deal with the Welsh Government, whereby we realised a manifesto pledge to increase spending on mental health services by £20 million a year, and to improve access to trained counsellors and therapists in the community.

An example of a successful school counselling scheme is being implemented by Plaid-run Gwynedd and is operating in both Gwynedd and Ynys Môn. Since its instigation in 2008, 500 children a year have received counselling, and I am glad to say that very few of them have gone on to be referred to child and adolescent mental health services. In fact, in 2014-15 more than 11,500 children and young people across Wales received counselling, and 89% of those seen did not require onward referral after the completion of their counselling.

However, despite significant progress in that field in Wales, there are still areas of concern. A number of issues remain about the provision and delivery of CAMHS, including the transition from child to adult services and the support offered to children and young people who do not meet the clinical threshold for CAMHS but who still need support. In Wales, the comparable waiting times for child and adult mental health services are such that four of every 1,000 children and young people are waiting for treatment, which is eight times greater than the equivalent number of adults.

A particular point to which my attention was drawn came from my surgeries, as I am sure is the case for many Members here today. It seems that those children and young people who cannot attend school because of mental health issues fall between the cracks. Olivia Hitchen is 15, and I am glad to say that she was happy for me to mention her name—of course I asked her first. She lives in Corris in Dwyfor Meirionnydd and has explained how better support needs to be provided for young people who suffer extreme anxiety when they are placed in the crowded environment of a school classroom. It struck me as interesting that we expect children to operate in social groups for the purpose of education in a way that is strikingly different from the operation of most working environments; we do not usually put people in large groups with one person addressing them. If individual children do not fit into the conventional classroom, there seem to be precious few alternatives for them, particularly if they have mental health issues as well.

Olivia is highly intelligent and articulate. Her issues with anxiety appear to be reduced when she does not attend formal education, but she now needs to achieve formal qualifications, such as GCSEs, through examinations. Surely our education system should match the needs of the child and not expect our children to be moulded to the needs of the education system.

My final point today relates to the non-devolved ways in which children’s wellbeing may be improved. Of course, poverty increases the risk of mental health problems; it can be both a causal factor and a consequence of mental ill health. My constituency of Dwyfor Meirionnydd has one of the highest poverty rates in the United Kingdom. Of the 11,312 children living there, it is estimated that 2,510 live in poverty. Increasingly, those children who are in poverty live in a household where at least one adult is in work—there are 1,958 children in that situation in my constituency. A move into work is not automatically a move out of poverty. The impact of this Government’s punitive universal credit moves is hitting children in my area hard. Families in my constituency face a four-year freeze in their benefits, and the cumulative effect of the changes to support will mean that many families lose out overall, thus aggravating mental health-related issues.

Every child must be given a chance of achieving robust health and happiness. Despite the gains created by the examples I have cited from Gwynedd and from Wales overall, more must be done at both Welsh Government level and UK Government level to ensure that the best opportunities exist for all our children.

David Rutley (Macclesfield) (Con) 

It is a pleasure to serve under your chairmanship, Mr Nuttall; it is the first time I have done so. I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing the debate. During his time in office he really helped to highlight the challenges in mental health and he continues, quite rightly, to put the spotlight on mental health now. We are all grateful to him for the work that he has done in this area.

It is clear—obviously partly because of the Prime Minister’s speech—to all of us who have tried to make some efforts on young people’s mental health over the last year that it has become a major issue. For me, it became absolutely clear that it was a critical issue around 18 months ago, when I had a group of about 10 young people come to Parliament for an induction day. In a gap in the Q and A session, I decided to ask them what they thought was the most pressing challenge that their generation faced. In unison, those 10 young people, who were studying for their A-levels and had great prospects ahead of them, did not talk about tuition fees or debt; they talked about mental health. They said that mental health is the challenge we need to deal with.

As I started to explore this area in more detail, I went to an event at a school—it was a Christmas party, I think—and spoke to one of the parents who happened to be involved in dealing with pupils with pastoral issues in another neighbourhood. She talked about the increased incidence of self-harm, particularly among young women, which the hon. Member for Bridgend (Mrs Moon) mentioned. I then had the chance to speak to a number of children who were not actually dealing with mental health challenges in their own life but who were really worried about how they could help their friends who were. They were coming home and asking, “How do you deal with a friend who is involved with self-harm, or who is considering it?” Trying to come up with those solutions is a heavy burden for a 12 or 13-year-old, so these issues need to be tackled urgently.

I am grateful to YoungMinds for the work it is doing. As I have spoken with its chief executive, Sarah Brennan, and her team, it has become clear that mental health is now not just a challenge for the one in 10 children who we have heard about, or the one in 12 to one in 15 children who are dealing with self-harm; the latter figure could even be higher, according to the hon. Member for Bridgend. It is clear that young people’s mental health is a growing challenge. It is not just static; it is growing. Therefore, because of the increase in the number of referrals and because of the challenges that exist—from talking to my local mental health service provider, Cheshire and Wirral Partnership, I know that they exist—we must tackle the issue. As I have said in previous debates, the issue is amplified by social media. Feelings of low self-esteem and low self-worth need to be tackled and we need to help build resilience.

Although, obviously, not everything has been done yet, the Government took an important step forward with the “Future in mind” report, and credit needs to be given to the Prime Minister for her efforts and for the initiatives she put forward yesterday: mental health first aid training for teachers and staff; a thematic review by the Care Quality Commission, with Ofsted support; a new Green Paper on children and young people’s mental health; and the absolutely key aim—it has not been mentioned in this debate but we must ensure that it is delivered—that by 2021 no child will be sent away from their local area to be treated for general mental health disorders. My hon. Friend the Member for Bury St Edmunds (Jo Churchill) highlighted that concern. The Prime Minister was honest enough to highlight that treatment is only part of the answer. What we need to do now is prevent mental health challenges and build resilience.

Something else that has not been mentioned today is the important investment of nearly £68 million in digital mental health services to provide online therapies. It is absolutely critical that we can multiply the expertise out to as many people as possible, making it easily accessible through digital technology.

In the couple of minutes I have remaining, I want to highlight what else we need to do next. We need to learn from best practice. Peer-to-peer support does not cost a huge amount and we need to ensure that we do it. The Emotionally Healthy Schools programme in Cheshire East has been particularly helpful. We must also ensure that there is counselling support and space available at school.

I know that you are keen for me to wind up, Mr Nuttall, but let me just say one thing in conclusion. We need to ensure that the digital funding that is available pushes forward recognition for greater support from social media themselves. Often social media are a cause or an amplifier of mental health challenges. We must ensure that easily accessible apps are in place to support these young children.

Finally, given what the Prime Minister has said, it is time for our various third sector charities to come together with a clear set of asks for the Government and a clear plan of action that they would like to see us take forward; YoungMinds, the National Society for the Prevention of Cruelty to Children, Barnardo’s and all organisations that have clear expertise bringing to bear a clear plan of action that will deliver for those young people who are suffering and those we do not want to see suffer in the years ahead.

Mr David Nuttall (in the Chair) 

I ask the Front-Bench spokespersons to restrict their comments to nine minutes, so that we can leave a couple of minutes for the mover of the motion to wind up at the end.

Patricia Gibson (North Ayrshire and Arran) (SNP) 

It is a pleasure to serve under your chairmanship, Mr Nuttall. As a former secondary school teacher with more than 23 years’ experience, I am pleased to be speaking in the debate, and I am grateful to the right hon. Member for North Norfolk (Norman Lamb) for bringing it forward. He has direct personal experience of the issue and has spoken movingly about it. I think that we would all agree that he has moved the debate forward, certainly in England, where much more focus has been placed on the matter.

There is no doubt that over the past 20 years we have all started to become more aware of mental health, and of how widespread its challenges are in our society. The right hon. Member for North Norfolk articulated the importance of continuing to move the agenda forward, and that is a very good thing, because the greater our awareness of different mental health issues, the forms they can take and the challenges they pose to our society, the better equipped and educated we are as we try to deal with them, and that is never more true than in a school setting.

We know that the teenage years can be challenging in and of themselves, as young people grow, discover who they are and try to find their own path in life, and mental health issues that are not addressed in those formative years can scar a young life forever. Indeed, as the hon. Member for Bury St Edmunds (Jo Churchill) pointed out, the whole family unit is scarred and caused real pain and anxiety.

We often hear Governments talking about attainment, teaching and learning, nurturing and citizenship, and inclusion, but none of those things are possible in their truest sense unless our children and young people enjoy good health, including good mental health. The statistics outlined by the hon. Member for Bridgend (Mrs Moon) are truly shocking. Apart from the human cost, we of course need to consider the huge economic cost.

All those who have contact with young people are charged with creating a supportive, positive and fostering environment. Of course parents have a role to play, but things might manifest themselves in school and not at home, so all those who have contact with children must be vigilant. Schools have a privileged and important role in child protection. I can think of examples from my time in education when it was through the vigilance of a teacher that a young person who was struggling was identified and offered vital support, shielding the young person from falling into a downward spiral of problems and despair.

In Scotland, child and adolescent mental health services are linked to schools, and they work with young people referred to them by schools. The number of mental health professionals in those services has more than doubled under the current Scottish Administration. We all of course welcome the extra £15 million announced by the UK Government to help tackle mental health issues in young people, because we know that it is important in achieving positive outcomes.

I want to say a word or two, if you will permit me, Mr Nuttall, about some of the work that has been ongoing in Scotland for a number of years. In Scotland we have already built up support networks at the early intervention level to ensure that young people, parents and health professionals, as well as schools, are much more aware of how to help young people who begin to show signs of mental distress. In addition, we have already seen good examples of staff in schools being upskilled in areas such as mental health first aid, and some schools have involved young people themselves in the training programmes, so that they can support their peers. That might go some way towards tackling the stigma, which the right hon. Member for North Norfolk outlined.

In Scotland we are getting better at this work. The demand for child and adolescent mental health services has increased year on year, with 10% to 20% more young people starting treatment every year. That is being driven in part by the unmet need that we know has always existed across the entire UK, which is now being picked up by GPs, staff in schools and other children’s services. We are getting better, but we are not there yet, and there can be no room for complacency on such a serious, widespread and important issue. I will point out, however, that for a number of years now Scotland has had a dedicated Minister for mental health, which is a symbol of the kind of commitment required by the enormous social issue with which we are confronted.

The new measures announced by the UK Government are good—of course they are, as far as they go—but let us not forget that, as the fierce advocate for mental health, the right hon. Member for North Norfolk, has already pointed out, mental health funding has not always made it to the frontline services where it is desperately needed, and that must be addressed. I note the comments about waiting times, and I say to the Minister that Scotland was the first nation in the world to introduce, in 2010, waiting time targets for child and adolescent mental health services. That is a good path that the UK Government should think about going down. Unfortunately, in 2015 people in England were told that it was not feasible to have such targets. Why is it not feasible? If it can be done in Scotland, there is absolutely no reason why it should not be done in England.

Every constituent part of the UK needs a coherent, ambitious and bold mental health strategy to address the scourge of poor mental health, which has a huge effect on society. The Scottish National party Government is in the process of setting out their vision for mental health for the next 10 years, to transform mental healthcare in Scotland—including for children and young people—funded to the tune of £5 billion over this parliamentary term, funding that has been prioritised despite enormous budgetary pressure.

It is that kind of big thinking—that joined-up thinking—that is needed by those living with poor mental health wherever they live in the United Kingdom. I am interested in the plans that the Minister will set out today. Will she look at some of the excellent work being done in Scotland to see what lessons can be learnt to improve the situation in England?

Barbara Keeley (Worsley and Eccles South) (Lab) 

It is a pleasure to speak in this debate with you in the Chair, Mr Nuttall. I, too, congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this debate.

We have heard from Members of all parties: my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), who was here for a short while; my hon. Friend the Member for Bridgend (Mrs Moon); and the hon. Members for Taunton Deane (Rebecca Pow), for Bury St Edmunds (Jo Churchill), for Dwyfor Meirionnydd (Liz Saville Roberts), for Macclesfield (David Rutley), and for North Ayrshire and Arran (Patricia Gibson). We have heard much today much about the state of mental health services for children and young people, which was the focus yesterday, and about some of the causes and challenges. I, too, welcomed the Prime Minister’s intervention on children’s mental health yesterday. It was a step in the right direction, but inadequate without work on existing resources, which I will come on to. If mental health treatment is a burning injustice, it needs more than what I have seen summarised as teacher training, a review and a Green Paper.

Providing mental health first aid training in secondary schools will help some young people, but given that 50% of mental health problems start by the age of 14, why is that training not being extended to primary schools? A further commitment could fund a counsellor in every school, as we have heard in this debate when it was discussed by the right hon. Member for North Norfolk. We have also heard about the excellent results of school counselling in Wales.

The Children’s Society has stated that school-based counselling is seen as accessible, non-stigmatising and effective by children and pastoral care staff. As we have heard, it estimates that the additional cost of ensuring a counsellor in every school would be around £36 million; that is an overall £90 million cost when we include the current use of counselling by schools. That is not a great sum and it could make a great difference.

Personal, social, health and economic education should be statutory in our schools. That already has the support of the House. The Chairs of four Select Committees, including the Health and Education Committees, supported that as a

“crucial part of preparing young people for life.”

Importantly, the most recent Ofsted report on PSHE provision found that in two fifths of schools where learning was weak, pupils have gaps in their knowledge

“in the serious safeguarding areas of personal safety in relation to sex and relationships, mental health, and alcohol misuse.”

Does the Minister agree that if the Government are serious about tackling the stigma around mental health, making high-quality PSHE lessons statutory would be a good place to start?

Clearly, schools can play an important role in identifying vulnerable young people who may be living with mental ill health, such as those in care or those who have experienced abuse and neglect. Schools need to be supported to identify and respond to the safeguarding and emotional needs of young people affected by abuse and neglect, yet according to the Children’s Society, less than half of mental health trusts have clear pathways set up for referrals of children who have experienced sexual exploitation. If we think of the number of places in this country where that has been an issue, that is a serious gap.

Given the emphasis on the role of schools, it is deeply worrying that the National Union of Teachers’ analysis of Government figures for the national funding formula consultation found that funding would be cut from a very large percentage—98%—of England’s schools. My hon. Friend the Member for Liverpool, Wavertree, referred to the impact of cuts on schools’ budgets and their ability to fund counsellors. Some Conservative Members feel that their budgets will improve, but for many schools, they will not. Does the Minister agree that putting greater financial pressure on schools will, as we have heard, damage their ability to employ counsellors and take on other vital work to link schools with mental health services?

If schools and teachers take on a role in mental health, they need to be able to make a referral to mental health services quickly. On average, nearly one in four young people are turned away due to high thresholds for accessing services. It is unacceptable that vulnerable young people are turned away from the services they need. When young people do get access to services, they can still experience wide variations in waiting times across the country; average waiting times for treatment range from two weeks in Cheshire to 19 weeks in north Staffordshire. Such disparities must be addressed.

I turn briefly to the issue of young people in crisis waiting long periods for a bed, or being admitted to units hundreds of miles from home; as we know, that includes young people with eating disorders being sent to Scotland for treatment. It is clear that the stress and sense of isolation that that causes can damage a young person’s chances of recovery.

The Prime Minister said yesterday:

“By 2021, no child will be sent away from their local area to be treated for a general mental health condition.”

That is simply not soon enough. Will the Minister tell us whether that target of 2021 for out-of-area bed placements can be brought forward?

I turn now to CAMHS funding and the £1.4 billion of extra funding promised from 2015 to 2020. YoungMinds found, through freedom of information requests, that in 2015-16, only just over a third of clinical commissioning groups had increased their CAMHS spending by the full amount allocated to them, and this year only 50% of the CCGs had increased their spending to reflect the additional funds. As we have heard in this debate, it is totally wrong for such funding to be used for other NHS priorities. We have also heard that it is important that we know what commissioners are spending the CAMHS funding on. The hon. Member for Bury St Edmunds was right to talk about Members of Parliament being able to drill down into CAMHS spending.

There has been an issue with the way that CCGs have reported their CAMHS spending to NHS England. The Royal College of Psychiatrists reported that CAMHS funding ranges from £2 per child per year in NHS Luton to more than £135 per child per year in NHS Birmingham South and Central. When pressed, the CCGs with the lowest expenditure levels said that they had reported only the figure for the additional spending allocated to them, rather than their total CAMHS spending.

In our debate on children’s mental health in October, the Minister talked about delivering “accountability through transparency” on spending. I wrote to her on 7 December about the confusion among CCGs on the figures that they should be reporting on their CAMHS spending. I asked her to investigate and, if necessary, issue guidance so that we have the accurate figures on CAMHS spending that we need if we are to monitor that important area. I have yet to receive a response, so perhaps the Minister will respond on that issue.

Given that one in four young people are being turned away from services, we should be prioritising practical and measurable solutions to make sure that young people who need to access mental health services can do so. The Government can start the improvements, as a springboard from what the Prime Minister covered yesterday, by ensuring that the entire £250 million that was promised in each year of this Parliament is spent as intended. This spending should be ring-fenced for CAMHS and not used elsewhere in the NHS. If the social care precept can be ring-fenced, why not funding for children’s mental health?

Some schools in some parts of the country are doing excellent work on the “Future in mind” programme. In Salford, we have an emotionally friendly schools programme to support our teaching staff. We have approved registers for schools counselling. We have established school champions and young ambassadors for peer support. We are doing a review of transitions from primary to secondary school. We have developed an emotional health directory of services for children and young people, which sets out the services available and resources on websites. We are establishing a rapid response advice line for frontline professionals in schools to give them advice and guidance in times of crisis or if they lack understanding.

So much is going on, but as the right hon. Member for North Norfolk said, things are not even across the country. The Government should make it a priority to ensure that young people have timely access to clinically effective mental health support when they need it. “Future in mind” set out

“A five year programme to develop a comprehensive set of access and waiting times standards”

to bring rigour to mental health. I feel that a five-year programme is too long. It does not seem fair to spend so long developing access and waiting time standards when young people are not receiving the treatment that they need. Does the Minister agree?

Yesterday’s announcement could have been of a counsellor in every school, statutory PSHE and the ring-fencing of funding for children’s mental health. The things that we have discussed in this debate and to which I have just referred would have more impact on the burning injustice of mental health treatment than what has been summarised as teacher training, a review and a Green Paper.