Motion made, and Question proposed, That this House do now adjourn.—(Iain Stewart.)
I am sure that my esteemed colleagues, including the Minister, will have already read my article concerning this important debate on the PoliticsHome website today. But I do understand the competition for parliamentarians’ time, so I have brought with me a hard copy that I am happy to share if anyone would like to read it. Those more digitally minded can find it on the website.
The mental health of thousands of children and young people has reached crisis point. This week is Children’s Mental Health Week, intended to shine a spotlight on the importance of children and young people’s mental health. The Mental Health Foundation has found that childhood determinants are the primary factor in future mental wellbeing, with over three quarters of all mental health problems emerging by the age of 20. The Government set out their ambition in their mental health Green Paper in 2017. However, does the Minister agree with analysis by Barnardo’s stating that the plans let down children and young people in three quarters of England who will see no improvement by the end of 2022-23?
I hope that everyone in the Chamber will agree with me that no child should have to reach crisis point to get help—but far too often, as we all know, that is the case. A crisis can come in many forms. It can be seen in the criminal justice system, where a staggering 95% of 15 to 21-year-olds in custody have been found to suffer from a mental health disorder. It can be seen in the tripling in the number of young people under 18 with a recorded diagnosis attending A&E since 2010. It can be seen in the 74% increase in suicide rates for 10 to 19-year-olds since 2010. It can also be seen in Local Government Association findings that social services were seeing more than 560 cases of children with mental health disorders every single day—an increase of more than 50% in four years.
The right hon. Gentleman makes that point very well. A lot of research has been done on this by the Royal Society for Public Health. It is a contributing factor—one of which there are so many.
Looking after our children and young people requires children’s and young people’s mental health services to be properly resourced. At the moment, this is simply not happening. Almost a quarter of NHS child and adolescent mental health wards were rated as inadequate or requiring improvement by the Care Quality Commission in 2019. We also know that we have a huge shortage of mental health professionals, with a workforce that has hardly grown since 2010. According to the Royal College of Psychiatrists, we need an additional 4,370 consultant psychiatrists to meet current Government commitments. A recent British Medical Association survey revealed that almost two thirds of nurses said that on their last shift there was a shortage of one or more nursing staff. So can the Minister tell me how these shortages will be addressed?
I thank the hon. Lady for this absolutely superb Adjournment debate on a very critical issue. While there is, as she says, an onus on Government to respond, does she recognise that, as the health charity Place2Be says in early-day motion 137, tabled only this week by me and others—it also says that the theme of this year’s week is Find Your Brave—schools, churches and voluntary sector youth organisations also provide help to children at a time when they need it?
The hon. Gentleman makes a really important point. Far too often, we do not recognise the work that schools are doing, and the charity sector, especially, has contributed significantly. Importantly, the Green Paper does not recognise that.
Today I want to focus on the public health approach, utilising early intervention and prevention. This is far too often overlooked, but it is a vital part of any attempts to tackle the crisis we are facing. Furthermore, if we fail to support children at an early stage, we will inevitably feel the impact further down the line when emergency services will be forced to step in. That is what we are seeing at the moment, and change clearly needs to happen.
So what am I talking about and what does it look like in practice? Let us take local government. Because of huge cuts by national Government, 60% of local authority areas have seen a real-terms spending drop on mental health services for children that come under the “low level” bracket, which includes early intervention for things like eating disorders and depression. Or let us look at our creaking and failing criminal justice system. Research by Revolving Doors found that children of offenders are three times more likely to have mental health problems or to engage in antisocial behaviour than their peers—and, as I said, almost all 15 to 21-year-olds in custody suffer from a mental health disorder. Reducing reoffending and the number of parents experiencing incarceration is not just a good in itself but may prevent their children from having mental health problems and reduce the likelihood that the child is involved in offending in the future. Will the Minister explain why, in answer to my written question, the Department for Health and Social Care admitted last week that it had
“not made a formal assessment of the adequacy of mental health services or mental health assessment in Young Offender Institutions”?
Let us take community-based mental health services. The Care Quality Commission, in its review of healthcare and adult social care in England in 2018-19, found that 21% and 10% of community-based mental health services for children and young people are rated as “requires improvement” or “inadequate” for the responsive key question.
Take schools, which the hon. Member for Strangford (Jim Shannon) mentioned. Schools in Birmingham are facing a funding shortfall of more than £90 million in 2020, but they are still working hard to fund their own mental health support or arranging peer mentors. Why are they doing that? One reason is that waiting times for referrals—if the referral is even granted—are far too long. Last year, I conducted a survey of schools in my constituency of Birmingham, Edgbaston and discovered that 90% had seen an increase in staff and students suffering from mental health problems. That is not sustainable without a substantial increase in support for our schools. Take looked-after children. According to Government data, they are nearly five times more likely to have a mental health disorder than their peers.
Take poverty. The TUC found that poverty in working households has increased by 800,000 since 2010. Poverty contributes to mental wellbeing. The Centre for Mental Health’s Commission for Equality in Mental Health found that children from the poorest 20% of households are four times more likely to have serious mental health difficulties by the age of 11 than those from the wealthiest 20%.
My hon. Friend’s speech is resonating with me. In the conversations I have had with primary school teachers, they talk about the stress that children as young as six, seven and eight are under because their families are struggling to pay the rent, despite the fact that the parents are at work. Poverty is a major driver of this. We have to tackle both things—the mental health needs of our young people, but also the poverty in which they live.
My hon. Friend is right; poverty has consequences.
Take social security. The Government’s flagship policy of universal credit is not only driving more households into poverty but is creating a climate of fear and threats. Those are all factors that lead to poor mental wellbeing.
No child should have to reach crisis point before they are able to get help with their mental health. We cannot pretend that the causes of mental health are simple or that they are not impacted and exacerbated by inequalities and injustice. The Centre for Mental Health has rightly raised the futility of funding mental health services that support symptoms if those resources are diverted from preventive measures to tackle poverty and inequality, including policies in the criminal justice system, education, public health, youth services, housing and social security.
Those sectors and services are all in vital need of long-term, sustainable support, and that is why I am calling on the Minister to ensure that a public health approach is introduced that promotes mental wellbeing, prevents future mental health problems and supports recovery from mental health issues. There are different ways to achieve that, but I would like to ask the Minister to take the first step and, with a reshuffle imminent, ask the Prime Minister to introduce a children’s wellbeing commissioner, or similar, with real teeth, powers and resources to work across Departments.
It is a pleasure to respond to the excellent speech by the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), and I thank her for securing this important debate. I also thank the Members who made interventions, to which I will respond, with your permission, Mr Deputy Speaker.
I do not recognise some of the scenarios that the hon. Lady described. I have not read her article, but if she would like to give me a hard copy, I would be delighted to read it. She is obviously passionate about this subject. I have been in the House all morning, but I have had time to glance at the Children’s Society report that was published today. I was delighted to see that the Children’s Society highlights that the Government have made huge efforts to tackle mental health stigma through tireless work with schools and the Every Mind Matters campaign, which has reached 1.3 million people countrywide.
I am pleased that this debate is occurring during Children’s Mental Health Week. Today is also Time to Talk Day, which encourages everyone to be more open about their mental health in an effort to end mental health discrimination. It is going to be difficult to achieve parity of esteem between mental and physical health until we can completely eradicate the discrimination associated with mental health.
Our most recent data shows that one in eight five to 19-year-olds has a mental disorder. When it comes to young women and girls, the data is even more striking. Young women and girls are more at risk of self-harm, with about three times as many young women and girls aged 10 to 19 self-harming compared with men. The suicide rate for women and girls between the ages of 10 and 24 is at its highest on record, and it has nearly doubled since 2012. So I am with the hon. Lady on her concern about mental health and young people, and I am particularly concerned about the mental health of young women.
Those figures are heartbreaking. However, as the recent Children’s Commissioner’s report highlights, there have been major improvements to children and young people’s mental health care in recent years. I think it is important that we accept that. We need to get to that place so we can look forward to where we take these improvements.
I would like to mention Claire Murdoch, who is the clinical lead in NHS England responsible for the delivery of mental health programmes, as highlighted in the long-term plan. Claire described this to me yesterday as a bath that had been left empty for a very long time which suddenly had had the funding taps switched on—but we cannot fill the bath from empty to full immediately. The bath is filling, and it is filling with the £2.3 billion that this Government have committed to mental health. Just to put that into perspective, that is over half of the entire prisons estate budget. That is how serious our commitment is to addressing parity of esteem and mental health, particularly the mental health of children and young people. We will continue to drive forward this progress to ensure that every child can access the high-quality mental health care that they deserve.
I refer the House to my entry in the Register of Members’ Financial Interests.
Funding for mental health has increased right across the United Kingdom from when I first started in the field. However, we are really trying to raise awareness at the same time, and the more we raise awareness, the more we increase the demand. Increasing awareness and demand is a good thing, but we need many more psychologists to be working in the field alongside the psychiatrists to meet the demand.
The hon. Member is absolutely right, and I will come on to the workforce in a moment.
Making sure that people recognise this issue was part of the Every Mind Matters campaign. I do not know if everybody saw that, but we had the royals and celebrities such as Davina McCall promoting the Every Mind Matters campaign. We did that to reduce the stigma and to show that it was okay, because really successful people—hugely high achievers in society—have mental health issues and are concerned about mental health. Part of the project was to break down the stigma associated with mental health, which is a bit of a barrier to people accessing mental health care, and to get over that stigma to begin with.
We know that an increasing proportion of young people are seeking mental health help from the NHS, and we are responding by already ramping up capacity. We are on track to meet our commitment to improving access. By next year, 70,000 more children and young people will be accessing specialist treatment each year, compared with 2014-15. That equates to 35% of children and young people with a mental health condition, and that is starting from zero.[Official Report, 12 February 2020, Vol. 671, c. 9MC.]
Can the Minister expand a little on how those young people are going to access that specialist support, because an early years counselling service in my constituency has a waiting list of 500 young people? It really does concern me, because the only way they are going to get any support is when there is actually a crisis. She keeps referring to the money, but can she give a bit more detail about what people can expect on the ground?
Indeed; I will go on to address access and waiting times. The money that has been given to CCGs to spend on children and young people’s mental health is ring-fenced, and the hon. Lady might want to go back to her CCG and ask to see how much money it has been given by the Government and how it is being spent so that she can assure herself that the money we are providing to her CCG is being spent on children and young people’s mental health and is not being siphoned off somewhere else. Claire Murdoch and her team at NHS England have been looking at CCGs across the country where they think there are problems and mental health services are not being commissioned adequately, but the hon. Lady may want to go away and do that with her own CCG, and check that it is spending the money that has been given on children and young people’s mental health.
I think what my CCG will say is that the money is just not adequate. Birmingham is one of the youngest cities in the country; there are so many issues across the city in terms of trying to access care and there just are not the resources and the services, and we are not doing enough to engage our charity sector or support schools. I know that the Government have made an announcement about providing counsellors in secondary schools, but what about early intervention—what about primary schools given that we understand those issues are manifesting themselves very early on? Why are we allowing things just to continue and therefore having to spend much more money later on? That does not seem to make any sense.
One of our announcements has been to launch the trailblazer schemes, which we are hoping to have in 25% of schools by 2024. I do understand the problem in the hon. Lady’s area. I recently spoke to a headmaster at a school in Birmingham, and he told me that a third of the pupils in his school were receiving pastoral care or mental healthcare, and the reason was that a third of his children came from chaotic homes where either one or both parents were addicted to gambling, drugs or alcohol. As a consequence of having a third of the school roll in this situation, the school had serious problems with the children in the school.
So in some areas the challenges are very difficult. The hon. Lady said that we cannot just throw money at this, but the money has to fund the services—that is where it has to start, and then the workforce have to come.
The trailblazer schemes are doing incredibly well. I went to see one in Hounslow recently. We have committed to having 50,000 more nurses and are trying to train more mental health nurses, and we are having great success in getting people through universities and through the right courses and into schools. The school I visited in Hounslow, where the mental health workers were working for the children, was incredible to see. I spoke to a large group of the children who are receiving mental health support during the day, and they told me that they are being taught coping strategies. One young boy, whose name I will not mention, said to me that he suffers from anxiety—he gets anxious—and they have put an app on his phone so he has his time to be anxious and panic. His app time is at six o’clock, and he will go on to his phone and use his app.
There are so many aspects to the care being provided in school. There is early intervention, spotting mental health problems as they begin very early on. They could spot eating disorders almost as soon as they were arising in young girls. There are also issues such as anxiety and depression, and others that may not wholly be mental health-related but where the presentation of the problem was a mental health issue.
We are hoping to have 25% of schools across the UK covered by 2024, but, as I said, the bath was empty, so when we turn the tap it cannot fill straight away. The work has started. The people are being trained; they are being rolled out in schools right now, as we speak. I can say that early intervention, having seen it at work myself, is working. That was reassuring, because 18 months ago there were none of those teams in schools; there was no early intervention in any school anywhere. So the fact that we are watching these teams roll out into schools is incredibly reassuring.
On eating disorders—I will work my way through my speech, just to make sure I cover every aspect—more young people are getting the treatment they need. There has been a significant improvement in treating times in NHS care. An extra £30 million is being invested every year into children’s eating disorder services and there are 70 new or expanded community-based teams covering the whole country. Nationally, we are on track to meet the target of 95% of children and young people with an eating disorder accessing treatment, with a one-week referral for urgent cases and four weeks for routine cases.
I went to an eating disorder unit a week last Friday and met some of the young women there. It was fantastic to see the work being done. Once the young women go in, they have to stay in for quite some time. I am not sure that many people realise that an eating disorder is the deadliest mental health condition. One in four young women die from their eating disorder. It is the only mental health condition where the person suffering from it is scared of getting better. It therefore presents an incredible challenge to the mental health professionals who are working with those young girls. I saw the new eating disorder unit up and running, the work it was doing to turn the young women around and the investment that has gone in. The unit is managing to turn those young women around in a shorter time; it is just fantastic to see.
While recognising that we are still filling the bath and that there is more to do, what I really want to do is celebrate—I do not think that the hon. Lady will blame me for doing so—the good work being done by NHS professionals, including doctors, mental health nurses and those coming out of universities, to work on our trailblazer schemes in schools with young people. I want to celebrate their achievements. I am also very pleased that, after years of under-investment, NHS funding for children and young people’s mental health service is now rising and will continue to rise as we work towards the goals set out in the long-term plan. Funding for mental health services will grow faster overall in the NHS budget, in real terms worth at least £2.3 billion. The funding for children will grow faster than the funding for mental health care, which will grow faster than the overall NHS budget. This transformative investment will mean that by 2023-24 an extra—this is an important figure—345,000 children and young people from nought to 25 will receive mental health support every year.
Of course, some children will unfortunately experience a mental health crisis and will need rapid mental health support. I, like others across the House, am pleased with the strong focus on crisis care in the NHS long-term plan, which sets out investment of about £250 million in crisis care. I am not sure who mentioned A&E and hospitals; maybe it was the hon. Lady. We now have, in almost all A&Es across the country—I think it is 97%—a mental health liaison worker.[Official Report, 12 February 2020, Vol. 671, c. 9MC.] When somebody—a child or an adult—presents at A&E with a mental health condition, they are now seen by an A&E mental health liaison officer.
I am aware, however, that there is also a need to provide more support in the community, and to encourage early intervention and prevention. In fact, most of the £2.3 billion that has been allocated to mental health is for community services. Tim Kendall, NHS England’s national clinical director for mental health, says that no mental health service is ever better provided in a hospital than it can be provided in a community, except for the most serious cases. That is why we are delivering a new school and college-based service to help children and young people, staffed by a new workforce, through our children and young people’s Green Paper on mental health. It is about encouraging partnership working between services, and bringing together health and education to provide early intervention mental health support for children.
The Minister is being extremely generous in giving way. There is a lot of good work being done, as she has underlined, but one of the gaps—this is often raised by Members across the House—is autism diagnosis and intervention at an early stage, so that children get the support they need with the least detriment to their learning, development and education. She may not be able to respond today, but perhaps she could let me know about that at some point.
It would not be appropriate for me to respond to that because autism is not in my brief as a Minister. That comes under the Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage), but I will make sure that the hon. Member gets a response to that question.
To turn to the children and young people’s mental health Green Paper, every school will be encouraged to have a senior lead for mental health as well as access to mental health support teams, which are the trailblazer schemes.
Does the Minister think that it is right that we will be expecting teachers to take on another role? They are already leads for safeguarding, FGM and Prevent—a huge array of things. Does she really think that that is right and that it will address the issues?
As I explained, we have the trailblazer schemes—we are putting fully qualified, dedicated mental health workers into schools. I imagine that some of the schools in the hon. Member’s constituency will be beneficiaries of that, so the responsibility will not be with the teachers; it will be with the mental health workers. I absolutely take her point: teachers have a huge amount to do. I will check with my officers which schools in the Birmingham area have trailblazer schemes and whether they are due to go in to help her. She described her area as having 500 young people waiting, so I am sure that it is very much on the list. I will also check with Claire Murdoch at NHS England, which is responsible for delivery. It is quite interesting that whenever I say to constituents in my surgery, “The Government provide the money and the policy but NHS England is responsible for delivery,” they say to me, “Who are NHS England? I don’t know who they are. You are the Government.” However, it is responsible for delivery so I will check with Claire Murdoch what is happening in the hon. Member’s area and where the trailblazer schemes are going.
Mental health support teams will be rolled out to a fifth of schools. I am sure that the hon. Member will be pleased to know that the new schools-based service is in addition to existing provision for children and young people with mental health needs. It is in addition to the additional funding that has been given to the care commissioning groups. I will also touch base with her commissioning group. One of my concerns has been that the money that is ring-fenced for children and young people’s mental health is perhaps not always being spent on what it should be spent on, so I will touch base with it. That would also give us a better picture of what the care commissioning group is dealing with. These new plans will significantly increase the availability of mental health support to children and young people and build on existing provision.
On the workforce, to deliver and spend the money, most of which will go on salaries, we need the people to spend it on to deliver the mental healthcare. We are not complacent about the scale of the workforce challenges associated with achieving the very ambitious plans for mental health services, and making transformation a reality will require significant shifts and innovation in the way in which we deliver our services.
We have seen promising results from NHS Improvement’s work to improve retention among mental health trusts. I spoke to a group of students recently who were considering healthcare as a future career; they were considering midwifery. We need more midwives. We have a lovely, glamourised image of the role of midwives from the television, from “Call the Midwife” and “One Born Every Minute”. People who are considering going into NHS caring professions are looking at the more glamourised areas of care, and I am struggling to persuade people that mental health is a fantastic, rewarding career. We want more mental health nurses. In fact, two weeks ago, I announced that the grant for those who want to work in mental health nursing will be £8,000—they will get the upper tier.[Official Report, 12 February 2020, Vol. 671, c. 10MC.] They will also get assistance with childcare costs. So I ask people who are considering nursing overall as a career please to consider mental health nursing. I know how difficult it is. When I was training to be a nurse, we were offered 12-week placements in maternity or psychiatry, and my entire cohort chose maternity, so I know the challenge that I am up against. We need to increase the workforce, but we need to attract more people to that area.
Social media was mentioned earlier. In that regard, the NHS holds only part of the answer. We must do more across Government to protect the mental health of our children, and that includes protecting young people against harmful online content. We now know more about the impact of social media platforms on the health and wellbeing of our young people, and the need to manage the detrimental impacts. The scale of the challenge that we face in protecting children online is vast. That is why the chief medical officer commissioned an independent review of the evidence, and gave advice about setting boundaries for children and young people online. The Government’s “Online Harms” White Paper sets out a range of legislative and non-legislative measures detailing how we will tackle online harms, and also sets clear expectations for tech companies to keep children safe.
My right hon. Friend the Member for New Forest East (Dr Lewis) mentioned online harms earlier, and he was absolutely right. We face many challenges in our modern society, such as poverty—which was mentioned—as well as online social media and addictions, and many of those challenges filter down and have an impact on young children.
I am extremely proud of what has been achieved so far in relation to children’s and young people’s mental health. As I said earlier, we have achieved more than any previous Government, including those of my own party. We are increasing funding massively, and we are introducing a whole new service through mental health support teams so that more children and young people than ever before—345,000—will be able to access mental health support. We have made huge progress on putting mental health on the same footing as physical health.
We know that the Care Quality Commission has raised numerous concerns about mental health provision and instances in which young people are not receiving the care that they need. The Minister says that it is the responsibility of NHS England to deliver on that, but what more does she think she can do to put pressure on NHS England? What can we do? I do not understand how it is possible for a care provider that has been rated inadequate to continue to provide care for other people. Who should intervene if the necessary changes have not been made, and the CQC has allowed a young person to continue to receive inadequate care?
I am not sure which service the hon. Lady is talking about. If she is talking about an in-patient unit, perhaps she would like to speak to me afterwards so that I can obtain some more information for her, rather than just guessing. As for how we can ensure that NHS England delivers, I have regular meetings—in fact, I had a meeting yesterday afternoon—with both Claire Murdoch and Tim Kendall to get updates. Just a couple of weeks ago, Claire announced the launch of the first ever gambling clinic. They are working very hard at NHS England to deliver the long-term plan. As I have said, however, it is a long-term plan. The bath was empty, but the plug is now in, the taps are on, and it is filling up. Claire is working her socks off, as is everyone else, to deliver as rapidly as possible, but the other side of the coin is the workforce—getting the mental health nurses in and trained, recruiting them through universities, which has been more successful, and finding people who want to attract others to work in mental health. Claire is delivering those services as fast as she can, but they do not deliver themselves. They need people to deliver them, and that is what we are working so hard on.
In the context of NHS England, the hon. Lady asked what we could do. It is my job to hold it to account, and I can assure her that I am doing that every step of the way. Most people who work in mental health know Claire Murdoch and her 45-year reputation of working in mental health. She is a formidable force, and I do not think that anyone is going to prevent her from delivering as fast as she can. She has said to me that we have never had it so good and that we are going to motor ahead with this. That is exactly what is happening.
The Prime Minister has announced his absolute commitment to mental health, and I am confident that by continuing with record levels of investment, improving access and waiting times and focusing on prevention as well as treatment, we will provide a brighter and healthier future for all our young children.
Question put and agreed to.