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Mental Health Provision: Children and Young People

Volume 633: debated on Tuesday 12 December 2017

Motion made, and Question proposed, That this House do now adjourn.—(Chris Heaton-Harris.)

It may be quite late in the evening, but I wish to raise some serious issues arising from the publication last Monday of the Government’s Green Paper on children and young people’s mental health provision. I am pleased to see the Minister on the Treasury Bench and look forward to hearing her response shortly. It is a shame that the publication of the Green Paper last week was not accompanied by an oral statement when there is so much to discuss, but it is heartening to see so many Members in the House so late this evening.

After talking to people with lived experience of mental ill health, young campaigners, clinicians and parents over the past few months, I know that there was a huge degree of anticipation and expectation attached to the Green Paper. The issues are well known to hon. Members. Demand for mental health services for young people is increasing. The number of children being admitted to A&E in a mental health crisis is at a record high. Self-harm among young people, especially teenage girls under the age of 17, has increased by 68% over the past three years. Face-down restraint was used more than 2,500 times on people under the age of 18 in mental health units in 2014-15, which is the last year for which records are available. Yet face-down restraint is something that should be—and is expected to have been—phased out.

The money allocated to mental health is not reaching the frontline, and when I and many others called for the cash to be ring-fenced in the Budget, that call went unheeded. I had the opportunity to ask the Minister at the Health Committee to ring-fence the money, and her response was that:

“in my experience ring fences ultimately become ceilings.”

I tell her today that young people in my area would certainly take that ceiling.

This financial year, the Young Person’s Advisory Service, the main mental health service for children and teens in Liverpool, has been cut by £757,000—a 43% cut. We have seen a raft of cuts to other key mental health services in my area, including services for young carers and the Liverpool Bereavement Service.

A recent Care Quality Commission report confirmed that young people across the country are waiting up to 18 months to access the treatment they need. Too many are turned away because they do not meet increasingly out-of-reach thresholds. Young people are literally being turned away and told to come back when their condition is more serious.

A local primary teacher emailed me recently and set out the cases of three students under the age of 11 who had been referred by his school to child and adolescent mental health services, including one who had displayed signs of a split personality and one who had harmed the family pet without showing signs of remorse. All three referrals from that primary school were rejected. Over the past two years, 100,000 children have been rejected by services, despite being referred. I ask Members to imagine if we treated cancer the same way.

I congratulate the hon. Lady on bringing such an important issue to the House at this time of the day. Taking into account reports that mental health problems affect about one in 10 children and young people and that 70% of children and young people who experience a mental health problem have not had appropriate interventions at a sufficiently early stage, does she agree that it is time not for words but for action that would see the Health Department and the Department for Education working cohesively to address the issue she has put forward?

The hon. Gentleman makes a really important point about co-ordination between various Departments to ultimately effect change and support young people across the country, and that is what I and so many others are really looking forward to. However, I am going to set out in the rest of my remarks why I think the opportunity has been missed.

We have seen programmes such as Channel 4’s “Kids in Crisis”, which have brought many of the issues I have set out to a broader audience. That has included the scandal of too many young people having to travel hundreds of miles from their homes to receive treatment and support—and that is if they get in at all.

We know that the younger generation, coming into adulthood, are prone to a range of mental health conditions: depression, anxiety, eating disorders, self-harm, suicidal thoughts, phobias and other challenges. Those destroy confidence, blight education, training and employment opportunities, alienate young people from society, and, in some cases, drive families to tearful despair.

There is a social justice aspect to this too. Children from the poorest fifth of households in our country are four times more likely to have a mental health difficulty than those from the wealthiest fifth. Health inequalities in our country persist as strongly in mental health as in physical health.

Would the hon. Lady agree that, in my vast and far-flung constituency—the second biggest geographically in the UK—what she says about distance is an extraordinarily pertinent and very worrying issue for my constituents?

I thank the hon. Gentleman for his intervention. We have heard from many Members on both sides of the House about families having to travel hundreds of miles to access treatment. Just last week, I heard of one young person being sent to Scotland to access in-patient treatment for eating disorders, because there was not a bed available for her in England. In certain parts of the country, it is certainly the case that people have to cross boundaries and to go north and south to access services, in a way that we would not accept if this was for physical health services.

Given this growing and what I can only describe as desperate demand for services for young people, I and many others eagerly awaited the Green Paper. I have read it many times, but it was—and I hate to say this—a disappointment. I believe that Ministers have failed to meet the scale of the challenge. The £300 million outlined for mental health support in schools sounds really impressive—until we read the detail and we realise that Ministers aim to reach just a fifth of schools over the next six years, with eight out of 10 schools remaining without the extra support until 2029. It really is a drop in the ocean. Ministers intend to roll out services over the next decade as though there was no urgency or imperative for action. I hardly need to point out that this means that most eight-year-olds today will see no benefit from these proposals throughout their entire childhood and adolescence.

I thank my hon. Friend for bringing this important issue to the House. Does she share my concern about the waiting times between referral for treatment and the start of treatment? Does she agree that much self-harm and, indeed, suicide of young people takes place during that waiting period? Does she believe, as I do, that while four weeks would be an improvement on most of the waiting times that our children and young people have had to face up until now, that maximum wait needs to be upped to until actual treatment and not just until the assessment for treatment?

My hon. Friend pre-empts a question that I was going to ask of the Minister, because it is not clear whether the pilot that the Government are going to introduce is based on a four-week waiting time for assessment or a four-week waiting time for treatment. Those two things are very different. In many parts of the country, young people will sometimes have an immediate assessment but then have to wait weeks, if not months, to actually access the treatment that they need.

The hon. Lady speaks with passion and authority on this subject. As the Member of Parliament for Cheltenham who has witnessed this explosion in adolescent mental health problems, I share her concerns. Does she agree that as well as looking at cure, we need to look at prevention and to understand why this explosion is taking place? The time has come for a really good, authoritative body of work to get under the bonnet of why these problems are arising as they are.

I thank the hon. Gentleman from the bottom of my heart for that intervention, because that is the crux of the point that I am seeking to make. I have sought to highlight some of the issues in the Green Paper, and I will highlight a few more, but the greatest problem is what is not in it—namely, what we can do to prevent mental ill health in our young people rather than deal with and treat it when they become mentally unwell. I will come to that in a moment.

The Royal College of Psychiatrists eloquently states what I believe, which is that the Green Paper lacks

“a suitable scale of ambition or speed of action.”

The royal college reminds us that in the Health Education England mental health workforce plan, which sets out the posts for which the NHS aims to recruit from now until 2021, there are no new consultant psychiatrist posts for children and young people’s community services—none at all. Yet we know that there is a massive shortage of child psychiatrists in our country.

I commend the hon. Lady for securing this debate because it is really good to be having a conversation about this Green Paper. It is worth mentioning that it is a great moment of progress to have a joint piece of work between healthcare services and the Department for Education on getting into the issue of mental health in young people, which is such a growing problem. Like my hon. Friend the Member for Cheltenham (Alex Chalk), I think that we have to get into understanding the causes better. As the hon. Lady said, we need to take action at greater pace and to a greater scale. Does she welcome the fact that, as the Royal College of Psychiatrists says, there has been a step in the right direction in that that there is an evidence-based approach, which is to be welcomed? Does she agree that a particular challenge that must be addressed is the need to recruit and retain the workforce that we need to deliver this care and support to young people?

I thank the hon. Lady. I believe that we both share the concern about the challenge of recruitment within the mental health workforce. The Government themselves acknowledge that there is an issue by way of the fact that they have put forward a plan to recruit these extra thousands of mental health workers between now and 2021. In the context of our conversation this evening about young people in particular, it is particularly disheartening and dispiriting that the specific plan that was set out only a few months ago contains nothing to expand the number of child psychiatrists—something that we desperately need. In the north-west, we really struggle to fill vacancies for those posts.

My hon. Friend is making a great speech about the real crisis in child mental health. Does she agree that the Green Paper places more and more focus on teachers, as opposed to health professionals, providing mental health support? Teachers are already really stressed by the volume of work that they have to do and they are not trained as medical professionals, so should that emphasis change?

I thank my hon. Friend for that important contribution. Another question that I hope the Minister will answer is how we can properly equip and train teachers to contend with the responsibility that they will be given if the plan set out in the Green Paper goes ahead. At the same time, the Department for Education is piling extra pressure on students with more testing. There are fewer teaching staff, which adds to the pressure on the remaining staff, and class sizes are larger. Cuts have been made to mentors, pastoral care and counselling. There has been a 13% reduction in the number of educational psychologists in our schools. The Royal College of Nursing points out that the number of school nurses has dropped by 16%, while the number of school-age pupils has gone up by 450,000. Young people face bullying, online threats, dysmorphic body image and advertising in a way that no previous generation has done.

Like many hon. Members, I am upset, appalled and outraged every week by the heartbreaking cases that constituents and their families raise with me in person or via email. Many Members in this House will recall the case in August of 17-year-old Girl X. She was restrained more than 100 times in a place that was not fit for her care, and she was left without a secure bed. The UK’s most senior family court judge, Sir James Munby, raised her case and warned us that we would have “blood on our hands” if this suicidal and vulnerable young woman did not get the treatment that she needed. But why was his continued intervention needed?

The case of Jack was brought to me this weekend. Jack is eight years old, and he has autistic spectrum disorder. He is in a severe state of anxiety and distress, and he has spent the last eight weeks on a ward in Alder Hey Children’s Hospital. He has had no specialist support from CAMHS and no specialist in-patient bed. He is getting more ill, and his family are, in the words of his mum Kerry, “in complete crisis.”

Just this afternoon, I heard about the case of Martha, who is 15 and has a history of self-harm. She has been admitted to A&E twice after taking an overdose. From a referral in June, Martha is still waiting to see a mental health professional. In the cases that I have described and thousands like them, every day counts, but young people are waiting weeks and months for treatment while their conditions worsen and their families are left distraught.

I do not believe that the Green Paper does anything for young people such as Jack, Martha or Girl X, or for thousands of other young people, whose lives should be filled with optimism and wonder as they look to a future laden with promise. I am concerned that instead, they are going to face years of torment, anguish and pain, made worse by the fact that so much of it is preventable. The majority of adults with diagnosable mental health conditions will have developed them under the age of 18. The life chances of thousands are being blighted. We are leaving a generation in pain; they are being let down because the care is not there.

Ultimately—I agree with the point made by the hon. Member for Cheltenham (Alex Chalk) —what is missing is the proper focus on prevention. How can we prevent mental ill health and keep our children well? We know that the first 1,001 days of a child’s life determine their life chances and life outcome, and that is why the previous Labour Government invested millions in Sure Start and children’s centres. We need to remove the factors that create mental ill health in the first place: neglect, childhood trauma, domestic abuse, bullying, insecure housing and poverty. Unfortunately, the Green Paper does not address those issues. Indeed, the words Sure Start, deprivation, homelessness and inequality do not appear in the Green Paper even once.

We do not need to be economists to understand that it is far more expensive to run a service that is based on crisis than a service that is based on prevention, not just in human terms, but in terms of taxpayers’ cash. What a wasted opportunity. I sincerely hope that the consultation on the Green Paper will be meaningful, that Ministers will listen to the voices of young people and experts across the country who are crying out for change, and that we will see some action.

In conclusion, will the Minister tell the House—I have asked this question, but let me reiterate it—whether the pilot, which I know is only a pilot, will introduce a four-week waiting target for assessment or for treatment? The Green Paper guarantees funding only for the period of the spending review, so what guarantees can the Minister offer us for maintaining funding after the initial three years are up? What will happen then? How will the lucky fifth of schools be selected for the first wave of support? How will her Government address the aim of real parity of esteem between mental and physical health? Reading the Green Paper, it seems to enshrine imparity by supporting only 20% of children over the next six years. Finally, is she convinced that this really is the best her Government can do for the greatest asset that we possess—our young people, who are our nation’s future?

I thank the hon. Member for Liverpool, Wavertree (Luciana Berger) for bringing this debate to the House. As usual, she speaks with clear passion on this subject, and she has very clearly outlined the challenges that we face. We have brought forward this Green Paper exactly because of the sort of examples she has articulated, and we need to do a lot more for our young people.

The Green Paper is centred on the support we are going to give through schools, through which we will achieve earlier intervention. We intend to be treating 70,000 more children and young people by 2021. I appreciate the hon. Lady’s impatience, but we are none the less trying to achieve a step change in the amount of support and care we give to children and young people. We have set out proposals for consultation, and I encourage all Members of the House to get involved in responding to them. I am very heartened that, notwithstanding the late hour and the difficult set of votes we have had, so many Members are in the Chamber, which is an indication of just how important this subject is.

The hon. Lady raised a number of issues that are, indeed, all challenging, and I will pick up on a few of them before I come on to the substance of my remarks. The issue of the workforce is extremely important. She and I have had many exchanges on this, and the reality is that our ambition can be delivered only to the extent that we can achieve an increase in the workforce. We are giving a very clear indication that mental health is our priority—we want to send the very clear message that there is a future career in mental health and to attract people into it; none the less, we have had problems with recruitment and retention for many years, and this will take some time to embed. Through the pilots, which she has described, we want to learn what works, and I hope we can deliver on our ambition to deliver a real change.

The hon. Lady also asked whether we are putting too much of a burden on teachers. I would dispute that: we have found that 61% of teachers want to know how best to support children when they see evidence of mental ill health, and nobody can doubt the real commitment of teachers to the children in their care. Part of what we are proposing in the Green Paper is to give them the tools to do the job, and to give them access to more treatment. This is the first time that schools, the Department of Health and the Department for Education have come together to deliver such a policy, and this is a very important way of achieving earlier intervention to support better outcomes.

The Green Paper seeks to build on the progress that we have already made—from setting up the first ever waiting times for mental health to supporting the recommendations of “Future in Mind” through investing £1.4 billion to bring together all services working with children and young people to improve mental health services. While we have heard about some of the very considerable concerns raised about services as they stand, the hon. Lady will have heard me say previously that we are in the midst of a huge programme to achieve change for the better.

I want to take a moment to pay tribute to the incredible staff who are rising to this very significant challenge. We are naturally focused on the shortcomings of services, but we need to recognise that many staff work incredibly hard, and their work must not go unacknowledged.

We are in the midst of an improvement. Last year we saw a 20% increase in the amount of money that clinical commissioning groups spent on children and young people’s mental health, rising from £516 million in 2015-16 to £619 million in 2016-17. I recognise the issues that the hon. Lady raised in her area. As she will be aware, they are under review by NHS England through Claire Murdoch’s programme board.

We have heard concerns about money not getting through to the frontline, but we know that the additional £1.4 billion is already making a difference. Amid the huge concerns raised, we have to keep in mind the huge achievements of the NHS, with many more lives changed for the better thanks to its work.

It is also worth acknowledging where we have achieved success with early intervention. We are exceeding the early intervention in psychosis waiting time standard, with 76.7% of patients receiving treatment within two weeks of referral, and we are on track to meet the waiting time element of the eating disorder standard, with 71% of urgent eating disorder patients receiving treatment within one week and 82% of routine eating disorder patient receiving treatment within four weeks.

The hon. Lady mentioned the pilots and the extent of our ambition with regard to the four-week waiting time. The target is to achieve four weeks for access to assessment for specialist services. While she might feel frustrated by that ambition, it is worth recognising that at the moment some children can be waiting for as long as two years, which is clearly unacceptable. We need to assess what works and ensure that any services that are accessed are based on clinical need.

“Future in Mind” brought together experts from across the sector to ensure that services dealing with young people had credible plans to improve services. We also made sure that these included the voices of young people themselves, and we intend to continue our dialogue with young people. Since “Future in Mind”, we have committed to rolling out mental health first aid to every secondary school by 2019, and to all primary schools by the end of this Parliament. We are also investing £15 million, with the help of Public Health England and others, in a public mental health campaign to train 1 million people in mental health awareness. I think we all agree that the earlier the intervention, the better the outcome.

The hon. Lady quite rightly raised the issue of young people having to travel too far for care, which clearly is appalling. NHS England has committed to eliminating inappropriate out-of-area placements by 2020-21, so we are seeing investment in services and beds where there is lack of provision. In particular, we have had a significant increase in provision in the south-west.

I appreciate the sincerity of the Minister’s remarks. All that I can say, given my earlier intervention about my vast and remote constituency the other side of the border, is that I would be grateful if she could share her Department’s expertise with the Scottish Government, because the same issues could be tackled in the same way north of the border.

I thank the hon. Gentleman for his intervention. I am pleased to acknowledge that I have a very good dialogue with the Scottish Health Minister. It is fair to say that all four nations can learn from each other when it comes to delivering better health outcomes and sharing best practice.

We know that young people are sometimes still taken to police cells when they are in a mental health crisis. The hon. Member for Liverpool, Wavertree outlined the very distressing case of the young woman who had been restrained many times. The Under-Secretary of State for the Home Department, my hon. Friend the Member for Louth and Horncastle (Victoria Atkins), and I yesterday announced new police provisions that will finally put an end to this practice. We will ensure that children will always be taken to places of safety. The issue of prone restraint for children really needs to be examined.

The Green Paper will build on these foundations to build a new approach to supporting the mental health of our children and young people. With over £300 million of funding available, we will train a senior designated mental health lead in every school and college to improve prevention work—many schools have already made that commitment—and create brand new mental health support teams working directly with schools and colleges, and we anticipate that they might be working within multi-academy trusts or through local education authorities, and some might be provided through the NHS. Through the pilots we will discover what works, and it will not necessarily be a one-size-fits-all approach.

I am conscious of the time and that the Minister will soon conclude her remarks, but I have two points that I would like her to respond to. Does she accept that what she is laying out is essentially replacing much of what has been lost in schools: the number of educational psychologists, peer mentors and counsellors lost from our schools because they do not have the funds to pay for them? I hope in her final remarks she can address prevention, which is a very serious point. What are she and the Government going to do to prevent mental ill health in our young people?

I do not accept the premise of the hon. Lady’s first point. We are trying to build a critical mass that schools will have access to. On prevention, the investment we are making in mental health first aid and training in schools will enable staff in schools to see when people are going through mental ill health issues. The earlier we can put that support in place the better. We are working with the Department for Digital, Culture, Media and Sport on what we can do through social media. We know that online bullying is causing a lot of mental health issues. As I say, this is a Green Paper. We are making money available. We want to see what works and we want to take this forward in a consultative manner. We will respond fully to any points made as a result of that consultation.

The point of the Green Paper is that we are looking to put support mechanisms in place so that children facing mental health issues have access to care. That is very much the focus of today’s debate and the Green Paper.

To conclude, as we are running very short of time, I am grateful to the hon. Member for Liverpool, Wavertree for bringing this subject forward for debate. I am sure it will not be the last time we debate it—in fact, I know for certain that it will not. We are trying to achieve a step change in the support we are giving to children and young people. We know that the situation is far from perfect at the moment, but we fully anticipate that we will meet our ambition in the five year forward view to be treating 70,000 more children by 2021.

Question put and agreed to.

House adjourned.