My Lords, supporting and promoting the mental health needs and well-being of looked-after children is of the utmost importance. It is not the job of any one person or organisation. Strong and effective multi-agency working across local authority and health partners is essential. No Health without Mental Health provides a co-ordinated, cross-government focus to improving mental health outcomes for people of all ages, including those in vulnerable groups such as children in the care of local authorities.
My Lords, I thank the noble Earl for his reply. Will he urgently consider working with local authorities to ensure that, in the early assessment of children when they are taken into care, a clinical psychologist with appropriate training or a child psychiatrist is involved so that mental health needs are recognised and can be acted on? Furthermore, will he say what the state of specialist looked-after children’s mental health services is? These are multidisciplinary teams developed in some local authorities and are particularly vulnerable to closure at this time of funding shortage.
My Lords, with his experience in this area, the noble Earl hits upon some extremely important points. As he will be aware, support for the mental health needs of looked-after children is at its most effective when child and adolescent mental health services, CAMHS, provide dedicated resources to work with looked-after children and their carers with trained and experienced staff. It is up to local authorities to decide the level at which staff should be appropriately deployed. Targeted CAMHS for looked-after children should work closely alongside the child’s social worker, carers and other professionals such as nurses and paediatricians. It is reassuring that data collected over past years for the CAMHS mapping survey by Durham University show an increase from 2003 to 2009 in the number of social services teams and teams with a focus on looked-after children, although those data carry a slight health warning in that participation in the survey, I understand, was voluntary.
My Lords, the noble Baroness may know that NICE and the Social Care Institute for Excellence prepared guidance recently on promoting the quality of life of looked-after children and young people. In doing so, they considered evidence including research reviews, a practice survey, a consultation with young people who have been in care, field work with practitioners and the testimony of expert witnesses. The evidence demonstrated that the health and well-being of looked-after children and young people are affected by nearly all aspects of their lives and care. The noble Baroness may like to know that a detailed list of that evidence is contained in appendix C to the guidance.
My Lords, some local authorities are experiencing a very large number of looked-after children moving from other local authorities. I believe that in Medway there has been an increase of some 21 per cent. What action are Her Majesty's Government taking to ensure that local authorities that accept children from other local authorities are able to provide the specialist care that this vulnerable group needs in the field of mental health?
The right reverend Prelate is quite right that the numbers of children going into care have been rising and some local authorities have been under particular pressure. But local authorities generally should be in no doubt that they have legal obligations in this area that they cannot obviate. The Department for Education has produced revised regulations and statutory guidance on care planning for looked-after children and care leavers, which came into force on 1 April. I have already mentioned the NICE and Social Care Institute for Excellence guidance, which should be followed alongside those regulations.
All local authorities in England must provide information on the emotional and behavioural health of children in their care and there are established screening tools to enable them to do that effectively. A recent study published by the Local Government Association found that more than 60 per cent of councils are seeking to protect children’s social care from any cuts.
Does my noble friend share my concerns that significant numbers of black and minority-ethnic children in the care system suffer from mental health problems, but do not receive the appropriate intervention and support until it is far too late and they have already become involved in the criminal justice system? Will my noble friend tell me what is being done to ensure early intervention, treatment and support for these young people and children?
My noble friend is absolutely right. She will know that minority-ethnic groups appear to be overrepresented in the looked-after population. Around 3 per cent of the child population of Great Britain is from black, black British or mixed groups, but 8 per cent of looked-after children are black and 7 per cent are from mixed groups. She is right that there is a problem. She is also right that early intervention is key. There is a strong emphasis on public mental health in the mental health strategy. The good foundations are down to early intervention, as I mentioned, and we are clear that this is a priority for the Government.
The Minister will be aware from recent research that an integrated budget actually makes sure that looked-after children and other vulnerable groups are more effectively responded to. Is he confident that the current confusion in the health service about the future and what the priorities should be is not preventing good work being developed in this area, because practitioners do not know what they should be doing?
My Lords, I see the Government's proposals for local health and well-being boards as absolutely key to the effective integration of services and working across boundaries. The noble Baroness will know that the NICE and SCIE guidance that I mentioned is all about how better agencies and services should work together to produce the best results. We have a big opportunity in the Government's reform proposals to do the very thing that she is seeking.