Question for Short Debate (Lords) on Mental Health: Children and Young People - Jan 30

To ask Her Majesty’s Government what assessment they have made of the recent concerns expressed by general practitioners that children and young people with mental health problems are unable to access National Health Service treatments; and what steps they will take to address them.

My Lords, there is a growing consensus that children’s mental health services need to improve radically to address the ever-increasing incidence of children’s poor mental health. This matters because poor mental health during childhood shapes the rest of our lives: over half of lifelong mental ill health starts before the age of 14, and three-quarters by the age of 24.

 

As has been widely chronicled, mental health problems among children are on the rise. Recent data from NHS Digital show that: the prevalence of mental health disorders among five to 15 year-olds has risen from one in 10 in 2004 to one in nine in 2017; two-thirds of five to 19 year-olds with a mental disorder had contact with a professional in the past year because of worries about mental health, but only a quarter had contact with a mental health specialist; and the number of referrals to specialist children’s mental health services has increased by 26% in the past five years.

 

Many of these children receive treatment far too late or, in many cases, not at all. According to a recent report by the University of Birmingham’s Mental Health Policy Commission, the average wait for children between their first symptoms developing and being able to access support is 10 years. Following referral, the Children’s Society estimates that young people wait an average of 58 days until they are assessed, then a further 41 days until they begin treatment, although waiting times vary significantly across the country.

 

In a recent survey, 1,000 GPs expressed their concerns about access to children’s mental health services. It found that 78% of GPs were worried that too few of their young patients would get treatment for mental ill health, and a staggering 99% of them feared that under-18s would come to harm as a direct result of these delays in care. These concerns are not limited to GPs. According to a YoungMinds survey of more than 2,000 parents and carers, three-quarters of them said that their child’s mental health had deteriorated while they were waiting for support from CAMHS. Despite the clear need for alternative forms of support during this waiting time, such as peer support or drop-in facilities, two-thirds said that neither they nor their child had been signposted towards any other sources of support. It is hardly surprisingly, therefore, that a PAC inquiry published earlier this month concluded that most young people with a mental health condition did not get the NHS treatment they needed, and that this will be the case for years to come while many face unacceptably long waits. I make no apology for starting this debate with rather a lot of statistics because it is vital that the severity of the situation is laid bare.

 

As well as battling long waiting times, many children get lost in the gap between primary care and child and adolescent mental health services. The children who need these services are often too ill to be dealt with by primary care but not ill enough for CAMHS. Many GPs end up referring patients to CAMHS despite knowing that they will be rejected, but knowing that they need more support. According to the British Association for Counselling and Psychotherapy, as many as one in four children were rejected for treatment last year. Of utmost concern, the children and young people rejected as “not ill enough” for CAMHS include young people who have self-harmed and others who have experienced abuse.

 

For many of these children, the only way to access the care they need is for their mental health to deteriorate to crisis point or for them to turn to private care. In fact, almost two-fifths of GPs surveyed said that they would recommend patients whose families can afford it to go private. It is completely unacceptable that we have such a growing divide between those who can pay for treatment and others who are left waiting. Seventy years after the creation of the NHS, families should not be forced to pay for the mental health care that their children so desperately need.

 

The problem is indeed stark but what is to be done? There is a lot to welcome in the NHS Long Term Plan. For example, the new commitment that funding for children and young people’s mental health services will grow faster than overall NHS funding is clearly a step in the right direction. However, the plan remains silent about the current thresholds that need to be met by children presenting with mental health problems. Although I welcome the commitments in the plan that 100% of children and young people needing specialist mental health care will be able to access it in the coming decade—a far more ambitious target than the 35% access-to-treatment target in the Five Year Forward View—the reality is that only three in 10 currently receive NHS-funded treatment. There is a very long way to go. My overriding point today is: where is the money and the workforce coming from to achieve the 100% target? There are huge challenges in ensuring that funding reaches the front line to enable these ambitious targets to be met amid continuing staff shortages and cuts to children’s social care.

 

In summing up the debate, can the Minister set out what steps the Government are taking to ensure that they meet the 10-year target for 100% of children and young people who need specialist mental health care to be able to access it? Can she also outline how progress towards the 10-year target will be measured and reported to Parliament? Indeed, I call on the Government today to ensure that this should take place at least annually. Will the Minister also commit to a timetable for introducing the proposed new four-week waiting times for CAMHS services nationally and an implementation plan to ensure that these new waiting times do not result in threshold increases?

 

The NHS Long Term Plan pledges that children and young people experiencing a mental health crisis will be able to access the support they need. This is welcome since the lack of children’s crisis care is of escalating concern. A survey of emergency departments carried out by the Royal College of Emergency Medicine showed that only a third had specialist CAMHS services available in the evening and only 27% had such services available on weekends. The lack of services means that, according to a recent “Panorama” programme, 1.5 million children live in an area without access to 24-hour crisis care. This is totally unacceptable. As with physical health, mental health problems occur at all times of the day and night, including at the weekends. The plan includes a new crisis hotline delivered through NHS 111, training for ambulance staff and other provisions such as sanctuaries and crisis cafés. However, it is not clear whether these commitments will be extended to all children and young people and whether they will be part of, or separate from, adult services. Could the Minister clarify these arrangements in her reply?

 

We all know that workforce is a huge constraint on progress. The recent Public Accounts Committee report found little change in overall mental health workforce numbers since Future in Mind was published in March 2015. According to a recent National Audit Office report, slow progress on workforce expansion is emerging as a major risk to delivering the Government’s ambitions for children’s mental health services. To make the NHS Long Term Plan a reality, the NHS will need to both recruit and retain more staff, attract returners to the profession, offer rewarding jobs and a more supportive culture, and look at job redesign. This is particularly pressing given that the number of child and adolescent psychiatrists working in the NHS in England has fallen by some 6% in four years. Of course, with Brexit looming, the prospect of finding the more than 23,000 additional staff needed to treat all young people with mental health problems seems very unlikely.

 

Alongside supporting children with pressing mental health problems, it is essential that we take a preventive approach. Schools clearly have a key role to play in this. The Government’s Green Paper, which was published over a year ago, seeks to increase the support available within schools through new mental health support teams and a designated senior lead for mental health in each school. As the Commons Education Select Committee and Health Select Committee concluded last May, while laudable, these plans lack ambition and the very lengthy implementation, rolling out only to up to a quarter of the country by the end of 2023, will leave hundreds of thousands of children unable to benefit from the proposals for years to come.

 

The Mental Health Policy Commission at the University of Birmingham has found that children with high resilience are half as likely to have a diagnosable mental health condition and concluded that early intervention schemes are greatly cost effective. There are many other early intervention approaches which have not been the primary focus of this debate, such as the importance of counselling in schools and other community settings, peer support schemes and open access drop-in mental health hubs with no waiting lists of the kind being piloted in some areas, often by the voluntary sector, which can help to prevent problems escalating to the point where specialist mental health treatment is needed.

 

I call on the Government to ring-fence the new money announced for mental health in the NHS Long Term Plan, so that the much-needed investment in mental health services actually reaches the front line. I also call for this to be monitored by the introduction of a strengthened mental health investment standard for children, with sanctions imposed on those clinical commissioning groups which fail to meet the standard without a valid reason. I greatly look forward to hearing the speeches of other noble Lords, who I know will have much to contribute to this debate.

My Lords, I thank the noble Baroness, Lady Tyler, for initiating this debate because it is such an important issue, as there seems to be an epidemic of mental health problems among young people. It is impossible to read or watch the media without seeing and hearing of mental health issues among this group. There are many reasons for the increase, including poverty, neglect, stress, bullying, poor physical health, social media and trauma.

 

Most children attend primary care. Children in the UK see their GP probably on average once a year, usually even more often. GPs have an understanding of the context of the issues of the families on their books and they are in a strong position to discover childhood mental health problems, but there are barriers which more often than not make this a difficult process. Parents may not realise that their child has a problem. Their attendance to see the GP may be for a physical health reason and, as an appointment usually lasts for only nine minutes, it is clearly difficult for the primary care specialist to get a clear picture in that time. GP recognition is the key step in assessing specialist services. Indeed, GPs are the main referrers to specialist services and failure to detect disorders may delay effective interventions. Parental perceptions of problems play an important role. Their awareness of a possible mental health issue is then relayed to the GP, which is a great advantage, and we know that GPs’ recognition of a mental health problem increases when parents express concern. There is a need for an awareness campaign for parents on the signs of possible mental health issues, along with increased training for healthcare professionals.

 

The majority of mental health issues start in childhood so early identification has not only a financial benefit but, much more importantly, the quality of life for the sufferer is substantially increased. Once an issue has been picked up there are gaps between mental health and childcare services creating a barrier for effective help for both children and parents. Services are patchy, with no access to psychiatrists and long waiting lists for CBT and counselling. There is a need for a community psychiatric nurse and a social worker in every practice along with an accessible community psychiatrist. There is a requirement for a joined-up approach between the department of health and the Department for Education, where career guidance at schools and colleges can be given to encourage students to go into these professions. Specialist training for GPs to identify problems, along with an expansion of primary care-based mental health services, would clearly relieve the pressure on GPs.

 

I can only touch on social media, but the Secretary of State issued an urgent warning on the potential dangers. They cannot be blamed for all mental health problems, but the platforms have a responsibility to sort themselves out along with an awareness campaign for parents on the dangers, signs of problems and safe use. Technology can be a force for good but how many more young people must be harmed or die before we get a grip on the problem?

 

I welcome the Government’s plans for new mental health support teams over the next five years working in schools and colleges, bringing early intervention opportunities along with better information and data sharing. I also welcome the fact that spending on children and young people’s mental health must increase as a percentage of CCGs’ overall mental health spend.

 

As mental health teams are rolled out, we need co-ordination with the child health workforce to avoid replication of the existing fragmentation, along with an increased frequency of data capture and improved transitions from children’s services to those for young adults. In the end it comes down to more highly trained professionals on the ground, joined-up thinking with the Treasury, the department of health and the Department for Education, leading to more students training in the required professions. That in turn requires financial backing to make sure that training places are available in all areas of the country. I have run out of time.

My Lords, I thank the noble Baroness, Lady Tyler of Enfield, for initiating this debate. Her concern for the health and well-being of children and young people is well known, and her speech today has confirmed that concern.

 

I share the anxieties of GPs, many of whom are struggling to help young people in the face of extraordinary stresses. Also under stress are services—not only youth services but health, education, social services and the police—and here lies the problem. Young people’s mental health is rarely sudden or one-dimensional. Mental health issues are embedded in experiences such as poverty and from their contacts with parents, families, friends, education, youth services, the police and health. Youth services are disappearing, while many schools are focusing less on activities such as sport, music and art as more are driven by an academic curriculum which places students under stress. This is an issue recently raised by the chief inspector of Ofsted. Of course GPs and other services are under pressure. Will the Minister agree that child mental health is the responsibility of a number of agencies and that those agencies, like schools, also need support and more emphasis on PSHE programmes, good pastoral care—such as school counsellors—and working together to focus on young people?

 

Two years ago in Portcullis House, I facilitated a Council of Europe-UK Parliament seminar on child mental health and child-friendly justice, with young people aged 14 to 23 and many NGOs. Children and young people were listened to and consulted respectfully. They were clear and articulate in their concerns about services and could identify factors that had gone wrong for them, now and when they were younger. Their main complaint was that services were too little and too late. They wanted services that were appropriate to their needs. One young woman, responding to an Association for Young People’s Health survey, said:

 

“Very often there’s no help available until the problem has become totally unmanageable”.

 

 

Above all, they want a consistent, sympathetic adult to relate to.

 

Apart from access to treatment, treatment for children and young people has to be customised. It is simply not acceptable to have under-18s put into treatment services designed for adults. Some young people have very specific needs for mental health, such as in relation to youth justice. A high proportion of young people in the criminal justice system have mental health problems, which may not be addressed and can only get worse. Services are a vital part of addressing mental health needs in the population. I am concerned about funding at a local level, the co-ordination of services locally and young people having to fill in questionnaire after questionnaire for different services. I ask the Minister: will the Government be imaginative and forceful in tackling this issue and encourage dialogue with young people and co-ordination between services?

My Lords, this is a very timely debate, and I thank the noble Baroness, Lady Tyler, and congratulate her on securing it. We have heard some of the alarming statistics on children and young people with mental health needs, and we know that current NHS services are unable to meet this disturbing increase. In an ideal world, we would be asking ourselves why there should be such an increase—some of the reasons were mentioned by the noble Baronesses, Lady Chisholm and Lady Massey—and doing our best to tackle the causes rather than just attend to the consequences. But that is another debate.

 

For the moment, I would like to use the brief time at my disposal to focus on some of the most vulnerable young people in our society: those with moderate to severe learning difficulties, whose mental health needs can be either missed or inappropriately treated in hospitals. I believe that they and many other people with mental health needs would benefit hugely from the provision of good services in the community rather than in hospitals or other institutions. I was greatly encouraged to find that the NHS Long Term Plan, which we will debate tomorrow, comes to a similar conclusion in its treatment of this subject, on pages 50 to 53. In particular, it emphasises the need to embed mental health support for all young people in schools and colleges—a strategy that has already been shown to be therapeutically effective and cost-efficient and that was mentioned by the noble Baroness, Lady Tyler.

 

We also know that a lack of good support for children with learning disabilities and behavioural challenges can lead to crises in families and a lifetime of restrictive, high-cost, often residential treatments for individuals when they become adults. The charity Mencap is deeply concerned about this and reports that, over the last few years, the number of children with learning disabilities admitted to mental health hospitals has gone up rather than down. Between March 2015 and May 2018, the number of children under 18 in in-patient mental health units doubled, from 110 to 250. There were another 465 young people aged between 18 and 24 in in-patient units last year. The average length of stay has remained the same, at 5.4 years, since 2013. These figures contrast rather starkly with the laudable and ambitious Building the Right Support campaign launched by NHS England in October 2015. Its aim was to close up to half of the in-patient beds across the country for people with a learning disability and to ensure that local areas develop the right community support by March this year. To date, only about 20% of those in-patient beds have been closed, and I have already referred to the way in which local community mental health services are severely overstretched.

 

In other words, as we have already heard, we have a long way to go before the good aspirations of the NHS Long Term Plan for all young people with mental health needs—and those with learning disabilities in particular—will remotely be achieved. Given the urgency of the current situation, I would be most grateful if the Minister would comment on the proposed timeframe for closing beds in institutions and making sure that effective mental health support for children and young people is available in all our communities.

My Lords, I also congratulate the noble Baroness, Lady Tyler of Enfield, on securing this debate. I think it is almost four years to the day since we last debated this subject in your Lordships’ House, and I read the speech the noble Baroness gave then with great care. She commented then on the need for much greater awareness of the issues and recognised the commitment to parity of esteem for physical and mental health, which of course is now enshrined in legislation—they do listen to us sometimes. No doubt this debate was in the Chancellor’s mind when in his last Budget he announced that funding for mental health services will grow as a share of the overall NHS budget for the next five years.

 

Although I have not spoken on this or related matters regularly in this House, it is an area of interest to me. Until recently, I was a trustee of Jewish Care, which incorporates Jami, the mental health service for the Jewish community. More recently, my wife and I have tried to spend some time helping mental health charities such as the Mental Health Foundation.

 

The Government have, of course, committed to provide an extra £20.5 billion to the NHS by 2023-24 and have introduced the first ever mental health waiting targets. The NHS Long Term Plan in England addresses some of the gaps in the Five Year Forward View for Mental Health, and it is particularly encouraging to see a greater emphasis on perinatal mental health care services.

 

It is true, as the aforementioned YoungMinds has claimed, that many local health bodies are diverting some of the new funding they have received for children’s mental health to other priorities and that, while some CCGs have made big increases in their spending, many others are using some of the new money to backfill cuts or to spend on other priorities. It seems that organisations such as the excellent YoungMinds are the safety net when the NHS, and particularly CAMHS, fails to catch young people.

 

However, at the very least, the NHS is to be congratulated on much better provision of data from April 2016 on mental health provision. As this was mentioned in Oral Questions this afternoon, I spent some time looking at the monthly statistics and learned that 600,000 mental health service appointments for children in the year to 30 October were unfulfilled, which means patients did not show up. Will my noble friend the Minister assure us that steps will be taken to improve this statistic?

 

I turn to my main point. Preventing problems from emerging in the first place must be the best way to ease the pressure on services. Early intervention is also more compassionate, as it reduces distress and prevents people reaching a crisis point. The big gains in protecting and improving mental health are to be had in our schools, communities, workplaces and, generally, the non-clinical spaces where we spend most of our time. There are some programmes that are helping to take the challenge on. The Mental Health Foundation’s Peer Education Project is a good example.

 

To make a real difference to the mental health of children and young people, we need to reach children before they need services and there needs to be better support for those who do not reach the diagnostic criteria for CAMHS. I have to agree with the Mental Health Foundation when it calls for greater attention to be paid to early intervention and prevention and for the investment of more resources in this area.

My Lords, I too thank the noble Baroness, Lady Tyler of Enfield, for this debate on access to NHS treatments for children and young people with mental health problems. Doctors on the front line have long complained about the dire situation and inadequate resources. This in itself is a massive issue. It is placing ever-increasing demands on already stretched services.

 

Let us put ourselves in the shoes of a child encountering these services, possibly for the first time, at hospital A&E units. A child experiencing a mental health crisis out of hours—perhaps a looked-after child having difficulty adjusting to their new surroundings or having an argument with a parent—and brought to A&E by their guardian as the only safe place to seek assistance often has real difficulties. Self-harm is often a coping mechanism to which they turn in this kind of situation. It is not an unusual occurrence and once the child has, in many cases reluctantly, been brought to A&E they will often have to wait for hours to see a member of the psychiatry liaison team, which is already stretched to full capacity seeing the adults they are more properly equipped to manage. In most cases the healthcare professional will not have the expertise to manage the situation with the child given that most psychiatry liaison staff are not trained in child mental health. NICE guidelines recommend that they then have to admit the child overnight until the appropriate team member can come to the A&E.

 

Imagine then that this is a Friday night and the team member will not be available until Monday morning. I am advised that this is not a rare event and often happens in A&E. Staff are dissatisfied, A&E departments are dissatisfied, as are the children and their parents. Where are we going with all this without the appropriate resources to address the growing number of children with mental health problems turning up at A&E?

 

Again considering this same child, once the assessment hurdle has been surmounted the challenge remains of accessing the necessary service required. With an increase in referrals of 26% over the past five years this has stretched resources to the limits. Worryingly, however, parents questioned for a recent YoungMinds survey reported that this intervening period between the first referral and acceptance on to the clinician’s caseload can be a risky time, with 75% reporting that their children’s mental health had deteriorated further while waiting for the services to be given to them. In fact, the longer they were left to wait the more likely it was, the parents said, that the mental health of their child would deteriorate even further. There are many cases where people had waited up to six months and some had waited up to a year.

 

As many as three-quarters of those surveyed reported that they were not signposted to any other service during the time they were waiting for the appointment, so during this period the child’s mental health will almost invariably deteriorate, possibly leading to self-harming, dropping out of school or having suicidal thoughts which they might act on. The parents’ mental health may also be impacted on with the stress that they suffer during this period. What may begin as a seemingly relatively minor mental health crisis—perhaps an argument with parents or something like that—has the capacity to escalate into an issue which becomes pervasive in all aspects of the patient’s life or, worse still, lead to something worrying, such as thoughts about suicide and ill health later in life.

 

This lack of signposting further compounds GPs’ fears about a patient’s interaction with mental health services. They feel that there is little else that can be offered. However, we now have of course the new 24-hours-a-day crisis hotline, which through phoning 111 can triage children and young people. Let us hope that this will make a significant change.

 

Yes, we have more money coming in, which is welcome—the Government are moving in the right direction—but we need to know when the training is going to start to find the extra staff needed. Perhaps the Minister will address that issue.

My Lords, I wish to focus my remarks on children and young people suffering from eating disorders, which are the most deadly of all mental health illnesses and which are affecting a rising number of young girls and boys.

 

I shall use the illustration of one young teenager suffering from anorexia to highlight the historic underfunding in this area. When she got to crisis point last year and required in-patient care, no beds were available. She was put on a general ward in the local hospital and while the care team were trying desperately every day and ringing round for beds—which is what they have to do rather than caring for other children—she was left there for nearly a month. When a bed became available, it was more than 100 miles away from her home. With eating disorders you are not talking about children being in in-patient facilities for weeks; you are talking about months and months. If she had been a child with a physical illness, that would not have been acceptable. We need more specialists in eating disorder facilities, and we need them now.

 

It is welcome that the NHS Long Term Plan, at paragraph 3.26, refers to additional investment being made in this area. When will further information be given about the size of that investment, and can the Minister clarify that it will be ring-fenced for eating disorders?

 

The second point I wish to raise is around waiting times. It is fortunate for children and young people who need to be referred to eating disorder services that there are waiting times in place. We are aiming to get to 90% by 2020—we are around 80% at the moment—and where I live in Surrey I am pleased to say that the CCG has found £1 million to improve the waiting times for access to treatment. However, there are huge variations around the country, as my noble friend Lady Tyler mentioned. What will the Government do to address the huge variations in waiting times for children and young people suffering from eating disorders?

 

As I said at the beginning, these are the most deadly of all mental health illnesses and we know that early treatment for children is critical, as it is for other mental health illnesses, as other noble Lords have said. Early treatment is essential and we need that money. I therefore ask the Minister to explain when we will get clarity about the amount of money that is going to children and young people’s eating disorder services and what the Government are going to do about the geographical variations in waiting times access.

My Lords, I shall try to make four points in four minutes. The first point is about funding. At the moment we are often working backwards, as other noble Lords have said, to help those who are already at crisis point. The Government have shown great leadership on this—I welcome the additional funding—but I am still extremely worried when consultant psychiatrists and others in the system to whom I have spoken say that the extra investment is not getting to the front line for specialist services. I am not someone who thinks that public spending is the answer to every problem, but sometimes a big part of the problem simply does come down to money, and this is one of them. I back up the point made by the noble Baroness, Lady Tyler, on this and ask my noble friend the Minister how the mental health investment standard, which is excellent, will help to make absolutely sure that funding is targeted at the services most under strain, particularly specialist CAMHS.

 

My second point is about early interventions and I will be brief. School counselling services clearly can play an important role in preventing mental distress from escalating. I have seen some brilliant examples in schools. Even at primary school level, if you put yourselves in the shoes of a child, that is still quite a late intervention. I agree with the point made by my noble friend and I urge the Government to keep up the momentum on helping families—and I stress families—in the peri and post-natal stages.

 

We need to be careful about a narrative where we think that A plus B will definitely prevent C. It will not, unfortunately. We should look at early intervention but some children will end up in crisis. Mental health illnesses can strike out of the blue and we need to make sure that each part of the system works properly.

 

My third point is about culture change. I spend a great deal of time talking to people about this. I know that some people worry that we are medicalising normal childhood or adolescent experience, as if by encouraging young people to talk about their mental health we are somehow putting ideas in their heads and stimulating a false demand that should not be there and that we cannot address.

 

This shows that as a society we are on such a steep learning curve—that, unbelievably, we are still at an early stage of understanding mental well-being and, at the same time, we are trying to teach our children. For me, it is the very opposite of creating epidemics of mental illness—it is about stopping them, by teaching children that anxious or unhappy feelings at certain times are normal, but they need to be given tools to manage them. We talk a lot at the moment about what sort of a country we want to be. I want my children to grow up in a society where all those who are able to be are in control of their own mental well-being. Philip Larkin famously said that:

 

“Man hands on misery to man”,

 

 

and while he is my favourite poet, I have never particularly liked that poem. There is always a chance to break cycles and hand on resilience rather than misery.

 

My last point is about joined-up government. There are so many other points I would have liked to have covered—I am running out of time—including the new Ofsted framework, transition to adult services and welfare reform. In broad terms I am delighted to see that the Government have moved to a birth-to-25 strategy, but how will this be led across government departments in practice? When I talk to people in Whitehall they emphasise how complicated this is, with many root causes and considerations. Because that is true, it is the very reason that cross-government working needs to be gripped. Every person at every level working on this should understand which interventions are intended to solve which problems, where responsibility lies and how success will be measured. We should be following the life of a child, not the silos of departments.

 

Finally, at my daughters’ school they often sing a song from “Matilda The Musical”. It is called “When I Grow Up”. One of the closing lines is:

 

“Just because I find myself in this story, it doesn’t mean that everything is written for me”.

 

 

When I watch the kids I often remember the most harrowing calls I took as a Samaritan volunteer over a decade ago from children who simply had nowhere else to turn. Sometimes children need help to write a better story. That is our job.

My Lords, I also congratulate the noble Baroness, Lady Tyler of Enfield, on securing this very timely debate. I also declare my health and education interests, as in the register. In the short time available I shall touch on three issues: funding, workforce and crisis care, which GPs have raised many times with me.

 

First, in the NHS Five Year Forward View the NHS budget was about £120 billion but mental health received only 15% of the total. As we know, one in four people will suffer some form of mental health problem during their lives and, critically, children’s mental health services receive only about 7% of the 15%, which is totally unacceptable. There is growing evidence that there is a huge rise in the prevalence of poor mental health, particularly among young women over the last decade, and a much faster rise in help-seeking and referrals to specialist CAMHS services.

 

The 10-year plan pledges that funding for children and young people’s mental health will rise faster than the average for the NHS and by more than it will for adult mental health services. Can the Minister indicate today the profile of this funding escalation up to 2023? Unless it is honoured, the thresholds for access to services, which GPs are so concerned about, will continue to rise.

 

Further, as has been mentioned, GPs have raised concerns that funding allocations to clinical commissioning groups have not always been spent on mental health services but have sometimes been used to cover deficits elsewhere in the system. This, again, is totally unacceptable. Can the Minister give further details of the mechanisms that will be employed to deliver the 10-year plan’s commitment to ensure that local NHS commissioners are held to account for the increases in funding for mental health services?

 

Secondly, to deliver the ambitions of the 10-year plan for mental health it is crucial that a robust and imaginative new workforce plan is published. As we have heard, the Royal College of Psychiatrists has pointed out that one in 10 consultant psychiatrist posts is vacant and the latest training programme data shows that 60% of training places for child and adolescent psychiatrists are unfilled. The Royal College of Paediatrics and Child Health, the Royal College of General Practitioners and the Royal College of Psychiatrists have highlighted that currently under half of GPs have received mental health training, while 82% of practice nurses feel ill-equipped to deal with mental health problems. Yet 90% of people with mental health problems are served in primary care settings. Can the Minister tell us when the new workforce plan will be published? Many of us were disappointed that it was not published at the same time as the 10-year plan.

 

Thirdly, and quickly, from my own work on the development of liaison and diversion services, I am well aware that it is essential that children in crisis need to be assessed and supported in an appropriate setting. Police cells have now been banned for the assessment of children who find themselves in some way connected with the criminal justice system but A&E departments can be equally inappropriate and a very poor environment for proper assessment. It is obviously welcome that the 10-year plan recognises this and the importance of investment in community-based crisis response services, and commits to ensuring that children and young people experiencing crisis will be able to access crisis care 24 hours a day, seven days a week. Can the Minister indicate the timescale for the delivery of that?

 

Finally, it is essential that we have a spread of in-patient beds across the country for people who need them, in their localities and not some distance away.

My Lords, I declare my interest, as in the register, as a lay member of a CCG. I congratulate the noble Baroness, Lady Tyler, on bringing us this debate. I know that we had a slightly false start getting here but we are here. The fact that so many noble Lords put their names down to speak in this debate, meaning we have only a few minutes each, shows that this is seen as an important issue across the House and that many of us are very concerned about the mental health of our children and young people.

 

I thank YoungMinds, Beat and the Royal College of Paediatrics and Child Health for their briefings. I also thank the Library. Like many noble Lords, I clicked on the links in the Library briefing and suddenly realised that they showed the journey we have been on for the last few years with some excellent reports that have been there for five or six years. The House of Commons Public Accounts Committee published its report in January. The Stem4 GP survey was published in December 2018. There was the excellent briefing from the House of Commons Library on children and young people’s mental health services. The National Audit Office published Improving Children and Young People’s Mental Health Services last October. The Care Quality Commission’s Are We Listening? A Review of Children and Young People’s Mental Health Services was published in March last year. There were debates in both Houses all the way through last year, averaging about one every couple of months or so. There was the National Health Service’s five-year forward plan, a publication on mental health well-being trends and so on.

 

I asked myself what the common thread running through all this was. It is the recommendations that noble Lords have highlighted in today’s debate. It really is time to stop talking and to start delivering. When will the number of weeks that children and young people are having to wait be reduced, by how much, and by what date? In a child’s life, 26 weeks is a huge amount of time and has devastating effects. My noble friend Lord Brooke and the noble Baroness, Lady Wyld, mentioned this. This seems to me to be a priority. When will the workforce be increased? The figure of an additional 4,500 was mentioned in the House of Commons PAC report of last December. Are the Government on track to deliver those relatively modest figures?

 

Finally, the last recommendation in the PAC report reads as follows:

 

“By April 2019, the NHS should set out to the Committee”—

 

 

that is, the PAC—

 

“what arrangements are in place to collect the data it needs to: set up a robust baseline, and monitor progress on children and young people’s mental health services in the ten-year plan … reliably measure patient outcomes; and fully evaluate … the Green Paper pilot areas to inform the national roll-out of services, including information from outside the NHS”.

 

That is by April, which is two months away. Are the Government on track to achieve that?

My Lords, I start by thanking the noble Baroness, Lady Tyler, for introducing this debate and for giving us the opportunity to discuss a very important issue. I know that she is a great campaigner on this issue. Regrettably, it remains true that many young people who seek help find it difficult to access the right support at the right time, as she has clearly identified.

 

I also thank all other noble Lords for their contributions to this incredibly important debate. As the noble Baroness, Lady Thornton, said, there certainly is not sufficient time to address all the very important issues that have been raised today in the four minutes that Back-Benchers have been given to speak.

 

I reassure my noble friends Lady Wyld and Lady Chisholm and the noble Baroness, Lady Tyler, that this Government are committed to ensuring that our children and young people, and their families, get the support they need at the right time from the NHS, schools, colleges, local authorities and our dedicated partners in the voluntary sector. As part of this long-standing commitment, we have already laid strong foundations for a step change in the quality and scale of support available through improving and expanding NHS mental health services for children and young people, and through the 2015 Future in Mind strategy, the 2016 five-year forward view for mental health and the NHS Long Term Plan, published earlier this month, as noble Lords have identified.

 

I say to the noble Baronesses, Lady Tyler and Lady Massey, and other noble Lords that we know that the current system is not perfect but we are working tirelessly to improve the quality and availability of support for children. This will take time. The noble Baroness, Lady Massey, rightly identified that collaborative working across the system is key to ensuring that we get it right.

 

I am grateful that noble Lords have recognised the additional funding going into mental health services. As my noble friend Lady Chisholm noted, after years of underinvestment, NHS funding for children’s and young people’s mental health services is now rising and will continue to rise as we work towards the goals set out in the NHS Long Term Plan.

 

I reassure my noble friend Lady Wyld that mental health services will grow faster than the overall NHS budget, creating a new ring-fenced local investment fund worth at least £2.3 billion a year by 2023-24. In addition, the plan includes a new commitment that funding for children’s and young people’s mental health services will grow faster than both overall NHS funding and total mental health spending. This transformative investment will mean that by 2023-24 an extra 345,000 children and young people up to the age of 25 will receive mental health support via NHS-funded mental health services.

 

I say to the noble Baroness, Lady Parminter, that we recognise that the standard of service provision varies for children and young people around the country, and I acknowledge the arguments that she has made. An increasing proportion of young people are seeking help from the NHS. We are responding by already ramping up capacity, and the NHS Long Term Plan has set out further priorities for the years ahead.

 

I hope that the noble Baroness, Lady Thornton, is reassured that we are on track to meet our commitment to improve access. By 2020-21, 70,000 more children and young people will be accessing treatment each year. This equates to 35% of children and young people with a mental health condition.

 

I say to the noble Baroness, Lady Tyler, the noble Lord, Lord Brooke, and the noble Baroness, Lady Parminter, that we have introduced the first ever access and waiting standards for mental health services, as they acknowledged, including two relevant to children and young people—on eating disorders and on early intervention for people experiencing a first episode of psychosis. Indeed, we have a target to ensure that treatment begins within two weeks for more than 50% of people experiencing their first episode of psychosis. Nationally, the NHS is exceeding the target, with 78.5% of patients having started treatment within two weeks by October 2018.

 

More young people are getting the treatment that they need for eating disorders, and there has been a significant improvement in treatment times for NHS care. An extra £30 million is going into children’s eating disorder services every year, with 70 new or expanded community-based teams covering the whole of the country. We are nationally on track to meet the target of 95% of children and young people with an eating disorder accessing treatment with a one-week referral for urgent cases and four weeks for routine cases by 2020-21. The most recent data shows that 80.2% of young people started treatment for a routine case within four weeks.

 

The noble Baronesses, Lady Tyler, Lady Massey and Lady Thornton, and my noble friends Lady Chisholm and Lady Wyld also noted the importance of recognising that there is no single defined service or model that can address the needs of all ages and developmental needs across mental health, and that existing services will need to work together. I am of course in total agreement.

 

An example of how this Government are encouraging partnership working between services is the Green Paper on children’s and young people’s mental health, which will deliver a new schools and college-based service to help children and young people and will be staffed by a new workforce. This brings together health and education to provide early intervention mental health support for children, as advocated by the right reverend Prelate. We are taking cognisance of preventive services for mental health, which is key and fundamental. Every school will be encouraged to have a designated senior lead for mental health, as well as access to mental health support teams that will sit in and around colleges and schools. This commitment was confirmed in the NHS Long Term Plan and will be rolled out to between one-fifth and a quarter of the country by the end of 2023.

 

This new schools-based service is in addition to existing provision for children and young people with mental health needs. Last month we announced 25 trailblazer sites, which will run the first wave of mental health support teams. Twelve of those sites will also test a four-week waiting time for children and young people to get mental health support from the NHS.

 

The workforce is, of course, integral to everything we are doing. I agree with the noble Lords, Lord Brooke and Lord Bradley, on the issues that they raised. We have always recognised that a skilled and confident workforce is at the heart of delivering improvements to mental health services. That is why we have set an ambition to create 21,000 new posts in the mental health workforce in priority growth areas to be occupied by 19,000 NHS staff. The Children and Young People’s Improving Access to Psychological Therapies programme has trained both new and existing staff in evidence-based therapies. Our ambition is to have 1,700 newly trained therapists working in children’s mental health services and 3,400 existing mental health staff trained in evidence-based interventions by 2021.

 

As the noble Baroness, Lady Tyler, and the right reverend Prelate the Bishop of Carlisle said, some children will, unfortunately, experience a mental health crisis and will need rapid mental health support. I want to thank the noble Baroness for contacting my noble friend Lord O’Shaughnessy on this important matter last month, when he was the Minister. Like the noble Baroness and the right reverend Prelate, I am pleased with the strong focus on crisis care in the NHS Long Term Plan, which sets out around £250 million of investment in crisis care by 2023-24.

 

Improving provision of children’s and young people’s urgent and emergency mental health care is a priority for NHS England as part of the wider transformation of mental health support. We have supported the development of children’s and young people’s urgent and emergency mental health care services and intensive community support services, including testing and evaluating models for crisis support. The NHS Long Term Plan is clear that the expansion of age-appropriate crisis care services for children and young people is vital, and I share that view.

 

I am conscious that I have only two minutes left, but there are lots of questions to which I want to give answers—I have been told to keep going.

Four minutes.

I have four minutes; that is good. I shall answer some specific questions. The noble Baroness, Lady Tyler, asked how the target in the long-term plan of 100% access would be measured. The NHS will publish further details about how the long-term plan will be taken forward, in an implementation plan due this spring, and more detailed plans in the autumn. She also asked about the timetable for introducing the four-week waiting time. As she may know, we have recently announced 12 areas that will test how we might introduce the four-week waiting time without the risk of perverse incentives, such as raising thresholds. Fuller plans will then be drawn up, informed by learning from those pilots.

 

The right reverend Prelate the Bishop of Carlisle asked about better community service and support for those with learning disabilities. I agree that we need to increase community services, particularly for those with learning disabilities. That is why the long-term plan’s significant investment in children’s mental health services is so crucial. As I said, by 2024 an additional 345,000 children will receive this support.

 

My noble friend Lord Leigh, and the noble Lord, Lord Bradley, also raised the issue of CCGs perhaps diverting funding for mental health services to other things. I reassure them—and the noble Baroness, Lady Thornton, who will probably know more, because she sits on the board of a CCG—that in 2017-18, 90% of CCGs met the mental health investment standard, which requires them to increase funding for mental health at least in line with their overall financial allocation.

 

I can tell the noble Lord, Lord Brooke, and others who raised crisis care and A&E that we are committed to rolling out liaison mental health services to every A&E by 2021. The long-term plan builds on this by committing to 70% of these teams meeting the “core 24” standard by 2024. We are committed to developing alternatives to hospital.

 

I have already addressed the issues around eating disorders. Of course, it is vital that we continue to build on the good progress that has been made. More details of the implementation plan will be available in the spring.

 

To conclude, we are aware that there is much work to be done, but I am enormously proud of the work that the Government are doing to improve access to mental health services, ensuring that many more children and young people can access high-quality vital mental health support. I am confident that by continuing record levels of investment, improving access and waiting times, championing parity of esteem through high-quality mental health support services, we will provide a brighter and healthier future for our children and young people. They deserve nothing less.