My Lords, with the leave of the House, I will repeat as a Statement the Answer to an Urgent Question given by my honourable friend the Parliamentary Under-Secretary for Health, Steve Brine, in the other place. The Statement is as follows:
“This morning the Care Quality Commission published its report Are We Listening? Review of Children and Young People’s Mental Health Services. This is the second piece of work commissioned by the Prime Minister in January 2017 to look at this area of services. Findings include: examples of good or innovative practice, and dedicated people working in every part of the system; a number of areas with strong practice, ensuring that patients and families are involved in planning care; and concerns around join-up between children’s services.
The Government have already committed to making available an additional £1.4 billion to improve children and young people’s mental health services, to deliver on the commitments in Future in Mind and NHS England’s Five Year Forward View for Mental Health. The CQC welcomes this progress in its report.
Spend is reaching the front line. Last year we saw a 20% increase on clinical commissioning group spend for children and young people’s mental health, rising from £516 million in 2015-16 to £619 million in 2016-17. By 2021, we have committed to ensuring that 70,000 more children and young people each year will have access to high-quality NHS mental health care when they need it. But we know there is still much to do. As Claire Murdoch, the national mental health director for NHS England, said in response to this report, CAMHS services,
“are now improving, but from a starting point of historic under-funding and legacy under-staffing, relative to rapidly growing need”.
In December, the Department of Health and social care, jointly with the Department for Education, published our Green Paper Transforming Children and Young People’s Mental Health Provision. This Green Paper already responds to a number of the problems raised by the CQC in its report, and sets out a range of proposals to strengthen the way schools and specialist NHS mental health services work together, and to reduce the amount of time that children and young people have to wait to access specialist help. These proposals are backed by an additional £300 million-worth of funding. We have carried out extensive face-to-face consultation on the Green Paper proposals and have received a very high volume of responses to our online consultation. We will respond to the CQC review, alongside the Green Paper consultation, in the summer.
The report also calls for the Secretary of State to use the inter-ministerial group on mental health to guarantee greater collaboration across government departments in prioritising mental health. This recommendation is already in hand. The inter-ministerial group has already contributed to the development of the Green Paper and will continue to provide leadership on the issues that this report raises.
The report also recommends that everyone who works, volunteers or cares for children and young people is trained in mental health awareness. We are already rolling out mental health first-aid training to every secondary school and have committed to rolling out mental health awareness training to all primary schools by 2022. We are also set to launch a campaign to raise awareness among 1 million people around mental health and are a major funder of the Time to Change campaign, which has shifted public attitudes on mental health.
This Government remain committed to making mental health everyone’s business and building good mental health for all our children and young people”.
I thank the Minister for that response and Statement. What emerges from the Care Quality Commission’s review of children and young people’s mental health is the glaring finding, to which he has not referred, that children are suffering because of high eligibility thresholds. We know that 50% of mental health problems develop before the age of 14, and 75% develop before the age of 18. Does the Minister recognise that imposing high eligibility thresholds means that children and young people are treated only when their condition becomes very serious? Will he look into the referral criteria as a matter of urgency so that children and young people are getting proper treatment at the right time, thereby preventing a crisis that brings greater suffering for those children and their families, and greater expense for the health service?
I thank the noble Baroness for those questions. On the issue of high eligibility thresholds, we are grappling with a need to expand the amount of mental health services that can be provided. Currently, about one in four children with a diagnosable mental health condition accesses NHS services. That is clearly not enough and the intention is to get that figure to one in three by 2021. Again, that is not enough but it would be progress. There is a need to move along the path, dealing first with those in the most acute trouble and then rolling out to those with less acute conditions. I agree with the noble Baroness’s point and recognise the issue. However, this cannot achieved overnight, not least because a huge number of new staff are needed to be trained in order to deliver that. We are looking at the issue of referral criteria. I should also point out to her that we have made big steps forward on waiting times and new standards for early intervention in psychosis and eating disorders. We are piloting a waiting time for access to specialist help and hope that that will start to move things along in terms of more children being seen more quickly, which is what we all want.
My Lords, does the Minister agree that more work needs to be done on finding out what the early warning indicators of mental health breakdown in young children are?
I absolutely agree. This is why the changes that we are making to mental health awareness training in primary schools is critical. Most primary schools, through nurseries, take children from four—and even two or three—years old to make sure that staff can spot the signs in school and signpost to specialist services, where required.
My Lords, I welcome the Minister’s Answer to the Question. I am sure that he will agree that mental health support teams will be critical in making all this work. However, CAMHS teams had huge problems in getting the workforce—and in getting it up to speed. What measures are being put in place to guarantee the resilience of these new teams?
I agree that that is a challenge. There is a plan to create 21,000 new medical and allied posts by 2021, which would be the biggest expansion in mental health services that has ever taken place—certainly in this country but even in Europe. How we are going to achieve that is set out in the draft workforce strategy that Health Education England has published. A big part of that is the creation of mental health support teams in schools. That will take time—we need to be realistic—but it is an ambitious goal and we know that that support is wanted and needed.
My Lords, I am interested on two fronts. Motability over the next three years will be getting a quarter of a million people coming into the scheme and a large number of them will be children. This will put a major strain on the service they require. I am interested also on a personal front. I have a marvellous young grandson who is on the upper end of autism, so I take a deep interest in both. I thank the Minister for what he has read out from the other place but I disagree. I am afraid that we are lacking hugely in this country. Basically, we are short of educational psychologists. I am no expert but, as any doctor will tell you, the earlier you can identify mental health problems—at three, four or five—gives an opportunity of treating them generally. The Green Paper is interesting but could the Minister do some more work on the ground to find out whether what he is being told is actually happening in practice in local authorities?
I thank my noble friend for that. I think it is a fair challenge. I hope he will be reassured that of the 21,000 more mental health professionals we intend to recruit, 1,700 are therapists—including psychotherapists, educational therapists and others.
My Lords, 17 % of children excluded from school in England have learning difficulties. Will the review the Government are talking about take account of that and see whether we should be doing more, because it could well be a cause of children’s mental ill health?
These are interconnected but separate issues. Anyone can suffer from mental health problems, including a high propensity of children with learning difficulties. A separate line of work led solely by the DfE is providing specific educational support for children with learning difficulties. The point of having specialist staff in all primary and secondary schools is to spot any child, whatever their vulnerability, and signpost them to services.
My Lords, have the Government done any analysis of the numbers? My daughter is a child psychiatrist working particularly with younger children. She points out to me that there is little attention given to the needs of nought to two year olds and their mental health in the Green Paper. We know that interventions are important in those early years. For the prevention of adverse childhood experiences and interventions after adverse childhood experiences, does the noble Lord consider it wise to ring-fence funds to support prevention and early intervention at that stage?
The noble Baroness makes an excellent point about the importance of that age group. I will write to her giving the specifics of the support available to children and families with children of that age. A significant amount of funding is going into specialist perinatal and mental health services for mothers, which is a big part of the picture, but not the whole. Health visitors are being trained in mental health support. I will write to the noble Baroness with more details but I am sure there is more to be done.
My Lords, have the Government made any analysis of the number of children living with parents who are suffering with mental illnesses more widely? Given the good projects that I have seen in primary schools, it is clear that this issue affects the whole family. It is not the child or the parents sitting in isolation but a family issue. I welcome the Green Paper but can we ensure that families know that it is for them to come forward, that they are in a safe space free of stigma, and that it is not just a child sitting in a box in a policy team?
My noble friend is right. Some of the schemes that are already active in schools—I am sure she knows about and will have seen schemes such as Place2Be—not only provide support for children but invite families in to provide family therapy where it is required. It is rare that these issues are isolated; they often affect, in one way or another, all members of the family. That is what we are trying to do and deliver through the schools.
My Lords, I too welcome the Green Paper. Last November I conducted a seminar in Portcullis House of European parliamentarians, children, NGOs and academics. The most important thing there was the voice of the young people. Their concerns have been expressed already—joined-up thinking, early intervention and well-trained professionals. Does the Minister agree that these are important? Does he further agree that the voice of the child in all this is absolutely paramount?
I know that the noble Baroness speaks with deep experience and passion on this subject and I completely agree; it is about making sure that those children’s voices are heard. We recognise that the picture of fragmentation described in the CQC report is not good enough and that is one of things we are trying to fix. It is a historic issue and it cannot be done overnight but we are working on it.
My Lords, the awareness is very important. Will the Minister ensure that mental health awareness is part of teacher training and part of the qualification of special needs co-ordinators? I have to correct him: psychotherapists are not the same as school psychologists and there has been quite a substantial reduction in the number of school psychologists who are available and able to identify mental health problems.
I will take the issue about the specifics of teacher training to colleagues in the DfE. I was talking about therapists in the broadest sense of the word: I think there is a recognition that we need more therapists of all kinds in all settings as we expand these services for young people.