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Child and Adolescent Mental Health Services

Volume 785: debated on Monday 30 October 2017


Asked by

To ask Her Majesty’s Government what action they are taking to ensure that children and young people can obtain timely access to Child and Adolescent Mental Health Services.

My Lords, the Government are committed to making sure that 70,000 more children and young people each year will receive evidence-based mental health treatment by 2020-21. Since publishing Future in Mind, the Government have made an additional £1.4 billion available to improve children’s mental health. Key mechanisms for delivery are local transformation plans, which cover the full spectrum of mental health, and the upcoming children and young people’s mental health Green Paper, which will contain proposals for further improving access to services.

My Lords, does the Minister agree that early intervention is essential to prevent escalation into crisis and lifelong problems? Is he aware that the number of CAMHS psychiatrists fell by 6.6% between 2013 and this year, while demand for their services rose? The number of qualified doctors who go into psychiatry is 2.6%, the lowest of any specialism, and some universities do not send any. Will he consult Health Education England to find out what it is doing about this, because the pipeline is drying up?

The noble Baroness is quite right to highlight the fact that we need more staff to meet the mental illness burden in society, which is sadly growing. I hope that she will have seen that Health Education England has announced that there will be 21,000 more mental health staff by 2021, of which 13,000 will be qualified clinical staff, including 700 more doctors. The warning she has made has been heard loud and clear and those changes have been made.

If I may, I would like to use this opportunity to say that I made a mistake in my previous answer, when I talked about there being 21,000 people eligible for flu jabs. If that really was true, that would be a poor place to be. It is actually 21 million, which is slightly more reassuring.

My Lords, I would like to ask the Minister about the 700,000 young carers, who often have severe mental health needs because of the stress of the duties they undertake, as he will know. We had high hopes of specific action for young carers in the refreshed carers strategy, but I understand that this is being rolled up into the consultation on the social care Green Paper. I am concerned and would like to be reassured that the Government have not abandoned the long-awaited carers strategy. If we are waiting for the social care consultation, how will he ensure that the mental health needs of young carers are urgently addressed?

I know that the noble Baroness cares passionately about this group of people. My understanding is that those policy issues are being considered in the round with the social care consultation. I shall write to her to clarify that point. She might like to know that, in the upcoming Green Paper on children and young people’s mental health, there will be an expansion of some of the work that has already gone on around providing mental health first aid and various other things in schools, which will capture some of the young people that she is talking about.

I declare an interest as having members of the family who have used child and adolescent mental health services. Does the Minister not agree that the fundamental principle of the NHS is free treatment at the point of need? Does he also agree that one of the major failures in CAMHS—it has been well evidenced by academic studies over the last two years—has been that, because of the shortage of resources, only those with the most critical needs are treated at all, and the early intervention which would help prevent needs becoming critical has been deeply neglected owing to an absence or lack of specialised therapies, particularly talking therapies? Will he confirm that the work on the most critical side is going to be extended so that children and adolescents can get care earlier and more effectively, saving the state money and fulfilling the purposes of the NHS?

Yes, I wholeheartedly agree with the most reverend Primate. We are making up for lost time, unfortunately, with children and young people’s mental health care and there is a lot to do. He will be pleased that the additional funding being provided is helping with the rollout of the children and young people’s IAPTs—the talking therapies. As I said, the intention of the extra funding is to be able to treat 70,000 more young people, on top of those who have already been treated, by 2021—so more young people are being seen. That will increase the 25% of the potential caseload currently dealt with to 35%. Obviously that is better but it is not the whole way.

My Lords, following on from that question, I ask what the Government are doing in relation to preventing children’s mental health problems by addressing parental conflict and family breakdown.

That is an incredibly important point because good relationships are very influential on young people’s mental health, and the Green Paper will look at the role of family conflicts. My noble friend will be pleased to know that the Department for Work and Pensions is launching a programme to reduce parental conflict in conjunction with the Early Intervention Foundation. I hope that it will have some positive benefit in reducing parental conflict, which is, of course, one of the causes of mental illness.

Does the Minister accept that there is a wide variation in the offering of services between one geographical location and another? Will the Green Paper which is being prepared address this, and how quickly will it be resolved?

The noble Lord is right about variation, sadly. We had the CQC thematic review on mental health provision at the end of last week, which showed that 80% of specialist in-patient care is good or outstanding but that that is true of only two-thirds of community care provision, with around a third either requiring improvement or inadequate. That is clearly not good enough. Patchy provision is absolutely one of the things that we need to deal with. The best way of doing that is by expanding both the number of children being treated and the size and quality of the workforce, to help us to meet our targets.

According to a Guardian article last month, English CAMHS is struggling to satisfy the rapidly growing demand of referrals. We all know this. Within the past decade, 68% of admissions into hospital because of self-harm were girls under the age of 17. What are the Government doing to decrease the number of young girls inflicting self-harm?

Again, this is one of the most difficult issues. Two hundred thousand people a year are admitted into the health service with self-harming injuries. Twenty per cent of young women under the age of 24 have said that they have self-harmed at some point in their lives—that is one in five. There are now NICE guidelines on self-harm and its treatment and there will be a new care pathway by 2019. However, I do not underestimate how difficult it is to crack this problem.