[Relevant document: Fourth Report from the Education Committee, Mental health and well-being of looked-after children, Session 2015-16, HC 481, and the Government response, Cm 9284.]
I beg to move,
That this House notes the recommendations of the Youth Select Committee report of November 2015 on Young People’s Mental Health; endorses the findings of that report on the need for more support from the Government for mental health services for young people; acknowledges steps taken by the Government, since its response of January 2016 to that report, with regard to some of its recommendations; and calls on the Government to set out what further progress has been made since its response and what its plans are further to improve mental health services for young people.
The motion concerns the report of the Youth Select Committee on young people’s mental health and the Government’s response to that report. I am grateful to the Backbench Business Committee for allocating time for the debate, the application for which was supported by more than 50 members from across the House, and to the hon. Member for South Cambridgeshire (Heidi Allen) for co-sponsoring the debate.
I start by paying tribute to the many health professionals and voluntary sector organisations working in mental health services for young people, the teachers and teaching assistants who support young people with mental health difficulties in classrooms every day of the week and the youth workers seeking to support our young people in many different ways. This debate is not about the commitment of those who work tirelessly to support our young people but about the resources and the framework within which they are working, which affect our collective ability to deliver the outcomes we need.
The Youth Select Committee report on young people’s mental health was published in 2015, as a consequence of more than 90,000 young people voting for the subject of mental health in the 2014 Make Your Mark ballot. It is an exceptionally important piece of work because it is a report on mental health by young people, about young people. Since I was elected last year, I have been struck by how often young people’s mental health issues have been raised with me; whether by individual constituents struggling to access the support that they or their children need, doctors in my local accident and emergency department or teachers in our local schools. The issue is raised very frequently, and no one thinks the current situation is even close to being acceptable.
I pay tribute to the Youth Select Committee for its excellent, rigorous report and clear recommendations, which fall into three areas: funding and the state of services; a role for education; and awareness, stigma and digital culture. The report concludes that mental health services are significantly underfunded, and young people’s mental health services even more so, and that the challenge posed today by young people’s mental health is unprecedented. It highlights significant problems in accessing services, particularly in relation to first contact through GPs, and raises the urgent need for every young person in the UK to leave school with a good understanding and awareness of mental health, empowered and equipped to look after their own mental health.
Does my hon. Friend agree that some of the issues on access that are raised by this very good report could apply equally to adult services, so there is clearly a read-across between the two?
My hon. Friend is absolutely right to say that, although today we are debating young people’s mental health, many of the same issues apply to mental health services across the board for all members of our communities.
The Government published a response to the Youth Select Committee report in January 2016. That response was, on the whole, disappointing. It referred mainly to work that the Government were already doing rather than the additional work that they and other agencies clearly need to do. Most disappointing of all, the response rejected the key recommendation that statutory levels of attainment in mental health education should be introduced for all young people. I welcome the fact that the Government have subsequently announced some additional funding for young people’s mental health, but I remain very concerned about the current state of mental health services for our young people and the resourcing of those services.
I will focus, therefore, on the current state of services, and what I believe to be evidence of a crisis that is growing, not diminishing, and demands a response far bolder and more comprehensive than that which the Government are currently offering. I will also return to the conclusions of the Youth Select Committee report.
One in four of us will experience mental ill health in any given year. That means that mental health is something that affects every one of us. All of us have a friend or family member who has mental ill health, and many of us will experience mental ill health ourselves. I have known close friends and family members who have suffered from severe anxiety that impacted on their daily lives, clinical depression and eating disorders. There are few worse feelings than the worry for a loved one who seems unreachable in the pit of depression, except perhaps the worry when that loved one is a child. All any of us wants for our own children and the young people we represent is that they grow up happy, healthy and resilient to the stresses and strains of our world. Watching a precious child struggle with clinical depression, severe anxiety or an eating disorder is absolutely devastating.
According to NHS statistics, around one in 10 children and young people has a diagnosable mental health condition; that is around three students in a typical classroom. Many more young people do not have a diagnosable condition but experience a period of mental ill health or emotional distress during their childhood or adolescence. The Government’s own measures of children’s wellbeing found that almost one in four children showed some evidence of mental ill health. Half of mental health problems are established by the age of 14 and three quarters by the age of 24.
Shockingly, suicide is the most common cause of death for boys aged between five and 19, and the second-most common for girls of that age, after traffic accidents. A recent survey by Girlguiding found that 69% of girls aged seven to 21 feel that they are not good enough. It is thought that around one in eight young people self-harm between the ages of 11 and 16.
I know that my hon. Friend also has concerns, which a number of us share, about serious youth violence. Does she agree with me that mental ill health is now understood to be a key trigger in gang and serious youth violence, and that this deserves a serious and concentrated focus from within the health service and the Government? There is some very good practice out there. It is, sadly, nothing like widely available enough to help us deal with this problem.
My hon. Friend makes a very powerful and important point. This is an issue that affects both our constituencies to a significant degree.
Only 0.7% of NHS funding is spent on young people’s mental health and only 16% of that funding is spent on early intervention. The Royal College of Psychiatrists also reports that additional funding the Government have committed to young people’s mental health is not getting to the frontline. Responses to a recent freedom of information request from my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) revealed that although the Secretary of State made a commitment that the proportion of funding for mental health services should be increasing everywhere this year, and this is desperately needed, 57 of the country’s clinical commissioning groups are actually reducing the proportion of funding for mental health services.
The charity YoungMinds reports that three quarters of young people with mental health problems may not get access to the treatment they need. Child and adolescent mental health services, on average, turn away nearly a quarter of children referred to them for treatment by concerned parents, GPs, teachers and others. That finding is supported by evidence from the Association of Colleges, which reports that, of 127 colleges responding to a survey, many reported real difficulties referring students on to health services in times of crisis, with 61% of respondents reporting that their relationship as a college with local mental health services is only “fair” or “not very good/non-existent”. The thresholds for support are going up at precisely a time at which demand for services is increasing. This has the potential to create a ticking time bomb of mental ill health for the future.
The average waiting times for all CAMHS providers was six months for a first appointment and almost 10 months for the start of treatment; and an investigation by Pulse recently found that three in five referrals from GPs to CAMHS are being batted back to primary care without any access to specialist support. When early intervention is not available, it is very often schools and colleges that end up dealing with the consequences, and they are woefully under-resourced to do so. A recent survey by the National Association of Head Teachers found that only a third of primary schools have access to a school-based counsellor, and that of those who do have access, 59% have a counsellor on the school site for one day a week or less.
I commend the hon. Lady for securing this debate on this very important subject, which often comes up in my constituency work. She makes a point about schools struggling to find support. That is certainly something I have experienced in my constituency, so I want to reiterate the point that primary and secondary schools know they have children who could really benefit from more specialist support and it is very hard for them to access it.
I agree with the hon. Lady completely. As we focus on prevention and early intervention, we need to think about early intervention in terms of age, as well as the stage of mental ill health.
As a consequence of the lack of early intervention support, the number of young people attending A&E because of a psychiatric condition has more than doubled since 2010. I have spoken to many doctors who tell me that when this happens and a seriously unwell young person presents at A&E needing a CAMHS in-patient bed, they frequently wait a very long time—sometimes days—for a bed to be identified. Often that bed is hundreds of miles away from home. One south London hospital has provided me with data that show a 37% year-on-year increase in the number of under-16s being seen in A&E with a mental health condition, and a 193% year-on-year increase in the number of those children being admitted to an in-patient bed.
Does my hon. Friend agree that while there is a shortage of beds, another issue, particularly in cities such as London, is poor quality housing? In cases where individuals could perhaps have been treated at home and in the community, that treatment cannot be delivered because of the lack of proper housing.
My hon. Friend is right. There are multiple causes and contributory factors to mental ill health, and multiple contributory factors that present obstacles to addressing that and providing the treatment people need, where they need it. Housing is certainly one of them.
In London, 69 young people from Lambeth, Lewisham, Southwark and Croydon were unable to receive in-patient care in the South London and Maudsley Trust. Of those, 45 were sent out of London for their care. This issue, of seriously unwell young people being sent a long distance away from home to access in-patient care, needs to stop. It is distressing for families, it stops young people receiving the maximum possible support from family and friends to help them recover, and it makes them more vulnerable. When young people are admitted to a CAMHS in-patient unit, very often the service is not what it should be. The Care Quality Commission found that 62% of CAMHS in-patient wards and units were inadequate or required improvement.
The goal of parity of esteem for mental and physical health was introduced into the Health and Social Care Act 2012 via an amendment by Labour peers, and was a landmark in the way that mental health services are considered. However, we only need to think for a moment about what our response would be if some of the statistics on young people’s mental health related to a physical condition to realise just how far away we are from the stated objective of parity of esteem being realised. Just imagine if 75% of people with a bacterial infection struggled to get access to treatment; if almost a quarter of referrals for cataracts were turned away; if people with a chest infection were routinely forced to wait until they had pneumonia before any help was provided; or those with a broken leg were forced to wait for days in A&E only to be sent to a hospital hundreds of miles away to be treated. It would be a national scandal. The state of our mental health services, particularly those for young people, is a national scandal: it just is not being recognised as such. Words alone cannot achieve parity of esteem; the Government must start to act differently.
What action, then, is necessary to transform mental health services for our young people? I want to return now to the conclusions of the Youth Select Committee report. The Royal College of Psychiatrists highlights three recommendations in the report, which it believes are key. First, the Government must increase funding for young people’s mental health services and ensure that this funding is ring-fenced to guarantee that the money “reaches the ground” to CAMHS. There is particular concern at the moment about the introduction of sustainability and transformation plans across the NHS, and the resourcing implications of those plans. The Royal College of Psychiatrists recommends that the Government introduce ring-fenced funding for CAMHS and rejects any sustainability and transformation plans that do not clearly set out a plan to improve children’s mental health services in their area. I hope the Minister will commit to that today.
Secondly, health services must pursue co-production, in which young people themselves are involved in the process of formulating policy to improve CAMHS. Research shows that where young people have a clear voice in service design, the end result much better reflects the real needs of the patients.
Thirdly, the Government must focus on improving mental health education in schools, with the aim of ensuring that young people leave school with not only an understanding of mental health, but an understanding of how to help their own mental wellbeing. This recommendation was made by the Youth Select Committee and it is supported by the Education Committee, the National Association of Head Teachers and other teaching unions, the United Nations and many others. The Government have introduced new lesson plans for the personal, social, health and economic curriculum, but there is a broad consensus across the health and education sectors that the role of mental health education in developing resilience, preventing mental ill health and safeguarding young people is so important that it should not be left to chance, and that along with sex and relationships education it should be a compulsory part of the curriculum. I hope the Government will reflect on the urgency of the situation and the consensus around the need for compulsory education, and will make a commitment to introduce it.
The Youth Select Committee report made many other practical recommendations, including the introduction of regional commissioning, the development of an app to provide mental health advice and support, and the introduction of plans to support students through periods of exam stress. I would welcome an update from the Minister on the progress that is being made to deliver these excellent ideas.
Finally, we know that one of the greatest barriers to delivering the mental health support and services that our young people need has always been the stigma that surrounds mental health. I want to pay tribute to a brilliant piece of work that was recently published by the YMCA in partnership with the NHS. Called “I Am Whole”, the research sought to identify the extent and impact of mental health stigma and included the finding that three quarters of the young people spoken to believe that people experiencing difficulties with their mental health are treated negatively as a result of stigma. The project also sought to address stigma directly by publishing a series of stories from young people about their experiences of mental health difficulties. These make for very challenging and moving reading.
Before I close, I want to read a quotation from the foreword to “I Am Whole”, from Connie, aged 22:
“Having mental health difficulties is like being trapped inside a thousand invisible prisons. There are a thousand reasons that as a young person you are driven deeper into that colossal void. Not only isolated by the struggles you’re facing mentally, but further enveloped in a thick, suffocating darkness. The darkness descends, comprised of a tangled web of myths, harmful language, misconceptions and misunderstandings. This is stigma. It is time for these myths to be dispelled, the web broken and the isolation to end. It is time for us to be free to talk about our mental health difficulties openly, so that we can access the services we need. Once the conversation begins, you promote understanding for others and break down misconceptions people hold…It is like being stood in the dark, untangling parts of that web until the sun’s warmth breaks through…the light reaches your eyes, and you look around to see you are not alone.”
When we talk about young people’s mental health, we are talking about the wellbeing of our precious children, about their health and happiness, about the resilience of the next generation and about the ability of young people to fulfil their potential and be everything they can be. We are talking about the ways to stop more families living with the heartbreak of a young person with mental ill health and about ways to stop more families suffering the devastation of a loss to suicide. There are few things more important than this and it is time the Government got it right.
Thank you for calling me to speak in this important debate, Madam Deputy Speaker. The report was brought to my attention by Lucy Broadman, my local member of the Youth Parliament, who has been in the Chamber for Youth Parliament debates. Lucy is in the Public Gallery to listen to the debate today and has even assisted me in formulating my remarks today—I will return to that later. As a result of the contact from Lucy, I made my own application for a Westminster Hall debate, but owing to an administrative error somewhere behind the Chair it was unable to be heard. I therefore congratulate and thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for bringing this debate to the Chamber today.
Before I address the subject directly, I would like to applaud not only the hon. Lady but the Backbench Business Committee for granting this debate, not just for the seriousness of the issue but for the legitimacy it confers on the Youth Parliament. As we all try to engage with young people more and more, it is imperative that the efforts of the Youth Parliament get acknowledged and debated in here. As Lucy, now a former member, tells me, when the Youth Parliament casts out for subjects, mental health is very often in the top five or six that concern young people, so it is important that it is considered. The report is excellent, but it is also important that we debate it today.
The report is thorough and makes several conclusions and recommendations, as highlighted by the hon. Lady, but I wanted to get a better understanding of the issues facing young people in the modern age that can lead to the mental health issues laid out in the report. It is a long time since I was a young person—[Hon. Members: “No!”]—thank you—so I thought the best way for me to understand the issue was to make use of the expertise of young people, as highlighted in recommendation 17 of the report. I decided to do that off my own bat, so I had a conversation not only with Lucy but with another 17-year-old young lady I know very well, Martha Banks Thompson. I asked them to tell me what their thoughts and experiences of life as a teenager were and about the pressures that they and their friends have to face in the modern-day world. Both girls are A-level politics students, but from different ends of the country. Lucy is from my constituency of High Peak and Martha lives in the constituency of my right hon. Friend the Member for Surrey Heath (Michael Gove). My remarks today are very much—although not completely—based on the conversations we have had.
Mental health issues in any person, of any age, are very often difficult to diagnose. As has been highlighted, they are not like a broken leg, which can be seen; they are not as tangible as that. Mental health issues can often be mistaken for a temporary emotional upheaval or distress, but in the young they can often be put down to other things: pure teenage angst, raging hormones or just plain old teenage moodiness—or, as some people say, the Kevin and Perry syndrome. Consequently, these issues go unspotted and unnoticed and therefore untreated. By the time it is realised that there is a problem, it has manifested itself to such a degree that it becomes even harder to treat.
Who would, should or could identify the problem? In all likelihood it would be an adult—a parent, a guardian or even a teacher. Because of that, there is a generational gap. I am sure anyone in the Chamber or listening today will have heard from a teenage the line, “You don’t understand”, and in this case I think that, as adults, we do not understand. So what should we look for and how does the problem manifest itself? There are various symptoms and they are all too easy to miss. As we have heard, there could be anxiety, depression, eating disorders, contemplation of suicide or maybe even self-harm. Self-harm can sometimes be seen as a cry for help or attention, but more often it is a symptom of a much deeper problem. When can it occur? In days gone by, the pinch points for stress among teenagers were usually exam times: January for their mock GCSEs—they were O-levels when I took them—or May for their final exams. However, in the modern world there are so many more pressures that can impact on young people and bring about problems.
How are things different from when we were young? What are the extra factors and circumstances that we did not have to contend with that the modern-day young person or teenager does? There are many, but it would be a derogation of our duty to consider this question without looking at the impact of social media, whether it is Facebook, Twitter, Instagram, WhatsApp or Snapchat, or the many more that those of us in the Chamber have probably not heard of. Only a few years ago, they were a figment of the imagination—in my day they were science fiction—but now not only are they part of everyday life, but for the modern teenager they are often the preferred method of communicating with each other.
These technologies have much to commend them and have many advantages, not just for the teenager but for all of us in the Chamber. I am sure many of us tweet and have Facebook pages, and I am sure we all have websites. Indeed, I would venture to say that most of our communication as Members of Parliament with our constituents comes via email, making us more accessible than we have ever been. It is good that we are, and so is communication between young people. Again, I am going to betray my age now, but the days of sending notes to the object of our affections across the classroom with “SWALK” written on the back of the envelope—
Exactly. I mentioned this to Martha and Lucy and they did not know what SWALK was. I can tell my hon. Friend that it stands for “Sealed with a loving kiss”. Those days are long gone. Now everything is done via social media. It is out in the open for everyone to see and it is also there forever. The SWALK letter is read. If it is not reciprocated, it is thrown away; if it is reciprocated, it is replied to. On social media, it remains there forever.
That brings with it perils and pressures. Relationships, appearance, fashion, style—all are analysed in the public glare. Relationships, attitudes and opinions once shared privately between friends are now put out for the world to see, with every comment seemingly soliciting a further comment or response and the rhetoric growing from that. With, for example, chat groups on applications such as WhatsApp, it is very easy for what could be seen as a little verbal leg-pulling or teasing to take on a sinister complexion. We increasingly hear stories of cyber-bullying and the posting of revenge pictures. I am sure all of us in this House have at one time or another been on the receiving end of comments online that we would see as offensive or upsetting. However, for a teenager, maybe uncertain, vulnerable or lacking in confidence, such remarks can have a shattering effect on their self-confidence and in turn their mental state.
Let us look at the media in general. The modern media seem to present all young people in reality programmes such as “Made in Chelsea” as perfectly formed human beings, which puts pressure on so many young people to be absolutely perfect. The slightest imperfection, perceived or otherwise, can become a major issue. We hear a lot about body image, too, and young people’s attitude towards it. Again, the desire to be perfect crops up, so when a perceived imperfection is not only remarked on but ridiculed via social media, it can be amplified and re-tweeted, when “likes”, “unlikes” and “comments” can become very cruel, particularly to uncertain and vulnerable teenagers. This can severely damage the self-esteem and mental health of a young person.
Our consumer society is another issue. As we see with mobile phones, clothing and computers, everywhere we look there is a thirst for the latest, the best, the biggest, the fastest and the shiniest, while anything less than the optimum is seen as a problem. This is another issue that ratchets up the mental pressure on young people. I am not saying that a young person’s not having the latest iPhone will lead to mental health problems, but I am saying is that if someone is vulnerable and has low self-esteem, this sort of thing can work to enhance those insecurities and push someone into the territory that we are discussing today.
We need to remember, too, that all these pressures—I have mentioned only a few—are impacting on young people at a time when their minds, brains and characters are still growing and forming. As we get older, we form our minds and personalities, and we develop our own resilience to many of these outside pressures.
My hon. Friend is putting forward a pertinent case and providing an accurate analysis of the pressures on our teenagers. Does he agree that it is important to recognise that we need an integrated solution, which requires education and NHS response, so that schools can get in very early and start tackling some of the behaviours that lead to poor mental health outcomes?
My hon. Friend is absolutely right, and his point about the need for a whole school approach is acknowledged in the conclusion of the report. It states that when children leave school, they should be conversant with all the issues around mental health, which the hon. Member for Dulwich and West Norwood also mentioned in her speech. As I was saying, as we get older, we develop our own resilience, but in young people that development is not complete. That is the issue that we need to be aware of, and it is where schools need to play a part in helping to develop that resilience.
As we know, a stigma is attached to mental health—and nowhere more so than with young people. No young person wishes to admit to it for fear of being labelled, and people often are labelled in this society. Parents are similarly affected, so this leads to a situation of potential denial—I am not sure that “denial” is exactly the right word—which further exacerbates the problem. There seems to be a lack of willingness to say, or a fear of saying, “Look, I have a problem, and I need some help.” There should be no stigma attached to any young person admitting that they are struggling with certain issues, and neither should there be any barrier to parents making a similar plea.
Young people should have somewhere to go to ask for help—the report mentions a counsellor—without fear of ridicule. They should not be judged or labelled either by their peers or by society. Parents can be the strongest help and support for any young person, and we should look to families and family support units as well. We need to enable parents to play as full a part as they can. A young person who is getting some help at 15 can find on turning 16 that they are suddenly deemed to be an adult and their parents can be almost excluded from playing a full part. An attentive parent who is trying to help can face being told, “We can’t discuss this with you, because your girl or boy is now 16.” We should look to see whether there is a way around that problem.
In conclusion, I would like to thank Lucy Boardman and Martha Banks Thompson for their help. They have given me an insight into the world of the modern teenager and into how 21st-century pressures impact on their lives in a way that did not impact on my life as a teenager or that of many other Members here today. It was a very illuminating and educational experience for me, and I pay tribute to both of them for their candour and their honesty. As I have said, talking about these issues freely takes a lot. Many of my remarks today have come as a result of their contribution.
I say gently to the Minister that we must not in any way fall into the trap of dismissing mental health issues in the young as mere growing pains. This is a serious matter. I know she understands, but let us recognise that to provide the help needed, it needs to be not only readily and easily available, but available for as long as it is needed for each person according to their individual needs.
I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) and the hon. Member for South Cambridgeshire (Heidi Allen) on securing this debate. I warmly congratulate, too, the clearly very talented Youth Select Committee on producing such an excellent report, which cogently highlights the need for additional and better mental health services for young people. It is a job very well done indeed.
For too long, those suffering from mental ill health have received far less care and attention than those suffering from physical ailments. Even though mental ill health accounts for 28% of the total burden of disease, it gets just 13% of the NHS budget. One in four adults is diagnosed with a mental illness at some point in their lives, but only about a quarter of those who need mental health services have access to them. Serious medical conditions are going untreated because of the disparity of esteem between physical and mental health that everybody—the Government, health professionals, patients, the voluntary sector—speaks of wishing to end. There is such a long way to go.
The consequences of our neglect of mental health services are devastating. Over a third of people with mild mental health problems and almost two thirds of those with more severe mental health problems are, in fact, unemployed—yet research shows that the vast majority of them wish to work.
I thank my hon. Friend for giving way and congratulate the Select Committee on this report. She makes an important point about the number of people with mental health issues who are unemployed. I have been struck by the message from schools; one in my constituency told me that it was referring 40% of its pupils for mental health support. Does she agree that early intervention, as highlighted in the report, is vital? Does she recognise the work of Members of the Youth Parliament, including Tafumi Omisore in Hounslow, who raised these important issues with us?
Absolutely. I totally agree with my hon. Friend, and as I go through my speech I am hoping to provide an example to show how intervention is particularly important for a very young child because of the impact on the rest of the family. Early intervention can do a lot to mitigate other events and difficulties occurring in the family that might include other family members, too.
Unfortunately, tragically and outrageously, young people’s mental health services often receive less attention than adult mental health services, so that young people’s mental health services have been called the “Cinderella of Cinderella services”. In November 2014, the Health Committee found that there were
“serious and deeply ingrained problems with the commissioning and provision of services for young people’s mental health.”
Many providers reported increased waiting times and increased referral thresholds for specialist services, where patients would have to show severer symptoms to receive treatment than they would have done in the past. GPs reported feeling ill-equipped and lacking in confidence when dealing with young people’s mental health issues. The Select Committee found that early intervention programmes were
“suffering from insecure or short term funding, or being cut altogether.”
There really is no excuse for this failing. Around half of people with lifetime mental health problems experience symptoms by the age of 14, and about 75% of them before the age of 18. Catching these problems early could well lessen the severity of adult problems, possibly saving the NHS money in the long term. More importantly, I would suggest, it would reduce unnecessary suffering and enable people to live better lives.
I want to be fair to the Government, who have recognised that there is a problem. In 2014 they set up a children and young people’s mental health and wellbeing taskforce, which made a number of recommendations in its 2015 “Future in mind” report. The taskforce identified a number of problems with young people’s mental health services. The right hon. Member for North Norfolk (Norman Lamb), who was then the responsible Minister, said that there needed to be a fundamental shift in culture, with a much greater focus on prevention and early intervention.
The taskforce rightly recognised that one of the challenges facing young people’s mental health services was—unsurprisingly—funding. I was pleased when the Government responded by announcing the provision of an additional £1.4 billion of transitional funding for youth mental health services, but that additional money needs to be considered in the context of the less encouraging overall picture of mental health services funding. NHS England’s planning guidance states that all clinical commissioning groups must increase their spending on mental health services by at least as much as their overall budget increases. However, there have been warnings from organisations including mental health trusts that mental health funding is not properly ring-fenced, and that NHS England’s target is being missed.
Let me again follow in the footsteps of my hon. Friend the Member for Dulwich and West Norwood. We know from the responses to a series of freedom of information requests from my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) that more than 50% of CCGs intend to spend a smaller proportion of their budgets on mental health in 2016-17. That clearly demonstrates that what the Government tried to do has failed, and that that target is being missed as well.
The hon. Lady is making some important points. She referred to the taskforce’s “Future in mind” report. According to one of its startling statistics, only between 25% and 35% of young people with diagnosable mental health conditions access support. Does that not underline the need for much better training and much more awareness among both teachers and GPs, in respect of early identification as well as early intervention?
We need early identification and we need early intervention, but we also need the funds to ensure that there are services to which people can be referred. That is the rub of this whole debate. There does not seem to be the necessary funding at any point in the journey of young people who need help, whether in the form of awareness, intervention or services.
I have been looking into the good work done in my borough, the London borough of Newham. Even in these difficult times, it is increasing its mental health spending in both absolute and relative terms, and its children’s mental health services received an “outstanding” rating from the Care Quality Commission. I wanted to find out how we could improve young people’s mental health provision, and to learn about the challenges that an “outstanding” local provider continued to face in its fight for better services. Professionals in Newham recognise that a good young people’s mental health service does not just help those who have already developed severe and serious conditions, but provides early intervention and preventive programmes so that problems can be dealt with at source.
Is it not important for young people’s mental health services to consider the needs of parents as well? I was struck by a recent case in which the parents did not understand where the issues had come from and could not identify what they were, and felt unable to understand how best to help their child.
My hon. Friend is right. The family is often key to the provision of the support that a young person needs, but a family may itself need intervention to gain the support that it needs to lead a mentally healthy life.
The national lottery funded a programme in Newham called HeadStart, which helps 10 to 16-year-olds, particularly in schools. It trains teachers in secondary schools to develop programmes that help to build resilience among their pupils. It also provides children directly with mentoring schemes so that they can learn from each other about how to manage mental health issues—it is peer-to-peer learning—and works directly with parents to show them how they can work through mental health issues with their children. Unfortunately, the scheme relies on lottery money rather than core funding, which means that its future as a core service cannot be guaranteed. It is often difficult to obtain the necessary proof that would persuade funders—including the Government—that core funding should continue, because the timescale is often not big enough to be persuasive.
Newham would love to run more services directly in the community, and more integrated services, because it knows that they make a real difference to people’s lives. M, aged two, and her baby brother T, just seven weeks old, were referred by a perinatal psychiatrist, who was helping their mother to deal with chronic mental ill health. M was still frequently breastfed, and showed a very insecure attachment to her mum. Her anxious, and therefore sometimes controlling, behaviour was making it difficult for her mum to wean her and to attend to the needs of the new baby, who was being bottle-fed. M’s speech was also delayed.
Following assessment, the family were offered parent-infant psychotherapy, which enabled them to reflect on the needs of both children, and gradually to help M to become more independent of her mum. At the same time, T was able to have more appropriate attention from his mum as the baby of the family. I am pleased to say that, following that intervention, M is more confident and her speech is developing. She sleeps in her own room, and has settled well into nursery. That is an example of our physical and mental health services working in tandem to improve real lives.
J was a 17-year-old who had been arrested and charged with possession of a weapon and affray. He had a history of violence and non-engagement with services. During the course of his referral to a youth offending team, the team became concerned about his mental health, and referred him directly to a child and adolescent mental health services specialist for an urgent examination. During that assessment, J was having suicidal thoughts, was highly anxious, and showed quite severe symptoms of obsessive-compulsive disorder as well as softer symptoms of attention deficit hyperactivity disorder.
The youth offending team nurse arranged for J to have urgent psychiatric treatment. He was put on medication for his anxiety, with an accompanying course of cognitive behavioural therapy for his obsessive-compulsive disorder. He will also be assessed for ADHD in the longer term once his more acute symptoms abate. I am pleased to report that J has not offended since he has engaged with the mental health services offered through the youth offenders team. That shows that integrated services are better for individuals, and better for the whole community.
Those are just a few of the stories that I have been told, but I believe that there are enormous challenges to the provision of community-based and fully integrated services. I am told that Newham would love to run services directly from general practices, but they cannot currently do so because they do not have the necessary resources. With the current staffing levels it would not be efficient, because staff would spend as much time travelling to and from general practices as they would spend helping patients.
Health professionals acknowledge that early intervention work often increases rather than reduces workload in the short term. Professionals in Newham worry that they simply will not be able to deliver the clinical hours that are necessary to help more patients. Over 50% of patients in Newham already have to wait for more than five weeks to see a specialist, and that figure can only increase when further cases are uncovered without corresponding additional resources.
Some well integrated and community-based mental health services are delivered in Newham and, I am sure, throughout the country, but if we want to preserve and expand those programmes, we must be aware that they need stable and long-term funding. A good place to start would be ensuring that money designed for mental health services actually finds its way to the front line.
I declare my entry in the Register of Members’ Financial Interests. I apologise for missing the opening couple of minutes of the speech made by the hon. Member for Dulwich and West Norwood (Helen Hayes).
I am delighted that we are having this debate, and to be participating in it, for two main reasons, which I am sure you will share, Madam Deputy Speaker, because I know your interest in this matter. First, this is an important subject. It is something that we are failing on, so it is right, proper and beneficial that hon. Members talk about it openly, especially because, as we heard from my hon. Friend the Member for High Peak (Andrew Bingham), young people are much more prepared than ever to come forward with their own stories of their problems and issues, hopefully so that solutions can be found through them.
Secondly, I am delighted to participate in this debate because it is part of the UK Youth Parliament’s work. It is significant that we are giving up mainstream parliamentary time in the main Chamber of the House of Commons to discuss a report by the Youth Select Committee, an offshoot of the UK Youth Parliament. It is a shame that we have to do it in Backbench Business Committee time rather than Government time, but I pay tribute to the hon. Member for Dulwich and West Norwood for securing the debate and giving it such an excellent start—this will clearly be a high-quality debate. I take the view—I think that you share this view, Madam Deputy Speaker—that the Youth Select Committee has now taken on such status and stature, with its production of reports of such high quality involving such good research, that not only should the Government produce a formal response to the reports, as they have, but they should give up Government time in this Chamber on an annual basis—just once a year—so that we can formally debate the work of the Youth Select Committee. I have put that idea forward for some time, so I hope that the Whips and Government business managers are listening.
I am a big supporter of the UK Youth Parliament. It was founded during my time in Parliament, and I always try to attend its annual parliamentary sittings, which are a great spectacle. It is always exceedingly frustrating for Members when we return on the Monday and the Speaker inevitably says, “Why don’t you lot behave as well as the UK Youth Parliament members who were here on Friday; they are very smart, very concise, very well behaved, don’t heckle and set an example?” It is a shame that the media coverage of the Youth Parliament sitting is not more extensive because it is a great event for a great organisation, and it is great that we are discussing its work today.
When I was the Minister for children and young people, we produced the “Positive for Youth” document, which was all about promoting that sort of youth engagement. One of the things I most treasure having done is helping the transition of the UK Youth Parliament across to the British Youth Council to secure its future. I pay tribute to all its work over the past few years. It is a mainstream part of the youth voice in this country and in this Chamber.
I was the first witness ever to be called before the Youth Select Committee. It was an awesome and intimidating experience. I was called for its first inquiry back in 2012 along with the then Transport Minister, Norman Baker. We rather too nonchalantly rocked up before this group of young people in the Boothroyd Room. They were exceedingly well-rehearsed and well-researched, and were certainly not taking any BS from anybody. I have appeared in front of Select Committees—mostly the Education Committee—on many occasions, but I have to say that this was the most intimidating experience I ever had as a Minister in front of a Select Committee, and it was fantastic. That shows why the work of this Committee, and this, its fourth report, need to be taken seriously.
This Youth Select Committee report is difficult to distinguish, other than by its cover, from a House of Commons Select Committee report, and I congratulate Rhys Hart and his team on their work on it. They did all the things they should have done: they visited experts and sufferers of mental illness, and took no fewer than 148 submissions from expert witnesses and others—if only all the other Select Committees had as many well-informed and well-researched submissions as it did.
The Youth Parliament also has a substantial democratic endorsement. In 2014, when its priorities and the subject of the Youth Select Committee report were decided upon in the “Make Your Mark” ballot—which includes a debate in this House in the Youth Parliament’s annual sitting—no fewer than 875,000 young people from up and down the country bothered to turn out and vote. Of them, more than 90,000 voted specifically for the subject of mental health services, which is why we are debating this report in the Chamber today. That is a huge democratic mandate.
Every year I hold an event in the House of Commons to present democracy awards to schools in West Sussex, including my constituency, that have achieved a high turnout in the elections that are held every February. Each year the turnout gets higher, so more and more trophies have to be given out, and an ever bigger room has to be booked to accommodate everybody. Last year, one school had a 100% turnout—all its pupils turned out to vote for its UKYP members, which is absolutely fantastic.
This report is a chunky piece of evidence that needs to be appreciated, looked at and, importantly, acted upon. I am delighted that we are giving time to it today, and I am also pleased that the Government produced a formal response to it, whatever we may think about the shortcomings of what they said. That was produced jointly by the then Health Minister, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), and the then Education Minister, my hon. Friend the Member for East Surrey (Mr Gyimah). Neither of them are still in those ministerial posts, but I welcome the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), to her new position. I am sure she has learned the ropes quickly and that she will continue to do so. We need consistency in our approach to mental health, however, and a much more joined-up approach—and not just between education and health, because there are many other aspects as well.
This subject is clearly important to young people, as is this report, so it should be important to the House and the Government. There are many useful lessons that we can learn.
I am also very frustrated, however. I have been in the House for almost 20 years. I have been shadow Minister for mental health, and I was shadow Minister for children and young people for some nine years, as well as Minister for children and young people. I currently chair the all-party group on children and the 1001 group, which is all about perinatal mental health. I have seen mental health Bills come and go, too, and have been involved in them. I saw the 2011 mental health strategy “No health without mental health”, which was a very important statement about the parity of esteem we need to achieve, although we still have not. In 2014, I saw “Closing the gap: priorities for essential change in mental health”, with specific commitments to improve mental healthcare for children and young people. I saw the rolling out of talking therapies and the improving access to psychological therapies programme. In March 2015, as has been mentioned, we had the mental health taskforce, which produced “Future in mind”. I have seen lots of good work in the Department of Health, in particular, such as that done by my right hon. Friend the Member for North East Bedfordshire, and in February this year the mental health taskforce produced the “Five Year Forward View for Mental Health”. There has been a lot of talk about the importance of mental health and the necessity of achieving parity of esteem but, as the hon. Member for West Ham (Lyn Brown) rightly said, there is still a very big disparity. And here we are again: we are still here talking about this, and record numbers of children and young people still have mental health problems.
Does the hon. Gentleman agree that we can have reports, taskforces and recommendations, but the real problem is that mental health is seen as a Department of Health issue, whereas what we actually need is a completely cross-Government approach so that mental health and wellbeing can be part of every single piece of policy development?
The hon. Gentleman is right; he pre-empts a couple of my comments. From my experience as a former Minister—and, I am sure, from his—the term “joined-up government” is a complete illusion. Joined-up government does not happen in practice. On becoming a Minister, one is cocooned in a Department, and instead of having a dialogue with colleagues in the Division Lobby or wherever, a huge wall suddenly comes between you. Trying to get interdepartmental action becomes really frustrating.
I remember setting up something called the youth action group, which consisted of Ministers from nine or 10 Departments and representatives of six major children’s charities. It was co-chaired by the Prince’s Trust and Barnardo’s. The charities came to us with problems—often complex ones—affecting young people. One example related to housing benefit and accommodation for children in care. I cannot remember what the specific problem was, but it involved housing, which was the remit of the Department for Communities and Local Government, and benefits, which were the remit of the Department for Work and Pensions, as well as children in care, who came under the remit of the Department for Education. Normally there was a vicious circle that involved people being pushed from pillar to post. Alas, that committee has not met for the past 15 months or so, but our meetings used to consist of at least six actual Ministers—not just civil servants—from the relevant Departments as well as their officials. We would get Ministers together and ask them to go away and solve the problem.
Mental illness falls into that category, in that it is not simply the remit of the Department of Health or the Department for Education. There are many other implications and knock-on effects that can relate to the underlying cause of somebody’s mental illness problems. The hon. Gentleman is absolutely right that the structure of government needs to be much better. We need taskforces that genuinely cut across Government Departments, but in my experience they will flourish only if they have the buy-in and direct engagement of Ministers at the top. One welcome initiative from the hon. Gentleman’s party was the appointment of a Cabinet-level Minister for mental health. I think that that appointment has slightly gone by the wayside now, but the principle behind it was absolutely right, in that it tried to join up all the relevant Departments at the top table.
May I remind the hon. Gentleman that I am the shadow Cabinet Minister for mental health? That post has not gone away on this side of the House.
I am delighted to hear that; I did not in any way mean to underestimate the hon. Lady’s contribution. However, when the hon. Member for Liverpool, Wavertree (Luciana Berger) held the position, she sat at the Cabinet table. I hope that that is still the case, and I would very much like to see my own party replicate that position in government, because this is such an important cross-cutting issue.
Mental health remains the Cinderella service of the NHS. Indeed, the report describes child and adolescent mental health services—CAMHS—as the Cinderella service of a Cinderella service. The whole question of parity of esteem and funding is important. We can have arguments about how much the NHS budget has increased and kept up with inflation, but in every year in which the funding for mental health remains static or, worse still, declines as a portion of the overall NHS budget, we are sending out a clear message that it is a secondary priority within the NHS, and therein lies part of the problem.
I do not want to be too negative, however. We are making progress, as are other countries. For example, when you go in through the main entrance of a hospital in Copenhagen, in Denmark, you turn left if you have diabetes and you turn right if you have a mental illness. And nobody cares whether you turn left or right; there is no stigma attached to mental illness. People are treated on exactly the same basis, and that is how we need to treat mental illness here. Despite the best intentions of many Ministers, that is just not happening in practice at the sharp end where our young constituents are trying to access the mental health support that they desperately need. It is certainly not happening in a uniform way across the whole country. As a result, at least one in four people in this country is still suffering from a mental health problem.
I have a particular interest in perinatal mental health, and I declare an interest in that I chair the all-party parliamentary group for conception to age two—the first 1,001 days. I am also chairman of the trustees of the Parent and Infant Partnership Projects charity. We now have seven parent infant partnerships—PIPs—across the country providing direct support and specialist perinatal psychological help to mums and dads with newborn babies. About half of all cases of perinatal depression and anxiety go undetected, and many of those that are detected fail to receive evidence-based forms of treatment. Alarmingly, at the time of the publication of the all-party group’s report, “Building Great Britons”, in February last year, just 3% of clinical commissioning groups in England had a strategy for commissioning perinatal mental health services. The upshot of all that, as the Maternal Mental Health Alliance has calculated, is a cost to the NHS of £8.1 billion for each one-year cohort of births in the United Kingdom. That is the equivalent of almost £10,000 for every single birth in this country, and it is a cost that the NHS can ill afford.
Why is this relevant to young people? Nearly three quarters of that cost relates to the adverse impacts on the child rather than the mother. Followers of attachment theory, which the hon. Member for West Ham (Lyn Brown) mentioned, will appreciate the strong link between achieving a strong attachment between the child and the primary carer and good nurturing from the earliest age—that is, from conception to the age of two, as our report puts it—when the synapses in the brain are developing at a rate of some 40,000 a second and the child’s brain, character and development are being formed. The earliest experiences shape a baby’s brain development and have a lifelong impact on that person’s mental and emotional health.
Research shows a direct link between what happens to a mum during the perinatal period and her child in later life. If a teenager aged 15 or 16 is suffering from some form of depression, there is something like a 90% chance that his or her mum suffered from perinatal depression. The link is that clear, so it is absolutely a false economy not to help mum out at that early stage. And let us not forget dad, who also plays a crucial role. Getting it right with parents and children early on is crucial to the good mental health of children and young people. This is not rocket science—technically it is neuroscience—and we should be doing it better, sooner.
Certain other factors have been flagged up in the report. My hon. Friend the Member for High Peak (Andrew Bingham) spoke about many of them, including the peer group pressure that our children and young people experience. In fact, I have no children any more. My youngest is now over the age of 18, but we went through the teenage years together and I have seen these things at first hand. No one can go out in the morning without the latest iPhone, without checking Facebook and without tweeting what they are having for breakfast and Instagramming a photograph of it. And that all happens just after they have got up. The pressure to succeed in school and the hothouse of exams and testing are not conducive to the best mental health, and young people need support to help them through the challenges. We never had those challenges in my day, which I guess was even earlier than that of my hon. Friend the Member for High Peak. Social media is a huge influence on young people, and it was just not around in my day. I would hazard a guess that it was not around in your day either, Madam Deputy Speaker.
Will my hon. Friend give way?
I will of course give way before I say something indiscreet.
I am sure that my hon. Friend would never saying anything indiscreet. He always makes important observations in such debates. He and I were at school together, and if bullying or similar was going on, children left their problems behind when they left school for the day. Does he agree that the challenge today is that such problems go home with the child beyond the school gates and during the holidays? Does he agree that digital service providers should take further steps to provide apps and protections that will help children in those difficult circumstances?
I do agree. Believe it or not, my hon. Friend is older than me and was in the year above me at school. He has aged rather better than me, but then he has not been in the House quite as long as I have. He is right about the dynamics of the stresses and strains in those days. How children communicate has also changed. For example, one of my daughters once put in her request for supper by text message from her bedroom to my wife and me in the kitchen—supper’s off! In an age when communicating has never been easier with email, social media, mobile device, tablet or whatever, the irony is that face-to-face communication between human beings has never been more rare or remote. Therein lies part of the problem. Communication between children and parents does not happen as regularly, and the fault lies with the parents as much as the children. Some people cannot talk frankly about the real pressures, strains and stresses on our children and about grooming, sex matters or drugs. In my hon. Friend’s day and my day, we perhaps talked more to our parents or other family members.
I will now pick out a few points from the report—I know that other hon. Members want to speak. We have reached a point at which one in 10 school-age children will have some form of mental disorder, and the age at which that happens is getting younger. Some 340,000 five to 10-year-olds have a form of mental disorder. If it is not detected early and acted on, it just festers and gets worse. Too often, the only immediate response if someone gets access to a clinician is the chemical cosh of drugs, which is in many cases inappropriate for younger children. Talking therapy, for example, might be more appropriate, but we increasingly find that when people have to wait weeks or months for them a call has to be made between waiting longer or giving some form of antidepressant.
The report flags up the big issue of the transition from childhood to adulthood. Nothing changes physically or mentally when someone receives an 18th birthday card from their Member of Parliament. The last thing that an 18-year-old needs if they are going through the stresses of mental health is to have a completely new process and system to deal with because they have suddenly become an adult even though their condition has not changed. There is a particular issue around children in care, who too often used to leave at the age of 16. Fortunately, we now have a new scheme, which I was proud to have piloted at the Department for Education, based on staying put, allowing for a longer lead-in time. Every child is different and different children will be ready to go into the big wide world at different ages. The report contains some good examples of best transition practice. Southampton general hospital has a 0 to 25 age range for its “Ready Steady Go” scheme, under which every person is treated differently—people have different “go” ages.
Turning to the report’s recommendation about GP training, it is right, certainly for younger children, that GPs will be the first port of call for clinical services. Training for GPs to deal with younger people’s mental health problems is not good. Young people may need a lot of confidence to go along to see a GP with a parent or whomever, and there must be a clear understanding of how to tease the best out of children, so we need better guidance. As the hon. Member for Dulwich and West Norwood mentioned earlier, young people should absolutely be in on the genesis of that guidance.
Another recommendation that we have heard a lot about relates to what happens in schools. The hon. Member for Dulwich and West Norwood quoted the National Association of Head Teachers briefing, which states:
“When children do not meet CAMHS thresholds, schools often become responsible for children’s mental health.”
In too many cases, they are ill-equipped to do so. We are dealing with potentially one in 10—three in a class of 30—children suffering from some diagnosable mental health disorder, and the chief medical officer says that three quarters of them will receive no treatment at all. That will obviously have an impact on the child, but there will be an impact on the class as well and it is very much in the school’s interest to do something about that.
We need better teacher training so that they are able to identify the signs that point towards a mental illness. They also need better awareness of where to signpost children to get the treatment that they require. They should also be able to talk about things more generally in class. We can argue whether PSHE should be compulsory—I have some sympathy with that—and whether mental health should be a formal part of it, but it must be done in an environment in which young people will feel engaged. It should not be just another lesson, but a place where they feel free to talk openly, to absorb and to learn.
The point about the proposal that mental health education should become compulsory is simply that its presence on the curriculum is too important to be left to chance. I entirely agree with the hon. Gentleman that it should be undertaken in a way that is engaging and effective at educating young people, but does he agree that whether it happens at all should not be left to chance?
The hon. Lady and I have the same objective, but I am always sceptical about a solution that means making something another compulsory part of the curriculum. Sex and relationship education is an interesting case in point. Some of the best SRE that I have seen has been from outside youth workers and others who can empathise with young people and talk to them in a way that they will appreciate, respect and learn from. Making it another subject taught by Mrs Miggins the geography teacher, who happens to have a free period on a Thursday afternoon and so can be in charge that term, can cause problems. More schools should automatically want to have well-informed mental health education in whatever form is appropriate to engage their children. It is in their children’s best interests. I do not think that my objective differs from the hon. Lady’s, but we can have a debate about how we can most effectively achieve it.
The hon. Gentleman makes a good point about the importance of having appropriate, properly trained, empathetic people—specialists—delivering mental health education to young people. He suggests that youth services could provide such education. The problem is that local authorities are cutting those services because they are non-statutory. Many schools that have been providing support and bringing in specialist experts to help young people and teachers in this curriculum area are also facing cuts. Headteachers are having to pare back services as they deal with reduced budgets.
I hear what the hon. Lady is saying and that is a subject for another debate. It is an issue on which I have campaigned for many years, and indeed I chaired a commission looking into the role of youth workers in schools. Some really good examples of best practice are available, often in academies, which have appreciated the value of youth workers, because they can empathise with young people better, and brought them into schools. That is missing in so many other places. I have been advocating giving other roles to youth workers, who, sadly, are no longer being employed, particularly in local authorities, because this is not a statutory requirement and therefore has fallen by the wayside. So I have a deal of sympathy with that view, but it is for another day and debate.
I wish briefly to deal with a couple more points, the first of which relates to the last one: the importance of resilience and character education in the well being agenda in schools. Recent Education Secretaries have begun to take that on board, and a lot of this subject lies within that area. Another issue to consider is how this is monitored, and another good recommendation in the report is that Ofsted should have a role in that. Ofsted now has a role in assessing behaviour in schools, but that should extend to how it copes with mental health problems among pupils—that should be on the checklist. We are really bad in this country at disseminating good practice, but I have seen many examples of it. I recall visiting a school in Stafford and sitting in on some of the sessions held by their full-time counsellor. The teachers had confidence in her, would refer to her children about whom they had some doubts, and the children would speak frankly to her. Such people can prevent a lot of problems from occurring later on in the schools that have them, but not enough schools do—again, there is a debate to be had about why that is.
We also have to address the issue of cyber-bullying and the role of social media. The report gives examples about websites that promote self-harm, which are a huge scourge. We need to be much more aggressive in tackling these sites, particularly where they relate to anorexia and self-harm. People are going to them to seek advice and find a solution because they have feelings about self-harm or problems with anorexia, but these bizarre websites are promoting those things. As the report suggests, we need some form of verification scheme and, as has been mentioned, a much more responsible and bigger role for our social media companies. They are huge companies employing many thousands of people, yet the numbers in their scrutiny and enforcement departments are woefully low. As Members of Parliament with Twitter accounts, most of us have blue ticks to show we are who we say we are. Can there not be some form of verification scheme, described in the report as a “kitemarking scheme”, so that young people, particularly those who are vulnerable and impressionable, have confidence that the sites they are accessing are there to give them support, not to encourage them to do harmful things to themselves? This applies to so many different areas, including in respect of radicalisation sites.
Body image has been mentioned, and Girlguiding, which regularly revisits the issue of body image and young girls’ perceptions, has recently produced a report on the subject. It is always so alarming and petrifying to see the number of young girls as young as 13 whose aspiration is to have plastic surgery. Despite the fact that their bodies are not even fully formed and that they are still growing up mentally, they are being conditioned to think that this is the ideal to which they must aspire. That is wrong, and these influences on our young people are at the root of so many of the weaknesses and vulnerabilities leading to mental illness and, in the most tragic cases, to suicide. In the old days, a note passed across a classroom with the words “Sealed with a loving kiss” might, at worst, end up on a playground floor. At the worst extremes, in the case of a form of sexting, the equivalent these days goes viral and ends up on social media in perpetuity, where it is open for millions of people to see. That is the difference between the note in our playground days and the casual, ill-advised text on social media these days.
Finally, the report makes recommendations about young people wanting to relate to people their own age, rather than old men in suits, which I guess takes in quite a few of the hon. Members here today. [Interruption.] Okay, I was talking about myself and my hon. Friend the Member for High Peak. They say that taking such an approach makes it easier to receive the right message, hence the recommendation that
“a consultation group of young people, both with and without a mental health history, be set up to work on and contribute to the anti-stigma campaign, and that someone is identified to ensure this happens.”
I completely agree with that.
My final point is that when I was a children’s Minister, I had four reference groups within the Department for Education, each of which came to me on a three-monthly basis: one comprised children who had been adopted; one comprised children in foster care; one comprised children in residential care homes; and one comprised children who had recently left care. They came to me in the Department without adults, we sat around the table and they told me exactly what was going on. They challenged some received wisdoms, and I got some of the best information that I ever got from any experts by speaking to those young people. This report has been produced by young people and by reference to many thousands of young people, many of whom have suffered and are suffering the sorts of problems that I and many other hon. Members have mentioned today. We need to listen to the voice of these young people, to act on their recommendations, and to include and involve them in the solutions. That is why this report is so important to them, but it needs to be equally as important to us, to this House and to this Government.
I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) on securing this debate and thank her for it. I also thank the Backbench Business Committee for allowing time for the House to discuss this issue. May I also put on record my thanks to the British Youth Council, the UK Youth Parliament and the Youth Select Committee for this excellent report? May I also give them another big thank you for allowing us again to talk about mental health on the Floor of the House? People perhaps get a bit sick of me saying this, but I say it again: the way to address some of the stigma is by talking about this more. Talking about this report as we have done today will mean that young people know we are taking this subject seriously.
As I said in an intervention, the report raises issues that cross over into those relating to adult mental health services. As the hon. Member for High Peak (Andrew Bingham) said, the unique thing about the report is that it gives those of us more advanced in years an insight into pressures on young people today that were not there when we were younger and into the challenges for parents and schools in dealing with them. The core of the report is very important, because it deals with a lot of issues that also affect adult mental health services.
I wish to concentrate on two aspects of the report: how young people get access to mental health services; and the vital issue of prevention and being able to address not just mental health, but mental health well-being. As has been said, how people access these services is important. The report talks about mental health services to young people being:
“The Cinderella of Cinderella services”.
Is this about money? Yes, it is, in some cases. My hon. Friend the Member for West Ham (Lyn Brown) eloquently mentioned that we can have all the aspirations in the world, but if the funding is not there locally to provide services, the services will not be there and people will not access them. I agree with the report that this is therefore about more cash, but it is also about how we structure our mental health services in this country.
Page 5 of the report sums it up well. It contains a diagram of a pyramid showing a list of organisations that commission mental health services—schools, local authorities, clinical commissioning groups and NHS England—and calls for a lead commissioner. I totally agree with that, but I would go one step further. When we talk about commissioning services, we need to talk about the treatment pathways and how people get into those systems. Adults trying to navigate the mental health system find that it is like a maze. Not only do they have to find their way through it, but when they get into it they on many occasions find that, as my hon. Friend said, they can wait weeks, months or years to get help—this help is available in some areas but it should be provided more quickly. Early intervention, especially for young people, can prevent problems further down the line.
I sympathise with parents today, because how do they know who to go to if their child has mental health problems? What do they need to ask for? We assume that, somehow, people are well versed not only in issues around mental health, but in how to access help—that is also true for families of adult sufferers. We do need that pathway.
The report quite rightly highlights the issue around GPs and GP training, but, as I have said many times, therein lies the problem. I am not criticising GPs, because there are some very good ones who do help, who are sympathetic and who can access services. I support the recommendation in the report for more training for GPs, but we need a more open system—a system of self-referral—which does not necessarily mean going through a GP.
That brings us to the issue around commissioning and how we provide mental health services in this country. Mental health services very much follow the medical model, but I am not sure whether that needs to be the case. What we need in this country is an open system, which involves the community and voluntary sector. I am suggesting this not because it is a cheap option, but because it is perhaps a better way of providing mental health services. However, those voluntary groups need to be funded, as my hon. Friend the Member for West Ham said. It is no good saying that we are going to pass this work over to some very good voluntary sector organisations and expect them to do it without the funding. Therein lies the problem. I give credit to the former Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), who was a great champion of parity of esteem and of concentrating on how to make the system better. As I said in an intervention on the hon. Member for East Worthing and Shoreham (Tim Loughton), it is no good just looking at mental health in terms of the Department of Health, because the cuts that have taken place in local government are having a direct impact on the provision of mental health services—I am talking about the closure of youth services and voluntary sector organisations that provide mental health services locally. This is a false economy. If we are putting more money into health and taking it out from elsewhere in the system, we will create an ongoing problem.
We also need a fundamental review of CAMHS, as it is a complete failure. I am not for one minute criticising the dedicated individuals who work in that service, because I have met them and know that they work very hard. Given their workload and the way that they get their referrals, they are doing a fantastic job, but the system is broken. We cannot have this situation in which young people are waiting possibly six months for an assessment, and in which families and the individual young person are somehow expected to cope.
Does my hon. Friend agree that, in some cases, children have to become badly ill before the problem is addressed? The problem should be addressed in the first place so that they do not get into that state.
That is the case, yes. I can say from personal experience that the longer a person leaves the problem undiagnosed or untreated, the worse it gets.
I wish to touch on this idea that parents are, somehow, geniuses and know how to deal with children with mental illness. They do not. I work with Kinship Carers in Durham, which is run by Lyn Boyd, a friend of mine. It deals with grandparents, uncles, aunts and others who often find themselves, later on in life, looking after young people and children. Many of them have quite horrifying stories to tell. They often end up with the children, because of abuse, because the parents cannot cope, or because they want to save them from the care system.
I had a case earlier this year in which a six-year-old was self-harming. When I looked at his background and talked to his grandparents who were looking after him, I could understand why, but the issue is how does he access CAMHS. They were told that he had to wait six months. There we have a couple, who are not the biological parents, looking after a six-year-old. All they can say is, “What do we do?” The child is also disruptive at school. That leads to pressure on the school, which then seeks to exclude him. What happens to the child then? We are talking about not just the trauma, torment and heartache of a six-year-old self-harming, but the knock-on effect on the family and the school.
We do need a new system. It may be a community-based provision. I would certainly like to see open access services—they could be run by well-funded voluntary sector organisations or by the local authorities and councils—where people can go for help or even on occasion just information. Those grandparents, for example, did not have a clue what to do. What does a person do in that situation? The system is certainly failing those individuals. It should not be up to me as a Member of Parliament to contact a mental health trust to enable those people to gain access to services. That is where we are failing.
The problem is not just about ensuring that we have joined-up local services—I have already said that local authority budget cuts are having a direct impact on the working of such services—but the changes in the national health service and GP commissioning, which has made things worse for many voluntary organisations. Contracts are being let for a whole host of services, many of which are too large and too complex. The idea that local community groups can bid for such services does not work because those services are just too big, which means that those groups are being excluded from the money that is available. I am not for one minute saying that anyone who works in the voluntary community sector providing mental health services wants a free ride. Those groups are quite happy to be evaluated. My hon. Friend the Member for West Ham mentioned a project in her constituency that secured lottery funding. That project will certainly have had to ensure that the outcomes were there and that it was accountable. There is no way that many of those small organisations, which in many cases would provide a cheaper and better option for delivering the service, can manage those contracts that are currently being let by the NHS.
The way in which the Government should look at this matter—it is perhaps very difficult in this age of austerity—is that if they deal with it properly, they could save taxpayers’ money. It would save not just the heartache of the individuals who are going through the system, but, if done properly, money as well. On page 9 of the report, the chief medical officer said:
“Early intervention services that provide intensive support for young people experiencing a first psychotic episode can help avoid substantial health and social care costs over 10 years perhaps £15 in costs can be avoided for every £1 invested.”
If the Government really want value for money, this is a way to do it. However, there is a problem, which is that, in this country it is said that we know the cost of everything, but the value of nothing. The investment now in young people will possibly not pay for itself for another 10 or 20 years, but when it does, the payback to society will be quite large, and not just in terms of our having a healthier and happier society.
Another area I would like to touch on, which is covered in the report, is prevention—through the work done in schools and by making sure that we mainstream wellbeing. The hon. Member for East Worthing and Shoreham mentioned the difficulties of Whitehall Government and the silos people are in. We have enough reports on some of these areas now, and we do not need any more; what we need to do now is to hardwire mental wellbeing into all public policy across Whitehall. Can it be done? Yes, it can. I was involved when the last Labour Government mainstreamed veterans policy. Bob Ainsworth, who was the Minister at the time, commissioned a report on veterans. He made sure that the issue was taken forward and that each Department, when it was coming up with public policy, took veterans into account. We need a similar approach to mental health and mental wellbeing. The only way to do that is to have a Cabinet Sub-Committee so that this is dealt with at Cabinet level and the main Departments make sure, when they are coming up with a policy, that they take into account mental health and mental wellbeing.
As I said, early investment saves money, but it also makes for a better society. Another issue where I totally agree with the report is supporting school counsellors. Counsellors could be something of a pressure valve in the system. If they are properly trained, and there is a proper network of them across schools, they could intervene early on and prevent some of these issues. The hon. Gentleman said he was reluctant to make it mandatory for schools to carry out this work, but, as the report says, we have national standards and curricula for physical education, so we should have them for mental health as well.
Again, it is a patchy picture. There is some good work going on in schools across the country, with teachers taking the initiative. In my constituency, Simon Westrip, a lecturer at Northumbria University, has done some work around mindfulness with local community groups, and he is now taking that into secondary schools. If we look at some of the feedback on and evaluation of mindfulness in schools, it is clear that this is not just about the effect on individuals; it actually raises standards in many cases. However, the approach to these issues is patchy, and unless they have dedicated time in the curriculum, or they are something governing bodies need to take into account, people will not do that. Done properly, such work will not only address the pressures that a lot of our young people face now, so that they are happier going through school, but it will save lives and, in some cases, save money in the long term. Is this rocket science? I am not sure it is. We in this country have to change our attitude to mental wellbeing. If we get it right in children, as the report highlights, the payback for this country and its economy in the long term will be tremendous.
Let me finish where I started, by thanking the British Youth Council for its work. I also thank it for giving us another opportunity today to talk about mental health on the Floor of the House.
I would like to start by commending the hon. Member for Dulwich and West Norwood (Helen Hayes) for securing such an important debate and raising so many important issues. The quality of the debate has been incredibly high so far, and I am grateful for the opportunity to be able to make a short contribution.
I will start, as others have, by paying tribute to the Youth Parliament. I want to give a shout-out to our young Members of the Youth Parliament in East Sussex: Joshua Moreton, Orla Phipps and Reuben Hayward-Brown. These MYPs do a fantastic job, and I hope that, one day, at least a couple of them will be sitting on these Benches as grown-up MPs—Madam Deputy Speaker, I am sure that you, for one, will agree that we could do with far more grown-up MPs in the House of Commons. The mentor of those three MYPs—and my mentor—Councillor Sylvia Tidy, has done a great job in supporting them, and she is a huge credit to East Sussex County Council.
I also pay tribute to the work of the Youth Select Committee, which has produced this important report. It is still shocking how mental health is treated as a second-class health issue, compared with physical illnesses.
This October, we recognise Breast Cancer Awareness Month by wearing pink ribbons. This month is also when some celebrate Halloween parties up and down the country. It remains a common occurrence for people to dress up as someone with a mental health illness because it is seen as scary to portray mental hospital patients next to flesh-eating zombies. In our culture, sufferers of mental illnesses are often supposed to be feared or ridiculed, and that must change. We have to challenge the stigma and attitude that are so present today; we must challenge those prejudices.
We are all often guilty of making assumptions that are just wrong—I am also guilty of that. As a new MP I received an early piece of casework. I heard about a young teenager who was struggling with an eating disorder, who was self-harming and who had run away from home. I just assumed it was a girl. When I met the parents, “she” was a boy.
We have already heard about the impact of mental health issues on young men. Suicide rates among young men are shockingly high. In the UK today, a young man between 20 and 49 is more likely to die as a result of suicide than he is to die from a cancer, in a road accident or from heart disease. The stats are shockingly high. We do better than Japan, where suicide is the leading cause of death for men aged 20 to 44, but we have a lot of work to do on prevention, early diagnosis and early treatment.
Mental illness also has consequences. It has particular consequences for young people who are already vulnerable to grooming and exploitation, who become more vulnerable when they suffer from a mental health issue. I recently chaired an inquiry for Barnardo’s into harmful sexual behaviour between children, where the victims and survivors are children, and where the perpetrators are children as well. A lack of self-esteem, an eating disorder or depression can sometimes be a factor in children committing, or being victims of, sexual abuse. That makes effective early diagnosis and therapy even more important.
There is an issue about these children sometimes being seen as troublesome, but not recognised as vulnerable or struggling with mental illness. Here, the Government can do more, by sharing best practice across schools, councils and police services. The integration of education and health is key—something my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) has already touched on.
The role of the digital world is also important in terms of its impact on young people’s mental health—something my hon. Friend the Member for High Peak (Andrew Bingham) has spoken about. The internet can be a dangerous vehicle for grooming vulnerable young people, so I especially welcome the Youth Select Committee’s recommendation that the Department of Health should develop a trusted app, with NHS branding, that young people can use to access mental health services—a positive use of the digital world that stands in stark contrast to the negative use of it. The Government have done great work on the youth mental health hub website, but the hub has not quite made it into app form, so I would be grateful for an update from the Minister.
Though we less youthful MPs have many disagreements across the Floor of the House, there is one thing on which we can all agree: we would be nowhere without the energy, enthusiasm and youthful brains of our hard-working teams. I was touched to hear the story of one young parliamentary assistant, who lost his brother to suicide. This is Jed’s story. Jed woke up on his day off to find his mum in despair at a Facebook message posted by his brother. The message read, “I’m sorry”, with the location, “At the Needles”—a beautiful but treacherous location on the Isle of Wight. Jed’s brother was hard-working, reliable, genuine and caring. He had suffered a marriage breakdown, but he was back to his former self, with a fantastic new girlfriend by his side. But Daniel Dwight took his own life. Writing afterwards, Jed said:
“It seems such a shame to think that he felt that he had nothing to live for...I for one can promise that I shall do everything I can to ensure that the world I grow old in will learn to be fairer, more caring, with a greater willingness to understand others whilst providing all important support.”
Jed’s experience, like that of others, shows what is at stake. We need to tackle stigma. We also need early diagnosis, early support and good-quality therapy that is offered within a sensible timeframe. Waiting months for therapy, whether for depression, anxiety, a personality disorder or an eating disorder, often just because someone has not quite reached a trigger level of concern, does not help them. It hinders their recovery because time allows their suffering to get worse, and they come to believe that their case cannot possibly be important, because if it was then surely the therapy would be provided sooner. This means that when the therapy finally is available, it is even less likely that it will be successful.
One of the key lines in the Youth Select Committee’s report is this:
“Until young people’s mental health services receive funding proportionate to that of physical health, we do not believe parity of esteem can be achieved.”
For me, that squares the circle. The amount of funding we put into mental health support and therapy is linked to our attitude towards it, and our attitude towards it is linked to the amount of funding we put into it. One must lead to the other. We in this place can lead on the funding, ensuring timely and good-quality therapy and support for mental health.
I welcome all the steps the Government have taken so far to improve support for mental health, and youth mental health in particular. The investment of an extra £1.4 billon in children and young people’s mental health services over the course of this Parliament is especially welcome, although there is always more that we could invest, and I urge the Minister to do exactly that. When funding parity is achieved, and timely and appropriate support is available to everyone who needs it, the taboo that surrounds mental health can be crushed.
Finally, I pay tribute to Jed for allowing me to share his touching account of the painful and still vivid memories of the day his brother committed suicide. We both hope that sharing his story might help to prevent others from taking that most desperate route, and remind any young person struggling with their mental health who is listening today that they are valuable and valued.
I thank the Youth Select Committee for an excellent and comprehensive report, compiled by our young parliamentarians with the backing of experienced evidence. It is extremely thorough, and a credit to them. I thank the Backbench Business Committee for scheduling this debate and the hon. Member for Dulwich and West Norwood (Helen Hayes) for leading it.
I must begin by declaring a professional interest, having worked for 20 years as a clinical psychologist in mental health. I continue to maintain my skills and engagement in line with the professional requirements of my registration. Just after the election, I had the great privilege of contributing to the evidence taken by the Youth Select Committee during its inquiry into child and adolescent mental health services.
Mental health is an extremely wide field, ranging from major mental illnesses such as psychosis to depression and anxiety, trauma, and eating and adjustment disorders. Childhood developmental disorders such as attention deficit hyperactivity disorder and autistic spectrum disorder are often also included in the sphere of mental health. I would welcome future debates on those important conditions too, because I feel that we shall not have time to do them justice today.
As a member of the all-party parliamentary group on autism, I have a particular interest in this field. I commend the recent report by Ambitious about Autism, which, worryingly for us all, highlights the fact that 80% of children with autism experience anxiety on every single day they attend school. For this crucial group, we must target our resources and make sure that early diagnosis and support are provided for the young child and for the whole family. More than half of mental ill health starts before the age of 14, and 75% before the age of 18. Early and effective intervention in and prevention of mental ill health during childhood are absolutely key in reducing morbidity. The quicker we intervene, the more effectively we intervene, and it is also more cost-effective for the NHS.
In 2014, the health improvement efficiency targets were adopted in Scotland and across the UK, meaning that patients should be seen, from referral to assessment, in 18 weeks, including in CAMHS services. The figure that I have researched suggests that in Scotland 84% of children and adolescents are now treated within this time, and we have set a benchmark of 90%. We have therefore come a long way in this regard, but we still have further to travel. There are now significantly increased referral rates. Although that may mean increased numbers of sufferers, it may also mean that stigma is reducing and people feel more able to present, so it is a mixed picture. However, mental health services in Scotland, and across the UK, are not the finished article. We should continually strive towards improvement, and that should always be guided by patient need and by research underpinning the most effective clinical practice.
As we have heard, mental health problems in childhood are extremely serious. At worst, they can destroy educational potential, or at least impede it, and impede relations with peers and within the family. They can also lead to suicide and self-harm. Difficulties must be assessed and recognised at an early stage. In Scotland, widespread staff training has been undertaken to try to ensure that we can pick up on mental health issues within this age group. We have rolled out cognitive behaviourial therapy, family therapy, interpersonal therapy and specialist interventions such as those for eating disorders, with a focus on seeing patients as close to home as possible. We must make continual progress on this.
There needs to be additional resourcing for tier 4 services for in-patients. For children and adolescents, in-patient treatment should be a last resort, because it takes children away from the family home and pathologises their difficulties. Best practice highlights intensive outreach approaches that enable children to be seen at home and treated in their natural environment, so maximising key family and peer supports. Children who need in-patient services may suffer psychosis, intractable eating disorders, severe obsessive compulsive disorders, and a variety of neurological conditions. There are currently 48 beds available in Scotland, and £8 million has been pledged to build a new unit in Dundee for children and adolescents with mental health problems. We must ensure that service provision meets needs. My clinical experience suggests a lack of available tier 4 beds in forensic and learning disability CAMHS, and that should also be addressed.
We need better communication channels between departments when children’s care is transferred between professionals, and importantly, as has been described, at key stages of development such as moving from adolescence to adult services. There requires to be a component of the training programme for general practitioners in primary care that identifies children’s mental health issues. I would include symptoms of autistic spectrum disorder and attention deficit hyperactivity disorder within that training. We need to shorten the time from presentation to referral, and picking up symptoms timeously assists greatly with this. As with diet and exercise, good mental health and well-being has to be normalised. These are all fundamental coping skills that impact on everyday aspects of our functioning and deserve to be slanted more towards health and well-being than diagnosis.
Access to mental health specialists in schools is merited, as well as mental health awareness and training, particularly training for staff in schools so that if someone is experiencing a mental health problem the staff can pick it up at a very early stage and help them to access services. Specialist training for teachers would be a positive step forward. Education for children is also crucial so that they can identify when they are struggling, identify what makes for good mental wellbeing and seek help when needed, and so that they can identify whether a peer is struggling. Young people like to be, and should be, fully involved in their care.
We need to modernise our approach to mental health services for children and adolescents. We must embrace IT and social media methods of communicating with young people, because in the modern world, it is often how they communicate. In previous debates I have mentioned a project in Scotland called SafeSpot, which is an application, website and school intervention to promote positive coping skills, safety planning and access to information about mental health services for young people. That is a good step forward. I am aware that recommendations for online standardised and approved resources would be a key step.
As has been mentioned, we must address bullying, particularly online bullying, which appears to be on the increase and which badly affects children’s lives. In fact, we must address bullying everywhere. Only this summer, when I was discussing mental health, I was informed by an MP who was a fellow member of a delegation that MPs have a high suicide rate—something that I was unaware of. We must lead by example. We must ensure that mental health and wellbeing are addressed in all aspects of life, and we must provide our own model.
There remains a lack of empirical data regarding effective interventions for young people with co-morbidity issues, by which I mean mental health difficulties coupled with learning difficulties or substance use. That has to be built on through research and treatment programmes. I would also like to touch on services for looked-after and accommodated children—particularly those who have violence risk needs or self-harm needs—who are some of the most severely disadvantaged in terms of services and the magnitude of difficulties that they present with. Further service provision for specialist groups and underpinning research are crucial, and I am extremely pleased that the First Minister will be pledging to support those groups.
Given that the weight of evidence for child and adolescent mental health services is in favour of psychological rather than pharmacological interventions for the majority of presentations, clear structures must be in place to support the delivery of effective evidence-based psychological therapies for children and adolescents. The number of child and adolescent mental health services psychology posts have doubled in Scotland, and I welcome that, but we need to continue and strengthen that progress. Uptake of such services has always tended to be poorer among people from socially disadvantaged backgrounds, and in such cases an assertive outreach approach may be required to ensure that some of the most vulnerable and disadvantaged children and families do not slip through the net.
To summarise, mental health services require parity of esteem and therefore considerable funding. I believe that this goes beyond party politics. It is crucial that we tackle it meaningfully in a cross-party manner, sharing best practice across the whole United Kingdom. We need real progress to reach children and adolescents and to help all our children achieve their full potential.
It is a great pleasure to follow the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron)—I hope I have got that correct.
Order. It is pronounced “Stray-ven and Lez-ma-hay-go”.
Thank you, Madam Deputy Speaker. I am suitably corrected and admonished at the same time. I am glad that you did not ask me to repeat that after you.
I particularly applaud the point that has been made about making this a cross-party matter on which we can all work together. As the young people have shown us in their fantastic report, working together will help to ensure that all voices are heard and recognised.
I thank the hon. Member for Dulwich and West Norwood (Helen Hayes)—her constituency is much easier for me to pronounce—for sponsoring the debate. I apologise for going back and forth from the Chamber, and perhaps I may explain to those who are watching why there are so few MPs on the Benches. My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) said that it would be good to hold such debates during Government time, when Members may not be in their constituencies. Of course, Thursday afternoon is also a time when Bill Committees sit, so Government and Opposition Members are required to attend those Committees. I hasten to add that I should also be in a Bill Committee, but I was so determined to speak on this matter that I have come to the Chamber. It is probably for that reason that I will always be asking Ministers for more from the Back Benches, rather than being on the Front Bench and able to deliver those things myself.
I commend the 2015 Youth Select Committee report, and I particularly applaud the 90,000 young people—many more took part in the vote—who voted that mental health services for young people should be the priority concern. They are absolutely right to focus on this subject, and I submit that they are in the best position to give their opinion on it.
I similarly decided that the subject would be a chief priority for me when I was elected as an MP in East Sussex 18 months ago. The severity of this issue, particularly among young people, became all too apparent to me. I found—I still do—the stories of carefree, confident and happy lives being shut down as young people enter a dark world of fear, anxiety and isolation to be incredibly upsetting.
As a result of my concern, I chose this issue as the topic of my question when my name was first pulled out of the hat for Prime Minister’s questions. I told the then Prime Minister that I had spent an afternoon in the small town of Battle in my constituency visiting three families, each of whom had a child who had not been given the early-stage intervention that they expected from the child and adolescent mental health services. I asked the Prime Minister for more focus on early-stage treatment so that young people’s conditions do not become more acute.
Providing such services is not only our civic duty, but an economic and social imperative. When my constituents ask me why the roads in East Sussex are in a state, I explain that I recently secured £250,000 from our county team to fund just one year of acute mental health treatment for one constituent. Fixing people has to come before fixing holes in the tarmac. The phenomenon may not have existed so openly when many of my constituents were younger, but it is now a huge financial concern to my county council colleagues.
I firmly believe that too much pressure is being loaded on to people too young. Social media and the internet, as pioneering as they are, are a curse on wellbeing, and internet service providers must be forced to do more. Every young person should have the right to have their web history expunged. Cyber-bullying is at last being recognised as a crime, but every school must ensure that its pupils are aware of good internet practice and the sanctions for abuse. We also need to be aware that young people and children are accessing graphic images and media on the internet that they cannot understand, process or cope with.
In the report’s consideration of education, I absolutely commend the recommendation
“that the Government develop and introduce statutory levels of attainment for mental health education…Schools should have autonomy to deliver mental health education flexibly but must be able to demonstrate how pupils reach the attainment levels.”
May I suggest that in so doing the Government should ensure that the curriculum combines a consideration of social media and the internet with wellbeing training?
We also need training for our GPs. The situation is summed up perfectly by the experience of a young person that is detailed in paragraph 32 of the excellent report. It is essential that the GP does not diagnose a mental health condition, but merely refers the young person to a specialist. I know that mental health specialists find it frustrating if GPs diagnose a mental health condition when the specialist does not regard it as such. Once that badge is given to someone, it is difficult to remove it. Equally, brilliant local GPs, such as those in Battle who have helped my constituents in their surgeries, have championed young people and become their advocate. They are incredibly frustrated by the delay in early intervention in mental health services. I work closely with my local CAMHS team, and I have the highest regard for the many excellent specialists who do their best. However, I am worried that constituents face lengthy waiting times and that some have been passed from pillar to post when receiving treatment.
Building up trust is a key ingredient of successful diagnosis and treatment. I hear stories about young people finding the courage and trust to open up about their condition, only to find a new practitioner at the subsequent session. It disappoints me that the young person can then regress because of that change of personnel. I would like a commitment to giving treatment on a fixed one-to-one basis. If we can do that for maternity provision, surely we can do it for mental health treatment.
When I attended the launch of the mental health taskforce, I was buoyed by the commitment of the then Minister and the chief executive of NHS England to implement the excellent “Five Year Forward View”. I was cheered by the commitment to funds to ensure that our acute hospitals have adequate mental health expertise on A&E wards to deal with those who are hospitalised as a result of mental health issues, or who have such a condition in addition to a physical illness.
My concern was driven by the experience of a family in my constituency following a suicide attempt. The NHS staff did not have the ability to deal with the mental health condition, and my constituent, a young man in his teens, was forced to wait until CAMHS staff could make their way over from another town miles away. I understand the need for specialist treatment, but it strikes me that there is a need for a culture change across the entire NHS, and that all staff should be trained to understand mental health and provide a basic level of treatment. Specialisation in health is important, but if the NHS becomes over-specialised, it can lead to a lack of general involvement in such care for patients.
I welcome the news that the Government will fund 24/7 mental health provision in our hospitals, but I was alarmed at the suggestion by the chief executive of my local trust that the funding may not stretch far enough. I also want to ensure that that specific coverage will not mean that other NHS staff with the necessary technical understanding and empathy will feel that they are not empowered to assist those many hospital patients who need help with their mental healthcare, in addition to their physical wellbeing.
Ultimately, getting early-stage intervention right is a key part of achieving a proper diagnosis for people with a mental health condition. We should not misdiagnose young people who are suffering growing pains and need the coaching and guidance of family and friends to overcome the problems of adolescence. However, I have met too many young children who face a difficult future because their mental health condition was not treated at an early stage. Funding mental health treatment is a most important investment, not only for people’s welfare and wellbeing, but to enable these amazing young people to fulfil their hopes and dreams in their careers, and to make something of themselves and their country.
I applaud the amazing work of all of those in the British Youth Council, many of whom live in my county of East Sussex, who have done so much to produce this excellent report. Those young people are leading the charge to ensure that the nation supports all those who are affected by this terrible condition. We owe it to them, and to all young people, to deliver a better mental health service, and many of the report’s recommendations will do just that.
It is a pleasure to follow the hon. Member for Bexhill and Battle (Huw Merriman), and I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) and the hon. Member for South Cambridgeshire (Heidi Allen) on securing this debate. My hon. Friend is having quite a week: she has pressed the Prime Minister about the serious issue of historical child sexual exploitation in her constituency; she is here today; and tomorrow she will help lead the charge on the Homelessness Reduction Bill. I am delighted that she has found time to lead this afternoon’s debate.
As one of the elected honorary presidents of the British Youth Council, I am particularly delighted that this debate arises from the Youth Select Committee’s report, “Young People’s Mental Health”. I hope that the fact that Members of Parliament have taken the initiative to make sure that we are debating it in the House of Commons reassures the UK Youth Parliament, youth councils and young people generally that their voice is being heard. Our challenge now is to make sure that their voice is listened to by Government.
It is also worth saying that much of the profile that the UK Youth Parliament enjoys in the Houses of Parliament, particularly the annual sitting, which will next take place in this Chamber on 11 November, arises from the personal support of Mr Speaker. I know that I speak on behalf of so many people involved in BYC and the UK Youth Parliament in thanking him for his consistent championing of young people’s voice in democracy.
My interest in young people’s mental health and the reason I am here partly stems from my time as deputy leader and cabinet member for health and wellbeing in the London Borough of Redbridge. However, the main reason I have chosen to be here instead of in my constituency on a Thursday afternoon is my experience, both as a councillor and as a Member of Parliament, of listening directly to young people talk about their concerns and issues, and those of their friends and peers, with mental ill health. Redbridge has a fantastic youth council, which, like the national UK Youth Parliament, has prioritised work on mental health. I will come on to talk about that.
While sitting in Redbridge Council chamber listening to young people from across our borough, I was struck by the way in which they talked in such an open, candid and courageous way about their own struggles with mental ill health and what they have seen in their classrooms and communities. Although much of what they described was harrowing and of concern from a public policy point of view, it is hugely encouraging that this generation of young people seem to be far more at ease with discussing mental health and have normalised discussing it in such a way that it is similar to how they discuss physical ailments. That gives us hope for the future when it comes to changing the culture surrounding mental health, which my hon. Friend the Member for North Durham (Mr Jones) has mentioned.
Recently I chaired a meeting of the all-party parliamentary group on youth affairs about mental health, and it was hugely encouraging to see young people from across the country pack one of the largest Committee Rooms of the House of Commons. The key message that came across was the failure of public services and health services to address concerns that many of those young people had experienced personally.
We know from so much of the research, particularly the excellent briefings we have had from charities such as YoungMinds ahead of this debate, that there are significant and well-known problems nationally with regard to mental ill health affecting children and young people. As my hon. Friend the Member for Dulwich and West Norwood said at the start of the debate, one in 10 children and young people has a diagnosable mental health condition. That is the equivalent of three children in every classroom. We also know that a great many more suffer periods of anxiety, emotional distress and ill health because of the growing pressures of childhood. That should give us all pause for thought and cause for concern.
Three quarters of young people with mental ill health may not get access to the treatment that they need. I am particularly concerned about the statistic that my hon. Friend shared showing that CAMHS is turning away nearly a quarter of children referred for treatment by parents, teachers and GPs. Those children have been referred by people who, to be frank, have expertise, and to turn such a high proportion of them away is wholly unacceptable.
My hon. Friend is making a powerful contribution, as have many others. This summer, Healthwatch Nottingham published the results of its survey of young people about their experience of seeking help and treatment. It found that 26% of young people had not sought any help or treatment at all, despite feeling that they suffered from a mental health problem. That was twice as likely among black and minority ethnic young people. Does he agree that we need to do more to raise awareness of the help that is available, which needs to take account of the needs of all young people?
I agree strongly. That leads me neatly on to a point I wanted to raise about the provision for young people. It is not just young people generally who are having trouble accessing mental health services. The Government and the health services need to look carefully at the profile of the young people affected. During my time as head of education at Stonewall, we published “The School Report”, a piece of research undertaken with young people by the University of Cambridge. It found exceptionally high and extremely worrying levels of mental ill health among lesbian, gay, bisexual and trans young people. The alarming rates of self-harm and suicide, to which many hon. Members have referred, are even higher for that particular group. More than half of LGBT young people are self-harming. Around a quarter have attempted suicide or considered taking their own life. Those levels are of epidemic proportions. That points to a crisis among LGBT young people, which is a symptom of wider poor provision.
My hon. Friend will be interested to know that the same report says that young people who identified as homosexual or bisexual were most likely to have experienced a mental health issue in the past or currently, and that their experiences when seeking treatment and support were more likely to be negative. Does that not give more credence to what he is saying about the need to deal with their specific needs?
It really does. One of the things that concerns me most about young people’s poor experience of mental health services—this was reflected at the discussion by the all-party group—is that it is not just GPs and headteachers who recognise that young people are being failed and turned away; young people themselves recognise that. I cannot imagine what it must be like to be a young person who is suffering from anxiety, depression or another form of mental ill health, who knows they have a problem, seeks help and is left to feel ignored, dismissed and unsupported. I have mentioned the proportion of lesbian, gay and bisexual young people who are affected, and it is even higher for trans young people.
I represent a constituency that is highly diverse ethnically and religiously. It worries me that Asian communities seem to be far less likely to seek access to mental health services. There is a job to do there to tackle stigma and to make the services more accessible. People from African-Caribbean communities face inequality. The failures of public policy on African-Caribbean people should shame our country. It is a further indictment that the majority of African-Caribbean people who come into contact with the mental health system seem to do so through the criminal justice system. That is a terrible state of affairs. Therefore, the issue of access and support is crucial if we are to deal with the problem.
This is partly about funding. We have had a good-natured debate this afternoon, so I do not say this to be objectionable or churlish, but on Wednesday, three or four Members on both sides of the House raised the issue of mental health with the Prime Minister, and her response was, to put it politely, inadequate. Beyond general statements about parity of esteem, she seemed unable to point to any meaningful actions her Government were taking on the issue of mental health.
I am sure that the Minister has come better briefed this afternoon, but the Prime Minister also needs to make this a priority. Much of this is about joined-up government—this will be a theme of mine this afternoon—and that requires leadership from the centre. It is not good enough for the Prime Minister to be sure-footed, although wrong-headed, when it comes to home affairs issues, but completely blind-sided on issues outside her comfort zone. We need stronger leadership on mental health from her and I was genuinely disappointed with what we saw during Prime Minister’s questions this week.
Parity of esteem is not about sentiment—it is about resources. About 11% of the NHS budget is spent on mental health and just 6.36% of that 11% is spent on children’s mental health. I recognise that the Government have made a commitment to invest £1.4 billion in child mental health in the next five years, and I welcome that, but I urge the Government to ensure that that funding is delivered sooner rather than later. Locally—other Members have referred to this—budgets are being cut or frozen in three in four mental health trusts. Seven in 10 CCGs and local authorities are freezing their budgets because of pressures from central Government reductions. My hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) has, through written parliamentary questions, highlighted that decisions coming down the track will make that picture even worse.
In the London Borough of Redbridge, the council is doing fantastic work with limited resources. However, I can say from first-hand experience—I declare an interest as an elected member of the council—that local government cuts are biting. The picture is compounded by the state of our local health economy. Both our NHS trusts are in special measures, although I hope one of them will be leaving special measures sooner rather than later. I hope that they will both leave, but I suspect one is nearer to the end of that journey than the other. Primary care is creaking, it is fair to say that our clinical commissioning group is struggling, and our community health trust has a rating that requires improvement. The challenge for Redbridge is not simply the funding reductions that affect my borough, but the fact that the funding formula does not lead to a settlement for Redbridge—for the local authority and for the wider health economy—that genuinely reflects the needs of our population. I urge the Minister to look carefully at how Redbridge has been disadvantaged through the funding formula, particularly in public health funding, and at what can be done.
I do not wish to get into a skirmish on funding, but does the hon. Gentleman agree that, as in my area of East Sussex, the way to find the efficiency savings that the NHS is required to make, in addition to the £10 billion that this Government have put in, is to have a “better together” organisation so that hospitals and all the other healthcare providers—at county level and so on—can talk together? That would not only save money, but mean that everyone is joined up, which is the way forward on such issues, as he has rightly said.
I very much welcome the hon. Gentleman’s intervention. He has anticipated some of my closing remarks about looking to the future. I will have some positive words to say about the direction of Government policy in that respect.
This issue is not simply about funding, but about leadership and accountability. I must say that the damning CQC report on the Brookside unit in the constituency of my hon. Friend the Member for Ilford South (Mike Gapes) has more than raised eyebrows. Some of its judgments about this facility for children’s mental health provision were:
“The ward environments were not safe, clean or suited to the care of children and young people… The wards were not adequately staffed… There was a high usage of restraint and rapid tranquilisation at the unit… The ethos of the unit was containment rather than therapy… Care plans reviewed were not recovery orientated and more behaviour orientated… During the inspection we saw staff refuse to facilitate the requests of young people… Young people stated the food was of poor quality and cultural and religious foods were not available”—
and those who know the London Borough of Redbridge will know how totally inappropriate that is. My question for the North East London NHS Foundation Trust is very simple: why did it take a damning inspection by the Care Quality Commission for sufficient action to be taken? From what I can see and from my conversations with colleagues in the local authority, there is clearly a road to improvement. It should not take inspectors coming in to highlight the fact that we have failed some of our most vulnerable young people in such a gross and unforgivable way.
Among my worst experiences as a constituency MP—these are universally my worst experiences—are in my surgeries on Friday afternoons when I see absolutely awful cases of people who have been very badly failed by public services. One case I will never forget was that of Simon Harris, a young man—he was 30 years old—who was failed by Goodmayes hospital because he was insufficiently cared for. While under the care of the NHS, he was allowed to take his own life, although he was in the very place that his family thought would keep him safe. I never again want to have a conversation with a constituent like the one I had with his incredibly stoic and courageous grandmother, Brenda. That is the consequence of mental health failure: it is simply the difference between life and death. I do not think that young people like Simon should ever be failed in such a way by the services that are there to keep them safe and well.
This subject is not just about public service provision, but about celebrating the work done by the voluntary sector. In the past year, I have visited a number of programmes in my constituency. I have visited Audacious Veg, a social enterprise that involves helping people suffering from mental ill health to set up their own social enterprise, growing and selling vegetables. This wonderful project runs in conjunction with the Forest Farm Peace Garden, another environmental and sustainability project, which gets people with mental ill health outside, interacting with others and active.
I cannot commend strongly enough to the Minister the importance of social prescribing. Here, public policy has a role to play. When Redbridge Youth Council, for example, commissioned the Redbridge Drama Centre to design and deliver a play on mental health to reach young people, 5,000 young people and counting across the London Borough of Redbridge were reached by that fantastic way of engaging young people in conversations about mental health.
Music can play a powerful role in therapy, as can sport. One of the most impressive projects I have visited in the past 12 months was Coping With Football, sponsored by the London Playing Fields Foundation and run in conjunction with the North East London Foundation Trust. Again, that project got young people outside, interacting and developing their skills and, most importantly, their self-esteem.
That brings me on to looking to the future, and I will press the Minister to take policy in a few directions. I have asked her to look at Redbridge’s funding formula, on public health in particular, and I hope she will undertake to do so. I also ask her to work with her colleagues in Government to think about funding nationally. The hon. Member for Bexhill and Battle talked about the value of joining up services locally, in particular local government and the NHS. I commend the approach being taken by the Government through the introduction of the accountable care organisations. In the pilot with Redbridge, the London Borough of Barking and Dagenham and the London Borough of Havering, that approach is bringing the local authority together with stakeholders from across the local health economy to join up public service provision. That will bear fruit.
We also need joined-up Government nationally, however. Other Members have made a compelling case for the Minister to fight her corner in public health, because investment in public health and early intervention is a money saver—and not just across Government; within her own Department we can reduce A&E admissions and the pressure on urgent and primary care if we get public health funding right.
The Minister also needs to make the case, along with the Secretary of State, across Government. For example, it is no good the Treasury making cuts to local government if that leads to cuts in public health funding and undermines the work of the Department of Health. It is no use cutting mental health provision if that leads to a spike in crime, an increase in the prison population and greater demand on the criminal justice system.
In education, it is no good asking Ofsted to inspect schools on mental health provision if school referrals to CAMHS are going unheard. We need to make sure the services are there to support schools. We also cannot continue with the postcode lottery on sex and relationships education and personal, social and health education. I hope we can revisit the issue of compulsory SRE and PSHE.
Finally, and most importantly—it is the reason we are here this afternoon—I urge the Minister and her colleagues in Government to listen to young people. That she is here this afternoon shows the importance the Government place on this report and the views of young people. My hon. Friend the Member for Dulwich and West Norwood talked about the importance of co-production and involving young people in the design of public services, and that is absolutely critical. But the Youth Select Committee has made a whole series of other recommendations that deserve not just the serious attention of this House but the response of Government. If that happens, we will get better public policy, and, I hope, we will have a generation of young people whose voices have not just been heard but, most importantly, listened to.
It is a pleasure to follow my hon. Friend the Member for Ilford North (Wes Streeting). I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) on securing this debate and the Backbench Business Committee on allowing it.
I have a new member of staff in Westminster, who started with me only last week, Matthew van Rooyen. He is 18 going on 28. He is cool, calm and collected; I have only seen him panic once so far, which was when he lost his hair gel. By an amazing coincidence he is from the village in south Wales where I was born, Kenfig Hill; more amazing still, I used to do judo with his mother when I was a child. As I have said before, Wales is one big family, and that has its advantages and its disadvantages, so in many ways this is Matthew’s maiden speech.
Matthew is a Member of the Youth Parliament and has been elected by fellow Welsh youth parliamentarians to represent Wales at the sitting of the Youth Parliament in this Chamber on 11 November. The calibre of the debate is always exceptionally high; at times, higher than some of our debates—Matthew is obviously driving the point home here—and I urge all right hon. and hon. Members to attend to show their support for the UK Youth Parliament.
By way of background, each year the UK Youth Parliament holds a UK-wide ballot called “Make Your Mark” that allows for young people to vote to campaign on an issue that is most important to them. The five campaigns with the most votes are then debated by members of the Youth Parliament at their annual sitting in this Chamber. Matthew has asked that I thank the House for allowing this opportunity year after year. In 2014, more than 90,000 votes were cast specifically to campaign for the improvement of mental health services. Following the debate, the Youth Parliament voted to campaign on mental health services as its priority campaign. The Youth Select Committee subsequently launched an inquiry into mental health provision, publishing its report in November 2015. Today, this report comes before the House for debate.
What the report indicates, quite simply, is that there is a lack of full and proper support for young people with mental health issues. Nearly 850,000 people aged between five and 16 suffer from a mental health issue. There is clearly a real need for good quality, mental health provision. The fact that over 90,000 young people voted for this as their priority campaign is indicative that the standard of service provided falls far short of the standard of service that can be expected.
It is not even the case that the service provided is good, but young people expect excellent and they deserve excellent. It is the case that the service is simply substandard. In written evidence to members of the Youth Select Committee, one young person explained their frustration:
“After a lot of deliberation, I decided to take myself to my GP in search of support…What you must remember is the amount of courage it takes to open up about your mental health issues. It is extremely difficult for someone...who’s totally confused about what’s going on in their life, to openly talk about having suicidal feelings in a five-minute appointment to someone who feels like a complete stranger. This landed me in a vicious cycle. I ended up returning to different GPs, in a desperate cry for help, but time and time again I was refused any help. It took seven visits before I eventually got the support I needed. Seven times I had to retell that same story. Seven times I was faced with not being ‘sick enough’ and seven times I had to walk out of that same GP surgery feeling absolutely crushed and demoralised.”
That young person is only 14 years of age.
The stories from young people, up and down the country, of substandard interactions with their GPs and medical practitioners are many. With countless witness testimonies, the report highlights the many areas where improvements need to be made with regard to the medical profession and health services. I would welcome an update from the Minister.
There is not one single area that needs improvement. We need to improve the overall state of services for those suffering from mental health issues. We must also look at the education system and what role this has to play in improving young people’s mental health. The report, very thoroughly, covers the education curriculum. It suggests improvements to personal, social, health and economic education, which would provide the most effective environment for mental health education. I broadly endorse those.
A key issue that has been raised time and again by the Youth Parliament is the need for a curriculum for life—to meet the needs of young people by having a national curriculum that sets them up to succeed and not fail. This issue is so fundamental to young people that it received the most votes in the “Make Your Mark” ballot this year. In the local authority area of Neath Port Talbot, in which my constituency of Neath lies, around 2,300 young people took part in this year’s ballot. I look forward to working with the Neath Port Talbot Member of the Youth Parliament further over the coming year.
To return to the report, the findings of the Youth Select Committee make clear the need for an all-encompassing approach to improving mental health and wellbeing. Although the Department for Education has introduced character-building and resilience programmes, the report notes that this is not the best method of improving the wellbeing of young people and instead proposes further training for teachers and academic staff. The report specifically mentions that teachers said in evidence that they feel they
“need more regular training on how we promote positive mental health.”
The Youth Select Committee recommends that, as part of the core content of initial teacher training, there should be mandatory training for teachers on young people’s mental health, with the training focused on how to respond to a young person who asks about mental health, how to spot problems and where to refer young people. The committee goes on to recommend the inclusion of a trained counsellor in all schools and agrees that schools should make counselling services available to all secondary school pupils. These are recommendations that I am sure every Member of the House will agree with.
Today’s debate has highlighted the vital work done by the UK Youth Parliament, the British Youth Council and the Youth Select Committee, all of whom I commend in assisting young people to have their voices heard. In recent times, there have been multiple reports and initiatives to improve mental health services for young people, aiming to reach parity of esteem, but until equal funding is achieved for physical health and mental health provision for young people, with funding for young people’s care at least equal to funding for adult’s care, the campaign will go on. Young people are our future. It is our duty to ensure their success and wellbeing. My thanks to Matthew—great speech, Matthew, and it is a pleasure to work with you.
I apologise to the House for missing the start of the debate—it started a little earlier than I anticipated and I was sitting on a bus in Millbank—and thank you, Madam Deputy Speaker, for calling me. I also thank my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes), and I congratulate her on leading this debate and the Backbench Business Committee on delivering it.
I am speaking towards the end of the debate, so I will try not to repeat the many excellent contributions that hon. Members have already made. Like so many other Members, I have had parents contacting me in great distress at the lack of adequate acute services when their children are in crisis. I had one parent who was worried about her daughter having to spend yet another weekend—this was not the first period of crisis she had had—in the children’s ward of the local hospital, as no specialist beds were available. The children’s ward is not a safe place for a young person in a mental health crisis, nor is it fair on the staff or children in the ward to have to support her either. She needed to be in a specialist bed, but in London there are too few tier 4 beds for young people.
I had another distressing experience, where a young man needed to go to hospital urgently, but because of a disconnect between the police, the ambulance services and the other services, it took two attempts on the same day to draw him from his house and get him to the safe place he needed to be in, leading to added trauma and distress and worsening his already critical health situation. To be fair, we are seeing some improvements locally, and we are promised additional tier 4 beds and better joined-up thinking between services, but I have to say that this is a small increase from a very low bar.
An additional problem is the break in consistent service when a child in crisis suffers further as they hit their 18th birthday. They lose one set of services and the adult services may or may not pick up at the same place, which does not make it easy for the child, the family and those trying to support her.
I pay credit to those working in the public and voluntary sector who support and heal these young people, but whose job is being made difficult because of the funding situation and lack of adequate joined-up thinking. In common with all Members here today, I want to thank the Youth Select Committee, the British Youth Council and the many Members of the Youth Parliament across the country for their work.
Earlier this year, I met Hounslow’s MYP, Tafumi Omisore, who told me about the history of this debate and how young people across the country had voted mental health as the top agenda issue for discussion among MYPs and the top issue that they wanted to bring to our attention. Tafumi told me:
“The future of tomorrow cannot possibly get to a stage where young people can rise to their full potential when they are being failed by this current generation”,
by which I think she means us. She continued by saying that they
“lack the support they need for Mental Health. Every time we say we need more support, Mental Health services simply get cut.”
National campaigns for the Youth Parliament come along only once a year, so we have to treat young people’s demands seriously. Tafumi will be holding sessions in her school to promote more education on this subject—and all credit to her.
Earlier in July this year, I met a group of primary and secondary school heads, and I expected them to raise with me the issues of funding, recruitment and retention and testing, which they did. What I had not expected was that they raised their concerns about children’s mental health and the state of the services available to them as being equally important. They were concerned about the increasing incidence of mental health problems, self-harming, disruptive behaviour and so forth. These headteachers had feelings of inadequacy when it came to supporting those children. They felt that they could not get them through a good-quality education and make them ready for the world of work or higher education unless they could give those young people better mental health support.
These headteachers said that the capacity of CAMHS was overstretched and that there were long waiting lists. They had real concerns about inadequate early intervention. They pointed out that more children were vulnerable for many and varied reasons, including mistreatment and abuse at home, and that more families were living in chaotic circumstances. They noted that more families were living in uncertain, insecure and poor-quality housing, which was exacerbated by austerity, particularly in respect of benefits and tax credits. Most parents and families were working, but they had suffered as a result of the changes to the benefit and tax credit system. Increasing numbers of families could not find enough money to pay the rent and put food on the table. This stress impacts on children—it could not fail to impact on them. The head of Kingsley Academy, who has been at the school only a year, told me that during her tenure, three of her children have been sectioned. Some of her children were self-harming and not enough support was available. The social work team could not cope either.
Some solutions were identified. Most of our schools either commission the Hounslow youth counselling service to deliver counselling or employ in-house counsellors. Strand on the Green runs a programme called “theraplay”, which combines therapy and art for children. It is very successful, but there is no funding left to allow it to continue indefinitely. The school heads concluded that not enough support was being provided.
An excellent youth counselling service serves the borough of Hounslow, and has done so for many years. Its counsellors strongly believe that Government cuts have led to the increased need for counselling. Less money means higher criteria for early entry to tier 1 services, and—as other Members have pointed out today—when tier 1 services pull out, young people enter the system when they are in crisis and need tier 3 and 4 services, which are extremely expensive. The Hounslow youth counselling service, like many others, is a tier 1 service, and is there to provide initial counselling and support. It is not a therapeutic service; it cannot be, and it is not funded to be. It does not have the necessary professional advisers. However, it is often the only option for young people, because higher-level services such as CAMHS will not see them for many weeks, and often for many months.
The Hounslow counselling service says that skilled and experienced staff are being replaced by others who are less skilled and experienced, which has made it difficult to maintain important standards in certain departments. It also says that there is no sign that the increase in the number of young people requiring counselling is slowing down, and that further cuts could worsen the situation. It is a voluntary service organisation, funded mainly by local government and the NHS, which are cutting support for the voluntary sector as their own funding is cut. It says that it is likely to see at least 3,000 young people per year and that the number is growing, but it is highly unlikely that it will be able to grow as well in order to meet that pressure. Its waiting lists will lengthen, and young people who are referred by schools or parents, or who refer themselves, will have to wait even longer for counselling.
Our experience in our borough reflects the experiences that other Members have described today. Children and young people are under ever greater pressures from social media, family poverty, housing crises and identity questions. Services are already stretched, and some face an uncertain future: as school and voluntary sector cuts are made, many are closing or have already closed. There is a lack of early intervention. Different services have different priorities, and there are reports of the decommissioning of early intervention services as a result of reductions in spending on social services.
We could do things differently. It is not just a question of funding, although we cannot fail to discuss that issue. My hon. Friend the Member for North Durham (Mr Jones) made an excellent suggestion, based on experience of the armed forces covenant. The establishment of the covenant under the Labour Government was led at Cabinet level, but it filtered through a range of services into local government. I was a councillor in Hounslow at the time, and we adopted the covenant, which filtered into several of our services and priorities. Could we not do the same for children’s mental health?
As many Members have said, we need to do more as a country, and the Government must lead. We must do better. We must listen to young people. We must deliver joined-up services, and we must deliver them early. By doing that, we will save money, but, more important, we will save our young people’s future.
It is a privilege to take part in the debate. I thank the Backbench Business Committee for selecting it, and extend my praise to the Youth Select Committee for its excellent report on young people’s mental health. It is a genuinely superb summary of the current situation, backed up by sensible recommendations, and it makes a welcome contribution to the wider debate.
The details of the debate have already been clearly outlined by the hon. Member for Dulwich and West Norwood (Helen Hayes). I agree wholeheartedly that it is a debate about resources and the framework for their use. I also agree that the current situation is not acceptable, and that the demand for services is indeed increasing. I thank the hon. Lady for her clear explanation of the position, and for giving some powerful statistics.
The importance of this issue to the young people of the UK nations is illustrated by the fact that it has been repeatedly chosen as a priority campaign by the UK Youth Parliament, and voted for in the British Youth Council poll. The issue has also been the subject of research by the Scottish Youth Parliament, with the report “Our generation’s epidemic”. So we need not wonder what issues are of concern to young people; they have clearly, intelligently and repeatedly told us and it is incumbent upon us as elected politicians to address the concerns highlighted. The fact mentioned already today by several Members, including my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), that more than half of all mental ill-health starts before the age of 14 serves to illustrate the seriousness of this issue.
I am also grateful to the hon. Member for High Peak (Andrew Bingham) for illustrating the risk of the issue going unnoticed and undiagnosed and for highlighting the generation gap technology has developed and the issue of cyber-bullying. I am sure I am not alone in this Chamber in being glad that my youthful teenage years are not preserved for posterity on the internet and in social media.
As well as highlighting an important issue, the Youth Select Committee report shows the importance of young people being engaged in our democratic debate. In Scotland we are already making good progress with this engagement, and our 16 and 17-year-olds had the right to vote in the 2014 Scottish referendum and 2016 Scottish Parliament election. That, however, is an issue that needs revisiting in another debate. I endorse the call of the hon. Member for East Worthing and Shoreham (Tim Loughton) for an annual debate in Government time on the good work of the YSC.
The issue of mental health is widespread. It affects every part of the country and people from all parts of our society. All ages, races, classes and backgrounds are susceptible to this illness.
The hon. Member for West Ham (Lyn Brown) highlighted the disparity between mental and physical health problems and emphasised the scale of the issue. We have heard many examples from across the House showing how young people have been affected and that more needs to be done.
All of us will be aware of local examples, and of groups working to address these issues. One such group which covers my area is the Falkirk and District Association for Mental Health, the subject of early-day motion 125 tabled by my hon. Friend the Member for Falkirk (John Mc Nally). Among the wide range of support the group offers is a befriending service to help combat the isolation experienced by young people suffering from mental health issues. The group also offers a health and wellbeing drop-in, counselling, support groups and other services.
But it is not just specialist mental health groups that help to tackle this illness. For example, the Open Door project, which provides supported accommodation for young people in the West Lothian area, carries out a risk assessment of every young person who approaches it for help. If following the assessment it feels there is an issue it refers them to “moving into health”, psychiatric nurses from the health and homeless team. Some 89 people were assessed in 2012-13, of whom 33 presented with mental health issues. Indeed, the project believes that the number of people presenting with mental health issues is increasing, a theme highlighted by several Members today.
Another example is the Chill Out Zone, or COZ, in Bathgate, a healthy living centre for young people aged between 12 and 20. It is a partnership between Children 1st, West Lothian Council and NHS Lothian. COZ provides a drop-in service that young people can use in their own time to get information, counselling and advice, or if a young person prefers they can make an appointment with a nurse or a counsellor to talk about sensitive physical, emotional, mental and sexual health matters.
I could go on highlighting many other examples, but I think everyone gets the picture. It is not just our young people who are telling us this is an “epidemic”; the evidence of support groups and the impact on other organisations locally demonstrates this for all to see, and highlights the need for action.
Of course in Scotland health and education are devolved to the Scottish Parliament, and many of the devolved issues were covered succinctly by my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow. I am grateful for her professionally informed opinions in today’s debate.
Mental health is a priority for the Scottish Government, as demonstrated by the fact that Scotland has the first dedicated Minister for Mental Health in the UK, and while across England funding for young people’s mental health services has been reduced since 2011 the SNP-led Scottish Government have doubled the number of child and adolescent mental health service psychologists, as part of an additional £150 million to improve mental health services.
The Scottish Government have welcomed the Scottish Youth Parliament’s recent research “Our generation’s epidemic”, which I mentioned earlier. That research was undertaken as part of the Scottish Youth Parliament’s Speak Your Mind campaign on mental health. Maureen Watt, the Minister for Mental Health, met representatives of the Scottish Youth Parliament in September and took note of their recommendations that relate specifically to the Scottish Government. They will be considered as part of the public engagement on the new 10-year mental health strategy for Scotland. The SNP will continue to review the legislation in Scotland to ensure that the interests of children and their need to form and maintain relationships with key adults in their lives are at the heart of any new statutory measures.
The Youth Select Committee report highlights the importance of ending stigma around mental health, and the SNP is committed to playing its part in ending that stigma. Education Scotland is developing a national resource to support the development and practice of nurturing approaches for primary schools. A whole-school nurturing approach can promote school connectedness, resilience and the development of social and emotional competences, all of which are key aspects of promoting mental wellbeing.
It is completely wrong that people with mental health issues should suffer discrimination and stigma, but sadly too many still do. The Scottish Government, in collaboration with Comic Relief, fund the See Me initiative to help address this, and they do invaluable work, but the truth is that each and every one of us has it within our power to do our bit to end this stigma and to be more understanding of people who have mental health problems.
It has been a pleasure to take part in this well-informed and largely consensual and good-natured debate.
It is a pleasure to speak in this important debate on the Youth Select Committee’s report, “Young People’s Mental Health”. I too want to thank the Backbench Business Committee for allocating time for the debate, but I agree with the Conservative Members who suggested that this matter should have been debated in Government time. We must underline the importance of this report.
I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) and the hon. Member for South Cambridgeshire (Heidi Allen) on securing the debate. My hon. Friend talked about the focus on the need for early intervention, as did many other Members. She also talked about the need for beds, saying that sending seriously ill young people away from home had to stop. I think we all support that view. She made it clear that, in her view, the state of the service was a national scandal, and she raised a number of points that we hope the Minister will respond to. They included the recommendations for ring-fenced funding for CAMHS and for co-production involving young people in the design of CAMHS, and the need to improve mental health education in schools. I will talk about those issues as well. My hon. Friend also referred to the notion in the YMCA report on stigma, “I am Whole”, of young people feeling as though they are
“trapped inside a thousand invisible prisons”.
We should keep that in mind.
The hon. Member for High Peak (Andrew Bingham) acknowledged the legitimacy of the Youth Parliament. He also talked about the pressures on young people and related that back to his own experience when he was young. That has been a bit of theme in this debate. My hon. Friend the Member for West Ham (Lyn Brown) stressed the need for early intervention. That subject that has come up many times today, and quite rightly, because early intervention can decrease the severity of mental ill health. She made a powerful case for the Government’s funding pledges to be fulfilled.
The hon. Member for East Worthing and Shoreham (Tim Loughton) talked about the importance of the status of the report and rightly said that it should have been debated in Government time. I am glad to have his support for the fact that Labour has a shadow Cabinet Minister for mental health, which is me. It is interesting that the Scottish National party Government also have a dedicated Minister for mental health. I think we are moving towards a position in which that is seen as something to be supported. The hon. Gentleman also talked about the effect of the pressures of social media on the mental health of young people. It is interesting to note that we shall debate the impact of social media on the mental health of young people in Westminster Hall next Wednesday.
My hon. Friend the Member for North Durham (Mr Jones) talked about the real problems that parents and grandparents face in navigating mental health services. He talked about commissioning and made some important points about the difficulty of working through GPs in our medical model. He also talked about local government cuts and said that they were a false economy. I shall talk about that as well. He also talked about the need for open-access services, given the difficulty in navigating the system.
The hon. Member for Wealden (Nusrat Ghani) talked about a teenager with an eating disorder, the suicide rate and the problems faced by young men. Although there is a focus on the impact on women of mental health issues, young men are also badly affected.
The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) talked about access to mental health specialists in schools and training for staff, which has been a theme this afternoon. She also mentioned the need to modernise approaches. We keep hearing about the importance of IT and social media, and she referred to the SafeSpot app. Like several hon. Members, she also talked about online bullying.
The hon. Member for Bexhill and Battle (Huw Merriman) is back in the Chamber. He came out of a Bill Committee to speak today and regards this topic as very important. His clear commitment to mental health was shown by it being the subject of his first question at PMQs. He also talked about social media and the need for early intervention.
I did not know that my hon. Friend the Member for Ilford North (Wes Streeting) was elected an honorary president of the British Youth Council. He quite rightly thanked the Speaker for his support for the British Youth Council and the Youth Parliament. It is important, as he has done, to listen to young people’s concerns about mental ill health because that can lead to open, candid and courageous discussions. It is good that groups of young people can become more at ease with discussing mental health—there is hope for the future. He also talked about the exceptionally high incidences of mental health issues among LGBT young people, including high rates of self-harm and suicide. He referred to the poor standards of care at Brookside adolescent unit. It took a damning report from the CQC to highlight its problems, the consequence of which was the death of the young man Simon.
My hon. Friend the Member for Neath (Christina Rees) gave us the first speech of Matthew, a member of the Youth Parliament who works in her team, and talked about the lack of full and proper support for young people’s mental health. She also mentioned the difficult experience of a young person who had to visit the GP seven times before getting help and felt crushed by the lack of support. Like other Members, she referred to training for teachers and having a trained counsellor in every school.
My hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury) talked about hospital wards not being safe for young people with mental health problems. A headteacher in her constituency reported having three children sectioned from school, which is a sobering thought indeed.
The hon. Member for Linlithgow and East Falkirk (Martyn Day), the SNP spokesperson, talked about many local groups. It is a sign of the difficulties facing support within the NHS that there is a need for all the groups he mentioned.
Before I move on, I want to pay tribute to the work of my predecessor, my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger). She has campaigned tirelessly for improvements to the mental health system. Her work helped to raise the profile of many issues that had not previously been given the attention they deserve. I join other Members in congratulating the Youth Select Committee on its excellent report.
The Secretary of State for Health recently admitted to failings in mental health services for children and young people. He said:
“I think we are letting down too many families and not intervening early enough when there is a curable mental health condition, which we can do something about when a child is eight or nine, but if you leave it until they are 15 or 16, it’s too late”.
People working in mental health services know all too well the truth of what the Secretary of State says. We know that on average one in four people experience a mental health problem, that 50% of adult mental health problems start before the age of 15, and that 75% start before the age of 18. Yet just 8% of our mental health budget is spent on children, with CAMHS, which have been referred to extensively, representing just 1% of the NHS budget. Members have quite rightly referred to that as the Cinderella of the Cinderella service. Does the Minister agree that 8% is far too small a proportion of the budget to spend on youth mental health, and does she agree that more needs to be done to intervene earlier when mental health issues are involved? Demand is clearly outstripping supply. Demand for child and adolescent mental health services is growing, but Government action is not meeting that demand. Funding for overstretched mental health services is not reaching the frontline, where it is so badly needed.
As my hon. Friend the Member for North Durham said, essential support services are being lost as a direct consequence of Government cuts to local authority budgets. Ofsted has reported that between 2010 and 2015 there was a 38% cut—£538 million—in funding for children’s centres, and a 53% cut, which is £623 million, in funding for youth services. Very many children and young people are not receiving the help that they need until they reach crisis point, and those cuts in local authority services are part of the problem. By failing to address these critical issues, Ministers are letting down vulnerable children and young people.
Sarah Brennan, the chief executive of Young Minds, has said that children’s mental health services have been “woefully” underfunded for years and that:
“While the government’s extra investment is welcome, it’s unclear whether it’s making a difference to frontline services. Even if the new money is spent where it’s intended, the Chief of NHS England has admitted that it will only be enough to reach a third of the children who need help.”
She goes on to say:
“Because of long waiting lists the threshold for accessing specialist services has got higher. Without treatment, problems are very likely to escalate and children are more likely to self-harm or become suicidal, to be violent and aggressive, or to drop out of school, which can ruin their prospects for the future. Delays can also have a disastrous effect on families, with parents forced to leave their jobs to look after their children”.
A report for the British Medical Association underlines that by telling us that the number of young people aged under 18 attending accident and emergency because of a psychiatric condition more than doubled between 2010 and 2015. The number of children and young people self-harming has also risen dramatically in the past 10 years, with the upward trend more pronounced among girls and young women. We have heard examples of that in the debate.
The number of referrals to child and adolescent mental health services increased by 64% between 2012-13 and 2014-15, but 28% of children and young people referred to CAMHS were not allocated a service. Members have referred to that fact in this debate. A report by the Children’s Commissioner found that 79% of CAMHS imposed restrictions and thresholds for children and young people accessing their service—I could go on. We have a tale in this debate of an increasing number of referrals to CAMHS, high thresholds for care and long waiting times. What all those things mean is that many children and young people are not receiving help.
Let me come back to the Secretary of State, because in reference to the quality of care that CAMHS teams provide, he said:
“I think this is possibly the biggest single area of weakness in NHS provision at the moment.”
Does the Minister recognise that the statistics we have heard in this debate show that demand for mental health services has clearly outstripped supply? Can she tell us what actions Ministers plan to take to address those issues?
I want to talk about regional variation, because it is an important aspect of the issues we are seeing. The Children’s Commissioner’s report also highlighted regional variations in treatment, suggesting that access to CAMHS is, in effect, a postcode lottery. The data gathered suggest that in England the average waiting time between referral and receipt of services from CAMHS ranged from 14 days in the north-west to 200 days in the west midlands. Does the Minister agree that that level of variation is totally unacceptable? Can she highlight what Ministers are doing to achieve swift access to care across the country at the same levels? A recent report on the state of mental health by the Public Accounts Committee warned:
“Good access to mental health services matters. Many people can make a full recovery if they receive appropriate, timely treatment. However, a high proportion of people with mental health conditions do not have access to the care they need.”
I wish to dwell for a moment on the state of CAMHS services, because that has been an important aspect of this debate. There is a lack of crisis services, a lack of accountability for transformation plans, and a lack of co-production with parents, carers and service users. One person asked, “Who cares for the carers because it certainly isn’t the mental health service?” That view of CAHMS is borne out by nurses who work in CAHMS. In a survey of 631 CAMHS nurses, 70% said that the services were “inadequate” or “highly inadequate”—I put it to the Minister that it is very worrying that the very people who work in CAMHS refer to the services in such a way—73% said that the main problem was too few nurses, 48% said that there were too few doctors, and 62% said that there were too few beds for patients.
Last December, the Secretary of State made this pledge:
“CCGs are committed to increasing the proportion of their funding that goes into mental health.”
However, as we have heard in this debate, increased front-line funding is not being delivered, and that is clear in the provision of services.
Let me refer to a matter that was raised by a number of my hon. Friends. In the responses to the freedom of information requests made by my hon. Friend the Member for Liverpool, Wavertree, 73 out of 128 CCGs—more than half those that responded—admitted that they plan to cut the amount they will spend on mental health, which underlines the fact that the funding issue is just getting worse.
Does the Minister agree that the Secretary of State has clearly broken his promise and that many CCGs are not increasing funding for mental health? As we have heard in this debate, the pledge to achieve parity of esteem is repeatedly being broken. Despite Ministers’ promises about achieving parity of esteem between mental and physical health, there is still a great difference in the treatment of families of children with physical rather than mental health needs—a number of Members referred to that disparity. Indeed, many physical health hospitals now have family rooms or flats in which parents can stay to support a child, and parents can, in some cases, get help with transport costs. By contrast, the families of children in mental health units feel isolated. There is no provision for families to stay, and no support with transport costs, which can become prohibitive. Often a child can be sent home with no transition plan. It is clear from this debate that the Government are failing to achieve parity of esteem.
We had four questions on mental health at Prime Minister’s questions yesterday, which is an indication of the level of concern among hon. Members. The hon. Member for Bexhill and Battle made mental health the subject of his first such question. As my hon. Friend the Member for Ilford North said, there was real disappointment about the responses from the Prime Minister, so I hope that we get better answers from the Minister today.
Much has been said about education and the role of schools. A report by the Education Committee on the mental health and wellbeing of looked-after children made the clear recommendation that schools should have a role in teaching about mental health and wellbeing. That report said:
“The interface between schools and health services needs to be strengthened to ensure that teachers and schools are better equipped to identify, assess and support children and young people with mental health difficulties.”
It has been quite clear in this debate that Members feel that schools and colleges should play a key role in promoting the good mental health of children and young people. More young people are experiencing serious psychological distress because they are under unprecedented social pressures. It is a credit to Members that those pressures are recognised.
Although we will not have time to cover this subject today, I have to say that easy access to the internet poses new challenges for young people. Cyber-bullying is increasing with more than one in 10 children now saying that they have experienced it. Young people cannot get away from bullying even when they have closed the door of their homes.
A number of Members have stressed the role of schools in ensuring that these problems are spotted as early as possible and addressed. Counselling services are vital. As a Salford MP, I am pleased that Salford has launched a register of approved providers of counselling in schools, and that one provider has already been appointed to deliver a two-year pilot to train and support a cluster of schools in counselling. My hon. Friend the Member for North Durham talked about the importance of counselling, but we recognise that there are funding problems. Many schools will not be able to afford to pay a trained counsellor.
Clear guidance is needed for schools on how to commission high-quality mental health support programmes and how to tackle mental health discrimination and stigmatisation. Will the Minister outline the Government’s plans to ensure that education, health and social services work together to provide an extra layer of support to spot and treat mental health problems? The hon. Member for East Worthing and Shoreham talked about how cross-departmental working can help.
Clearly, the best way to deal with a crisis is to prevent it from happening in the first place. It is critical that people can access the right information and that better support is provided in childhood and adolescence. That can help to reduce the incidence of young people developing mental health problems.
Overall, it is clear from the debate that actions speak louder than words. If Ministers are serious about tackling these issues, they must follow through with their funding pledges. Government cuts to local authority budgets, which I and others have referred to, have meant that many of the local services providing early intervention have had to scale back services or close their doors. I have talked about cuts to children’s centres, social workers, educational psychologists and mental health services in schools. There has been a reduction in care and support for under-18s, so we need urgent action. The Minister has been urged by Government Members, as well as Opposition Members, to relieve that pressure on overstretched CAMHS, but we also need to develop prevention and early intervention strategies. Crucially, the right help and support must be available for vulnerable children and young people when they need it, not 200 days later. I look forward to the Minister answering my questions and those of my hon. Friend the Member for Dulwich and West Norwood, and telling us what action will be taken to improve provision in this vital area.
I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) and my hon. Friend the Member for South Cambridgeshire (Heidi Allen) for initiating this debate on the Youth Parliament Select Committee report on young people’s mental health. I want to add my voice to those from both sides of the House in paying tribute to the Youth Select Committee for its powerful report—it is an important and timely intervention. As my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) said, Rhys Hart was, by all accounts, a remarkably effective Chair, and the 10 members were dedicated and focused. They won the admiration of the House of Commons staff who were involved, and they made particular mention of that to me before this debate.
The hon. Member for Ilford North (Wes Streeting) demonstrated quite clearly that he is an elected president of the BYC, with his particularly eloquent speech. He is right that we should thank those young people who have had the courage to speak up on their mental health experiences and opinions, and who have allowed us to refer to them today, because the value of those first-hand stories in this Chamber cannot be overestimated.
I would like to make a particular point of thanking the constituents of my hon. Friend the Member for High Peak (Andrew Bingham), Lucy Boardman and Martha Banks Thompson, and my own Youth Parliament representatives, Tara Paxton-Doggett and Rowan Ibbotson, who spoke to me about the mental health campaign. A number of colleagues have spoken about the impact of meeting the Youth Parliament representatives. As has been said today, what is important now is to prove that we have not just heard them; we have listened to them, and we are taking action on their words. That is why this has been such a moving and necessary debate.
Members have shared some very personal experiences of mental health and the services and support that they and their constituents have received. All of us will know the cases that haunt us. All of us know that we need to do better. As colleagues have said, over half of all mental ill health starts before the age of 14, and 75% has developed by 18. We know the distress that mental health problems cause to individuals and all those who care for them, and we know that the earlier we intervene, the better.
Children’s and young people’s mental health is a priority for this Government. Not only has the Health Secretary made it his personal priority, but so has the Prime Minister. It is time for a step change in the way that we deliver mental health services in the UK, and we are determined to deliver that. But we must not underestimate or under-sell some of the progress that has already been made, because that is thanks largely to the efforts of dedicated NHS staff, stakeholders, voluntary services and others. We have heard some success stories today, and it is important that we praise those involved for the hard work that they do in the face of great challenges.
We agree with recommendation 3 that funding needs to increase, as many colleagues have said. That is why we have increased investment in children’s mental health, with an additional £l.4 billion. While we do believe that it is right that local CCGs, led by clinicians, are best placed to prioritise their spending to meet the needs of local populations, we have been clear that this money is provided for mental health services, and we are requiring CCGs to increase their spending year on year.
Has the Minister considered the request from my local mental health providers that the Government consider ring-fencing the money for mental health so that it gets passed to the frontline?
I was attempting to deal with that point, but obviously not being very clear. As I said, we have been listening to these requests. We are looking very closely at how effectively the money is getting to the frontline, but at the moment we still believe that local clinicians are best placed to decide how to target these services. However, we have put in place a requirement for CCGs to increase spending on mental health year on year. We are also very clear that STPs must reflect the NHS mandate, which says:
“We expect NHS England to strive to reduce the health gap between people with mental health problems, learning disabilities and autism and the population as a whole”.
That will require great strides to be made in improving care.
This is happening in Newham, but not elsewhere. How long is the Minister going to wait for it to happen elsewhere before taking action?
One of the ways in which we are ensuring that money reaches the frontline is through driving accountability through transparency. Mental health services have lagged behind the rest of the NHS in terms of data and our being able to track performance. That is why the NHS will shortly publish the mental health dashboard, which will show not only performance but planned and actual spend on mental health. This is real progress.
Let me make a couple of points in addition to the useful points made by my hon. Friend the Member for West Ham (Lyn Brown). First, it is clear that CCGs are ignoring the Government’s requests, so we will need more action than the dashboards and transparency that the Minister has mentioned. The Secretary of State will need to go back to CCGs and make the position very clear to them. Secondly, as other hon. Members and I have said, there is the question of local authority funding. Over £1 billion has been taken out of various services for children and young people such as children’s centres and youth services. That is a factor too. Those two things need to be addressed.
It is not fair to say that CCGs are ignoring the funding that is coming through. Moreover, it will not be possible for them to ignore what is going on when transparency and accountability is put in place with data sets that clearly show not only performance down to CCG level but the amount of funding that CCGs are given and the amount they are spending. These data will be much more detailed than before. In January, we introduced the first ever provider-level data set on children’s mental health services, and that will provide data on outcomes, length of treatment, source of referral, and location of appointment.
The Health and Social Care Act 2012 contained one provision that I welcomed—allowing CCGs and others to commission services in the third sector, for example. A lot of the good work in this area is done in the third sector, but the problem lies in how the contracts are drawn up, because they are either too big or too complex for smaller organisations to bid for. Will the Minister look at that?
I am happy to look at it. We are very clear that there is a vital role for the voluntary sector to play in delivering some of these services. We hope that local transformation plans will be part of the way in which this is clarified. The programme to deliver transparency and accountability will be essential if local areas are not only to design effective services that match the needs of their local populations, but to be held to account for delivering them. I will not beat about the bush. We recognise that a complex and severe set of challenges faces children and young people’s mental health services. This area has been undervalued and underfunded for far too long.
While I am happy to investigate funding formulas such as those mentioned by the hon. Member for Ilford North in relation to Redbridge, I agree with him that leadership and accountability are also key to making the changes that we need. That is why we are committed to delivering real changes across the whole system, not just in funding, and to building on the ambitious vision set out in “Future in mind”. I pay tribute to my predecessors for the work they have done to bring those forward. As the hon. Member for Dulwich and West Norwood has said, we need to go further to drive through these changes, which young people have told us they want to see.
Children want to grow up to be confident and resilient, and they want to be supported to fulfil their goals and ambitions. We are placing an emphasis on building in that resilience, on promoting good mental health and wellbeing, on prevention—it is so important, as the shadow Minister has said—and on early intervention, as a number of the recommendations propose. We are looking, in particular, at how we can do more upstream to prevent mental health problems before they arise.
The Minister is about to move on to intervention. Before she leaves funding, which has been pretty key, does she believe that the 8% of the budget spent on young people’s mental health—1% for CAMHS—has been anything like adequate? I did put that question to her. If she does not think that that is adequate, could Ministers tell us what they think it should be? If CCGs are ignoring Ministers’ continual urges to them to make pledges, will there be sanctions against CCGs that do not put in that extra funding?
I think I have already answered those questions. The Government have been clear that we think that mental health funding for children and young people, as well as for other areas of mental health, needs to increase. That is why we have increased mental health funding to local areas and we are putting in place measures to improve accountability and transparency, and the STPs, to make sure that that can be tracked locally. We are going to see how it works in the first instance.
I must continue.
Another issue that was raised is the fact that children and young people want to know where to find help easily if they need it. I want to make sure that I respond to all the issues that have been raised, otherwise it will not be fair to the young people who wrote the report. Children want to know that they can trust such help when they find it. Young people are clear that they want a choice about where they can get advice and support; they want to be able to get it from a welcoming place, based on the best evidence about what works; and they want the opportunity to shape the services they receive. Many colleagues have spoken about co-production.
“Future in Mind” committed to sustaining a culture of continuous evidence-based service improvement, as well as improving transparency and accountability across the whole system, as I have mentioned. A big part of that is producing the datasets that I have mentioned, which will give local areas the ability to hold their CCGs to account. Those datasets will include information on funding. As the hon. Member for Neath (Christina Rees) told us so eloquently—Matthew’s maiden speech has made its mark on all of us—young people want, as we all do, to tell their story only once rather than having to repeat it lots of times to lots of different people. We are committed to delivering a much clearer and more joined-up approach, with services coming together and communicating more effectively.
As numerous other colleagues have said, young people do not want to have to wait until they are really unwell—until they have reached a higher threshold—to get help. Asking for help should not be embarrassing or difficult. They should know what to do and where to go. If they do have to go to hospital, they should be on a ward with people around their age and close to home. So we are delivering a step change in how care is provided and ensuring that access is improved so that children and young people can easily access the right support from the right service at the right time, as close to home as possible. I recognise that this is a process.
“Future in Mind” is more than just a report. It is more than just words. It has already brought together key players, focused efforts and given us a clear trajectory for improving services. It is only the start of the journey, however, and we need to maintain the effort, focus and political momentum from this place and in our local areas.
In February 2016, the “Five Year Forward View for Mental Health” set out the start of a 10-year journey to transform NHS care across all ages. The hon. Member for North Durham (Mr Jones) was absolutely right to say that similar problems can be tracked across to adult services. The report was clear:
“The NHS needs a far more proactive and preventative approach to reduce the long term impact for people experiencing mental health problems and for their families, and to reduce costs for the NHS and emergency services”.
A lot of it is simply common sense. The five year forward view for mental health is underpinned by additional funding, which I have already spoken about, and the NHS England implementation plan sets out in detail where and when that money will become available. It builds on the foundation of local investment in mental health services and the ongoing requirement, which I have referred to, to increase that baseline by at least the overall growth in allocations.
“Implementing the Five Year Forward View for Mental Health” sets out clear objectives, which will support improvements to the services that young people will receive. I think it would be helpful if I say exactly what they will be, as they will make practical changes. The first is a significant expansion in access to high-quality mental healthcare for children and young people. At least 70,000 additional children and young people each year will receive evidence-based treatment. By 2020-21, evidence-based community eating disorder services for children and young people will be in place in all areas, ensuring that 95% of children receive treatment within one week for urgent cases and four weeks for routine cases. By 2020-21, in-patient stays for children and young people will take place only when clinically appropriate; will have a minimum possible length of stay; and will be as close to home as possible, to avoid inappropriate out-of-area placements. Inappropriate use of beds in paediatric and adult wards—this has already been referred to—will be eliminated.
All general in-patient units for children and young people will be commissioned on a place basis by localities, so that they are integrated into local pathways. That is designed to address some of the concerns that have been raised today. As a result, the use of in-patient beds should reduce overall, with more significant reductions possible in certain specialised beds.
Those objectives are supported by a refresh and republication of the local transformation plans, which have been mentioned. The plans set out how local areas will work together to improve services for children and young people with mental health problems across the whole care pathway. The plans are, in fact, the richest source of information available to date about the state of children and young people’s mental health services across England.
NHS England has also commissioned a number of thematic reviews as part of an analysis of the LTPs. In July, it published the children and young people’s mental health LTPs, which provide a summary of the key themes. It is fair to say that, essentially, they found that there was a lot of variation in local areas in terms of approaches, quality and priorities. We have heard about that in some of the stories that have been told today. The LTPs are a starting point. They are living documents and are not designed to just go in a drawer. They are reviewed and refreshed at least once a year, and we are clear that children, young people, families and carers must be involved in the process, for the exact reason given by the shadow Minister, which is to increase accountability and effectiveness and to make sure that the plans actually work.
A number of key themes have emerged from the report recommendations and the LTPs. Recommendations 5 and 6 comment on the need to support the workforce. We acknowledge the need to address the capability and capacity needs of the workforce—from GPs and A&E, to the mental health specialist—to deliver on our ambition to transform mental health services. In line with the eight specific workforce recommendations of the taskforce report, we will work with Health Education England and others to develop a five-year mental health workforce strategy, which we will publish in 2017. That is a serious response to a serious problem, and it is designed to address a lot of the challenges that have been raised today.
As many Members have rightly said, access to services is a priority area and we need to address it. We know that young people do not want to wait until they are really unwell to access services, and we do not want that to be the case, either, so we are tackling the issue. In August 2015, NHS England published an access and wait standard for children and young people with eating disorders, as I have said. From January, compliance with that standard has been monitored via the data collected through the mental health services dataset. It is, therefore, being held accountable and the aim, as I have said, is that 95% of young people will be seen within a clinically appropriate timeframe by 2020. That is just the first of the waiting time standards.
NHS England has commissioned the National Institute for Health and Care Excellence and the National Collaborating Centre for Mental Health to develop a new evidence-based treatment pathway for children’s mental health. The project will report in March, recommending maximum waiting times for referral to treatment. An England-wide quality assessment will then be used to establish a baseline and trajectory to achieve those national waiting time standards in local areas. The matter was also raised by the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who is no longer in her place.
We are also taking action on particularly vulnerable groups of children and young people. In April, Alison O’Sullivan and Professor Peter Fonagy were appointed as the co-chairs of the expert working group for looked-after children, established to lead the development of models of care for looked-after children’s mental health, which has historically been a blind spot. The expert working group is about practical outcomes—not just what is needed but how it should be delivered, without jargon, proposing concrete milestones and measures. We expect that work to conclude by October 2017.
However, ensuring access to services will not be enough if young people do not feel confident and safe seeking help. All children and young people should feel able to go for help when they need to, without fear of discrimination or stigmatisation. We have made a lot of progress in tackling stigma in recent years. The fact that young people have been willing to tell their stories demonstrates that.
Time to Change is a campaign that aims to tackle the stigma around mental health. In October, it was given £20 million in funding from the Department of Health, Comic Relief and the Big Lottery Fund. We are committed to ensuring that the Time to Change initiative, which is run by charities such as Mind and Rethink Mental Illness, will work with schools, employers and local communities to do more and go further to reduce discrimination and to raise awareness. It is developing a targeted campaign for young people, working with experts by experience.
As “Future in mind” and “The Five Year Forward View For Mental Health” both made clear, co-production is now a fundamental principle in the way we seek to develop and improve services, and anti-stigma campaigns are no exception. However, as many colleagues have said, to make that work, and to see the progress that is so desperately needed, we also have to work closely with colleagues across government, in particular the Department for Education, but not exclusively.
We are determined to continue that collaboration, as recommendation 2 proposes. We have been working closely together to ensure that the vision of “Future in mind” becomes a reality. We are also working together to consider what more can be done upstream to intervene early—an issue raised by the hon. Member for West Ham (Lyn Brown) and many others—and to provide the right interventions as soon as they are needed. The report’s recommendations will be a valuable resource for us as we do that, including the recommendations on attainment, Ofsted, teacher training and a whole-school approach, which was highlighted by my hon. Friend the Member for High Peak. We know that this is the weakest link in our current process and we are prioritising activity in that area to ensure that young people get the support they need right from the start.
A number of colleagues have mentioned the issue of online pressures and cyber-bullying. That matter has been taken extremely seriously by the Government Equalities Office, which announced in September £4.4 million of funding to tackle bullying. That includes a number of measures to underpin the fact that all schools are required by law to have a behaviour policy with measures to tackle bullying among pupils, and they are held clearly to account for their effectiveness by Ofsted. However, we know that more needs to be done, including to support parents. That is why the GEO has also invested £500,000 in the UK Safer Internet Centre to provide advice to parents on how to keep children safe and provided support to the Child Exploitation and Online Protection Centre to support a national roll-out of parent information through schools.
Today’s debate has been important because it has provided an opportunity not just to reply to the details in the Youth Select Committee report, which is so important, but to test the Government’s commitment to mental health reform. I am grateful to colleagues for the time they have taken today to raise concerns, to champion good practice and to propose innovative solutions. I hope that, in my response, our commitment to reform mental health services is beyond doubt. I also hope that it is clear that I believe that it is only through concerted political will, allied with the extraordinary and selfless determination of the mental health workers throughout this country, that we will have any hope of achieving our goal of mental health services that are accessible when and where they are needed.
I look around the Chamber and I hear speech after speech expressing determination to see a change. It gives me courage because great reform requires long-term vision, non-partisan partnership and fine minds. I have seen all three of those today, not just in the excellent Youth Select Committee report, but in all colleagues’ speeches. That truly is a firm foundation for the tough task ahead.
I very much thank the 10 Back Benchers, the Opposition Front Benchers and the Minister for taking the time to be in the House to contribute to this debate. It has been an excellent debate, with some very powerful speeches. Members have acknowledged the scale of the crisis in young people’s mental health, very effectively represented those of their constituents who face mental health issues, brought to bear their direct experience in this field and called on the Government to take a different approach. We have discussed many statistics, and they paint a picture of a heartbreaking reality for young people and families across this country. Many Members have also highlighted the false economies involved in failing to invest properly in young people’s mental health, with the additional costs to the health service, local authorities, the criminal justice system and, indeed, to human beings themselves.
Many Members have paid tribute to the work of the British Youth Parliament, and I want to add my voice to those saying that the work of the Youth Parliament should be debated in Government time. We must continue to build the institution of the Youth Parliament as the voice of young people in our democratic process. It is right and proper that it should be given such a status. The debate has, on the whole, been very consensual, and it has shown the House at its best. I hope that Members on both sides of the House have communicated to the British Youth Parliament, the Youth Select Committee and young people across this country the seriousness with which we take this issue.
I very much welcome the Minister’s response, and her commitment to address this issue and to deliver a step change in young people’s mental health. She is right to point out that this will require resources, leadership and work across Departments. She mentioned work with the Department for Education, but work with the Department for Communities and Local Government will also be very important. As the Minister also has responsibility for public health, she will know the extent to which public health expenditure is so challenged at the moment. We heard from several Members during the debate about the impact of such cuts on mental health and as a direct consequence of them. I welcome her response, but it must be backed up by action, following through and delivering on those commitments.
I hope all Members from both sides of the House who have contributed to this debate will join me in holding the Government to account on delivering the step change we need to protect our vulnerable young people and on delivering a framework of support that will help them to be resilient, confident and healthy as they grow into adulthood.
Question put and agreed to.
That this House notes the recommendations of the Youth Select Committee report of November 2015 on Young People’s Mental Health; endorses the findings of that report on the need for more support from the Government for mental health services for young people; acknowledges steps taken by the Government, since its response of January 2016 to that report, with regard to some of its recommendations; and calls on the Government to set out what further progress has been made since its response and what its plans are further to improve mental health services for young people.