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Child and Adolescent Mental Health Services

Volume 793: debated on Wednesday 24 October 2018


Asked by

To ask Her Majesty’s Government what is their most recent assessment of access to treatment in Children and Adolescent Mental Health Services.

My Lords, the Government are improving and expanding access to children and young people’s mental health services. Because of the additional £1.4 billion available for these services, we expect that an extra 70,000 children and young people will access NHS specialist mental health services each year by 2021. We are either on track or exceeding waiting time targets for eating disorders and early intervention in psychosis, and the plans published in the Green Paper will further widen access to mental health support.

I thank the Minister for his Answer. Last week, Action for Children reported that one in three young people now have mental health issues. It also estimated that only a quarter of those who need help are currently able to access treatment from NHS services; this is quite often because they are not considered “ill enough”. I am particularly concerned by the often non-existent provision of crisis care for young people who are experiencing suicidal thoughts, self-harming, or just desperately needing help, often in the evening or at weekends—certainly outside of nine-to-five office hours. Could the Minister say whether setting up 24/7 crisis care provision for children, young people and their families will be a key priority for the Government in the forthcoming NHS long-term plan?

I certainly think that is an interesting idea which I am very happy to feed into that process. I know the noble Baroness is a great campaigner on this issue, and the numbers of young people who are suffering from mental health problems are, frankly, terrifying. On the point about access, she was right that around one in four children and young people have been able to access these services. Our ambition, which we are on track to meet, is that this should rise to 35%. Clearly, we ought to reach 100%, but that involves recruiting a very large workforce, which we are in the process of doing.

My Lords, can the Minister comment on whether there will be significant investment in trying to take psychology graduates into mental health nursing to enhance the number of people entering the profession?

I do not know the specifics on psychology graduates; I will write to the noble Baroness. If the number of nurses in mental health nurse training at the moment comes through into the profession, there will be 8,000 more mental health nurses by 2020. I am sure we will be keen to recruit them from wherever we can.

My Lords, on the issue of 24/7 services, CQC evidence suggests that the number of children visiting A&E departments for mental health treatment has more than doubled since 2010. Earlier this year, a CQC review highlighted growing demand as children, young people, their families and carers find that they have to reach crisis point before they can get help. On top of this, the recent FOI response to the BBC’s “Panorama” programme showed that at least 1.5 million under-18s were estimated to be living in areas where there are no 24/7 child mental health services. What steps are the Government taking to join up services across health, education, local councils and the voluntary sector to ensure that these vital crisis and support services are available and funded?

I recognise that there is variability across the country. Indeed, waiting times vary, which is not acceptable. That is why a new four-week waiting time standard is being trialled as part of the Green Paper I mentioned. I should also point out that new, community-based eating disorder clinics are being set up so that people do not have to go to an A&E environment and can access something that is better for them, frankly, both more easily and locally.

My Lords, I start by commending the Government for their important work in this area. It remains true that many people who seek help are often either not helped at all or put on a waiting list. Can the Minister outline the exact thresholds that are used when many people who seek referral are turned away? In the interests of transparency, it would be important for us to know what they are.

I thank my noble friend for her question. The definition is a “diagnosable mental health condition”. That is the performance target, or threshold, we work against. At the moment, unfortunately, only around 30% of children and young people with a diagnosable condition access care and treatment but we are clearly trying to increase that figure.

My Lords, have the Government made an assessment of the number of children and young people referred to community eating disorder services? Given that anorexia has the highest mortality rate of any mental health disease, how many of those referrals do not go on to get treatment?

The noble Baroness makes a very important point. There are 70 new or enhanced community eating disorder services. The intention is that they should serve over 3,300 children and young people every year.

My Lords, what consideration is being given to refugee children who come with tremendous trauma from the camps in Dunkirk and Calais? Is any consideration given to them and the threat that when they reach the age of 18, their status changes and they can face deportation? Can we not do something to relieve that anxiety?

As I hope the noble Lord will know, refugee children have as much right to access these services as other children. I should also point out that a new mental health assessment trial is being funded by the Department for Education specifically to design mental health assessments for looked-after children of all kinds, including refugee children.

My Lords, can the Minister say what work his department is doing with the Department for Education in making consistent the level of pastoral care available in schools, particularly for young people who have experienced mental health problems and may not be in an acute stage but need ongoing monitoring?

I am pleased to tell the noble Baroness that extensive work is being done. It was summed up in the plans outlined in the Green Paper last December and revolves around two things: every school having a designated senior lead for mental health and the recruitment of mental health support teams that will sit in and around schools. It is precisely about joining up education workers and health workers in the community to provide that kind of support.

My Lords, too many people in our young offender institutions are suffering from mental health problems. The Minister mentioned the likely increase in the number of nurses, but one of the problems with the young offender institutions is that there is an acute shortage of child and adolescent psychiatrists. Will he please tell the House what the situation is regarding those vital people?

I hope the noble Lord will forgive me if I do not have the specific number on psychiatrists. The plans to extend the mental health workforce as a whole cover all settings, including the recruitment of a further 1,700 children and young people’s therapists. I will find out whether the young offender institutions are included in that and what the figure is for psychiatrists.