Children’s Wellbeing and Mental Health: Schools 9.30 am
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...Request free trial
Children’s Wellbeing and Mental Health: Schools
9.30 am
-
(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.
-
(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.
-
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.
-
(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.
-
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.
-
(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.
-
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.
-
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.
-
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.
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Mr (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.
9.54 am
-
(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—
-
(Macclesfield)
(Con)
My daughter does.
-
—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.
10.04 am
-
(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.
10.12 am
-
(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.
10.20 am
-
(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.
10.26 am
-
(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 (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.
10.32 am
-
(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?
10.39 am
-
(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.
10.49 am
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The Parliamentary Under-Secretary of State for Health (Nicola
Blackwood)
It is a pleasure to serve under your chairmanship, Mr
Nuttall. I thank the right hon. Member for North Norfolk
(Norman Lamb), his colleagues and the Children’s Society for
initiating this debate. As ever, I pay tribute to his
continuing personal commitment to improving mental health
services, not only as my predecessor but also through
chairing the commission on children and young people’s mental
health for the Education Policy Institute. That work has been
extremely valuable to us.
The right hon. Gentleman is quite right to say that today’s
debate is both timely and hugely important. As many
colleagues have demonstrated in their comments, we know the
distress that mental health problems cause to individuals and
those who care for them. Some 10% of children have a
diagnosable disorder—700,000 in the UK—and they are twice as
likely to leave school with no qualifications, four times
more likely to become drug dependent and 20 times more likely
to end up in prison. He could not have put it better. There
is a compelling moral, as well as social and economic, case
for change. We know that if we can get our children and young
people the help and support they need early on, when problems
first arise, we can make sure that the problems do not become
entrenched. That is why the Prime Minister was clear in her
determination to improve mental health services and tackle
the burning injustice of those with mental ill health having
a shorter life expectancy.
As has been discussed, the measures announced by the Prime
Minister particularly tackle children and young people’s
mental wellbeing and build on the substantial work already in
train to implement “Future in mind”. We will continue that
work, so that we can go further and faster in intervening
earlier more often. In driving those reforms forward, one of
the challenges we still face—the right hon. Member for North
Norfolk identified this when he was a Minister—is the “fog”
when trying to identify and pinpoint the best treatment and
support for those with mental health problems. We need to
base policies on the most robust evidence possible, so that
we can be sure that we are providing the care that people
need at the right time and in the right way.
That is why the Department for Education is conducting a
large-scale school survey on the activities and approaches
used in schools to support children and young people’s mental
health in order to find out what works best, and why the
Prime Minister requested that the Care Quality Commission
undertake an in-depth thematic review—the first of its kind.
That is also why we are carrying out a prevalence survey on
children and young people’s mental health—the first since
2004, which was before YouTube, Twitter or Snapchat. The
survey will look at issues such as cyber-bullying and the
impact of social media for the first time, and it is on
course to report in 2018. It will fill an important gap in
our understanding.
As the right hon. Member for North Norfolk knows, I believe
very strongly that transparency in mental health services has
lagged behind that in acute services. At a national level,
data on children and young people’s mental health services
was included in the new mental health services data set for
the first time in January. It is still early days, but as
collection improves, new metrics to monitor delivery are
becoming available. We know from experience in acute services
that that does improve accountability, standards and safety
for patients. I will respond in detail to the comments of the
shadow Minister, the hon. Member for Worsley and Eccles South
(Barbara Keeley) about her letter—I do not have time to do
that properly right now—but we are looking at how we can
drive accountability, eradicate all shadow of confusion from
clinical commissioning groups about how they should be
reporting, and make sure that we get that data set exactly
right. As recommended by the taskforce, we will publish a
10-year research strategy to ensure that the
evidence-gathering is sustained. A new policy research unit
for mental health will be established in 2017 to make sure
that the research continues to become a reality.
While all the evidence-gathering is going on, we cannot stand
still. That is why we will press ahead with the
implementation of “Future in mind”. As the right hon. Member
for North Norfolk said, some areas are performing well and
improving, some need to get the message about why this is
important, and others are coming from such a low base that
they are still working on capacity building, so we are not
seeing evidence of improvement yet, but we are clear that we
are ambitious not only to deliver “Future in mind” but to go
further upstream and intervene earlier to prevent problems.
The evidence base that we are building will come together to
support the publication of the Green Paper, with increasing
focus on preventive activity across all delivery partners.
The Prime Minister committed initially to a new focus on
schools, colleges and local NHS services working more closely
together to provide dedicated children and young people’s
mental health services. We are supporting schools and the NHS
to develop work by evaluating models and approaches and
exploring the impact that closer working can have. We will
initially support that by funding the provision of mental
health first aid training for teachers in secondary
schools—we know that that works. That is our start. I am
going to do the training in the next few weeks, to see
exactly why it works.
As we know, the Prime Minister also launched a refreshed
programme of activity on peer support in schools and online
to help young people, through providing access to
well-trained mentors, as well as comprehensive support
structures to help identify issues and prevent them from
escalating.
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Mrs Moon
I urge the Minister to make sure that the Government look at
best practice across the devolved Administrations. It is not
a case of reinventing the wheel; let us look at what works
elsewhere and incorporate that.
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Absolutely. We are also looking at increasing support for
schools by finding the evidence of what is proven to work in
their approaches to mental wellbeing. That will be achieved
by a programme of randomised control trials of promising
preventive programmes across the country. As the hon. Lady
also mentioned, the refreshed suicide strategy has a
particular focus on self-harm, which is causing so many
problems in schools.
To make the measures work and to see the progress that we so
desperately need, we have to work closely with colleagues
across Government. As colleagues have said, schools and
colleges have an important role to play in supporting
children and young people’s mental health. That role is not
only laid out in statutory safeguarding guidance but is one
of the four areas of Ofsted judgment in the new common
inspection framework.
Colleagues are right: if we are to expect schools to play
this role, we must give them the right training and
resources. In 22 pilot areas, which include 255 schools
across the country, NHS England has been trialling a single
point of contact in schools. That programme has tested
improvements in joint working between school settings and
specialist mental health services—particularly improvements
in local knowledge and identification of mental health
issues—and it aims to develop and maintain effective local
referral routes to specialist services to ensure that
children and young people have timely access to specialist
support where required. It is also testing the idea of a lead
contact in schools and specialist mental health services and
examining how different areas choose to put that into
practice. The work is being independently evaluated by
Ecorys, and the final report will be available in the spring.
The question is whether that system is more effective than
having an individual counsellor in every school. We are
looking at that.
Other support available includes Government-funded PSHE
Association guidance, and lesson plans on how to teach mental
health across all four key stages. A range of training on how
to recognise specific mental health issues is available to
all professionals who work with young people through the
MindEd website; our analytics have shown that teachers are
the largest single group of registered users on the MindEd
tool. As the shadow Minister said, mental health and
wellbeing is an evolving and vital area of education, and we
need to make sure that it is fit for children growing up in
modern Britain, so the DFE is looking again at the case for
further action on PSHE and sex education provision, with
particular regard to improving quality and accessibility. I
am sure that it will keep the House updated on that.
The right hon. Member for North Norfolk is absolutely right
that school counselling can turn around a child’s whole life
trajectory, so schools are encouraged to provide counselling
services, and the DFE has produced guidance on good
school-based counselling as part of a whole-school approach
to wellbeing. It has also published advice on behaviour and
mental health, which provides teachers with information, and
with tools to help them identify pupils who need help and to
give effective early support in understanding when a referral
to a specialist mental health service may be necessary. An
advisory group, including sector experts and young people,
looked at what good peer support for mental health and
wellbeing looks like and considered how to encourage good
practice in schools, community groups and online. There is
much greater recognition that the earlier we pick up these
things, the better it is for young people and their mental
health.
The “Children and Young People’s Mental Health: Time to
Deliver” report from the right hon. Member for North Norfolk
found that we are making progress in many areas of the
country, but not nearly enough to be complacent. I agree
completely with that. We are restless in our ambition not
only to drive delivery of “Future in mind” in all areas, but
to go further and deliver upstream interventions to prevent
problems, rather than waiting until the need for treatment. I
hope that I have convinced the right hon. Gentleman that this
is an area to which we are fully committed, and that we will
continue to drive forward with his agenda.
Question put and agreed to.
Resolved,
That this House has considered the matter of supporting
children’s wellbeing and mental health in a school
environment.
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