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Children: Mental Health Assessments

Volume 787: debated on Monday 18 December 2017


Asked by

To ask Her Majesty’s Government, further to the remarks by Lord Nash on 23 November 2016 (HL Deb, col 1947), what progress they have made with testing new approaches to mental health assessments for looked-after children which were due to commence in April or May this year.

My Lords, the pilots were delayed by the general election but will start next year. Delay has enabled the design to effectively address the problems identified by the noble Baroness, Lady Tyler, and the Education Select Committee. In particular, we have taken forward recommendations of the expert working group on the mental health of children in care, which the Government commissioned to look at how to improve mental health and well-being support for looked-after children. We are currently identifying an organisation to support implementation.

I thank the Minister for his Answer and will not dwell on my disappointment that it has taken so long to get the pilots off the ground. It will now be important to understand how these pilots will fit with the new trailblazers announced in the Green Paper to trial new mental health support teams working with schools. Does the Minister agree with me that it would make sense for at least one area to trial both the new children-in-care assessment pilots and the new mental health support teams to see how they best fit together?

My Lords, we will work with our delivery partner to identify pilot sites, and there will be an up-front commitment to help meet any needs that are identified during the assessment process. One advantage of the delay is that we now have the mental health Green Paper, and we are trying to dovetail as much of the work from that into these pilots as we can.

Will the Minister join me in congratulating Hammersmith council, which on Thursday took in to look after a Syrian refugee boy from Greece who has serious mental health needs? Is it not a good sign that a local authority is doing that and showing what can be done for vulnerable refugees with mental health needs?

My Lords, I certainly congratulate the local authority on that great work. A number of pilots are operating across the country—over 80—experimenting with different ways in which to help these vulnerable children. Only last week, Ealing had an open day to showcase some of the work that it has been doing for vulnerable children, and invited every other local authority in the country. It has been able to reduce the number of children going into care, and to save money as well. So there is a lot going on and, with the launch of the pilots that I have discussed with the noble Baroness, Lady Tyler, we will be doing a lot more on this.

My Lords, I declare my interests in the register in children’s mental health. Can the Minister assure the House that the recommendations of the expert working group will be fully funded by the Government? In particular, will recommendations around children’s homes be fully funded? Children’s homes have the most damaged young people, who are placed there as a last measure, yet their staff are still very poorly qualified. David Berridge, the eminent academic, commenting on the predation on children in homes in Rotherham, said that we must start moving towards having higher qualified staff in children’s homes, given the complexity of their needs and their vulnerability to predation.

My Lords, in answer to the first question, the expert working group made 16 recommendations and we will seek to include all of them in the construction of the pilot programme. In relation to secure children’s homes, we all acknowledge that these are some of the most vulnerable children in our society. There are 14 secure children’s homes in England, covering 133 welfare and 117 criminal justice placements. The mental health Green Paper underlined the need to increase the number of qualified staff working with vulnerable children and we will certainly look very carefully at that.

My Lords, should we not welcome the determined efforts being made by charities and other bodies to secure more places for looked-after children suited to a state or independent boarding school, where good, externally inspected care is available for pupils with mental health problems?

My Lords, I very much agree with the noble Lord. At the moment we have the Boarding School Partnerships, an initiative which works with a number of local authorities and boarding schools to increase the number of referrals for children who might be defined as on the edge of care. My own home county, Norfolk, is one of the largest users of this scheme. It is doing a longitudinal study, which we hope will be released next year, to show the impact of these children being prevented from going into care by going to a boarding school. If, as I hope, this shows very strong improvements in these children’s lives, we will be showcasing it to other local authorities to encourage more of them to do it.

My Lords, it would be grossly unfair, particularly during this season of good will, to hold the Minister responsible for the sins—or at least the prevarication—of his predecessor, the general election notwithstanding. As has been mentioned, the expert working group on improving mental health support for young people in care reported last month. I hope the Minister can give an assurance that the Government will show rather more urgency in response to that report than they have in testing new approaches to mental health assessments for looked-after children. These children are five times more likely to develop a mental disorder than children living at home with their families, but only one-third of those diagnosed accessed children and adolescent mental health services—known as CAMHS. Will the Minister ask the DfE to ensure that areas where CAMHS access is low will be prioritised when selecting the local authorities and clinical commissioning groups for those pilot studies?

I reassure the noble Lord that we will be looking at all the recommendations of the expert working group, some of which included the points that he made. These include things such as establishing a virtual mental health lead, based on the success of the virtual school head process, and improving the strengths and difficulties questionnaires, which we discovered are not always being carried out as well as they should be. In the debate on 23 November last year, the noble Baroness made a point about the importance of assessing mental health at the same time as a young person’s general health assessment is carried out, so reducing stigmatisation. I hope this offers some reassurance to the noble Lord. It is quite right that he holds us to account, even in the Christmas period.

My Lords, what happens if children are identified, through the pilot assessment, as having mental health needs but there is no capacity to meet those needs in the local area?

My Lords, the pilots will be looking very much for the potential to join up with other government programmes that support the mental health and well-being of looked-after children. This will include the scope to link with the Green Paper proposals, which I have mentioned, and other related work such as NHS England’s testing of personal mental health budgets for looked-after children. There will be an up-front commitment to try to meet any needs that are identified during this assessment process.

My Lords, is the Minister aware that although the Health and Social Care Act gave equal priority to mental and physical ill health, even today a very vulnerable mentally ill child suffering deep pain may wait 18 weeks or longer for any medical intervention while a vulnerable child with comparable physical pain can expect treatment within a day? Does the Minister find that acceptable?

My Lords, I do not find that acceptable. As part of this process, we are looking at ways of ensuring that treatment for mental health issues identified in these vulnerable children is accelerated. We expect to have the invitation to tender for the pilot programme available in April next year, but, as I say, this is one of the issues that we are looking into.