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Mental Health Support: Young People

Volume 658: debated on Tuesday 9 April 2019

Motion made, and Question proposed, That this House do now adjourn.—(Mike Freer.)

I applied for this debate because of the cases of young people struggling to receive mental health support in my constituency of High Peak and in the county of Derbyshire. However, since last week, when the debate was announced, hundreds of parents, support workers, teachers and young people themselves have contacted me from across the country with heartbreaking stories of young people suffering with little or no support.

Their families suffer, too: like the mum of an 11-year-old boy in my constituency who has been severely mentally ill since last September. He suffers from panic attacks and his mum says he hardly eats or sleeps. He is unable to leave the house. He is very depressed and anxious all the time, and has been destructive and suicidal on many occasions. Mental health services will not support him, in spite of a referral from the GP, because they will not do home visits for a boy who is too ill to leave the house.

There is the six-year-old who is at risk of being excluded from school due to his behaviour. He has suspected attention deficit hyperactivity disorder or autistic spectrum disorder, but 18 months after referral the family are still waiting. Without a diagnosis, he can get neither the health nor education support he so desperately needs. His mum is trying online courses in child behavioural psychology, but she cannot help him without a diagnosis to access the medication and/or therapy he needs. The stories are similar from around the country and I thank all the people who have contacted me on this issue.

Does my hon. Friend agree that young people with autism who have mental health problems and their families have particular challenges in accessing appropriate services? Does she agree that Ministers need to look specifically at the needs of young people with autism who also have mental health problems? My experience in my constituency is that access to emergency support when there is a real crisis is often non-existent or inappropriate. There is then the question of transition for young people from being a teenager to being an adult. Does she agree that that needs a distinct approach?

I absolutely agree with my hon. Friend. There are so many areas of children’s mental health where support is needed, but with ASD a diagnosis is needed as well, which can delay the support they so desperately need.

I thank the hon. Lady for giving way. I did seek her permission to do so beforehand. I congratulate her on bringing this issue to the House today for an Adjournment debate. It is a critical issue and we are all very aware of it. Does she agree that the world young people face today, in which they have little privacy and so much exposure, is just so difficult? There is no place to go to get out of the reach of bullies or social media. This pressure sees so many young people struggling with self-esteem and self-worth. There must be more early intervention support for these young people to provide affirmation and tools for parents to help at an early stage and not let self-harming or suicidal thoughts begin.

I absolutely agree with the hon. Gentleman. I will come on to some of the additional stresses that young people are facing at the moment.

I met the Teenage Cancer Trust, which talked about young cancer victims who have mental health problems. They, too, do not have enough support, so I thank my hon. Friend for securing this debate.

Does my hon. Friend agree that with cancer, we cannot treat just the physical illness? We need to treat the mental side of dealing with it. That needs to be part and parcel of treatment and not just some sort of add-on that people seek afterwards.

I absolutely agree with both my right hon. Friend and my hon. Friend the Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney). I know that even long after the physical experience of cancer has left young people, children and adults, the mental scars can linger, particularly for families.

The number of children and young people overall with a mental health disorder has increased to nearly one in eight, according to the children and young people prevalence survey in November. That is around 1.25 million young people, yet only one in four young people with a mental disorder is seen by a mental health specialist. Over 400,000 children and young people are not getting any professional help at all in England—that is almost 1,000 young people and their families suffering in every one of our constituencies. The lack of support leads to their condition worsening.

In 2017, 46.8% of young people with a mental health disorder had self-harmed or attempted suicide at some point, and over a quarter of 11 to 16-year-olds. The threshold to access child and adolescent mental health services has become so high that local teachers in my constituency are asked to provide evidence that a child has sought to take their life before a referral will be accepted. It is not enough to be told that they have tried to take their own life—CAMHS wants evidence, and these are schools with children up to the age of 16. Even when young people are accepted, the waiting time for treatment from CAMHS in my constituency is over 12 months, and sometimes 18 months. That is not unusual. It is no wonder that children are driven to more and more desperate measures just to get heard.

The hon. Lady is making some powerful points in a powerful speech. I speak as the father of four children between the ages of 22 and 11. Any family in the modern era has to face these problems. Does she agree that parents need more support to understand these issues and to learn how to deal with them more effectively to try to help our children?

As a parent of four children aged between nine and 27, I agree that there are strains from modern life, but when parents need support, they find it far too difficult to access.

The waiting times in York are also horrendous. The funding, which has, in fact, gone down in the last year, is just £40 per child. Is not that so insufficient to match need?

Absolutely. It will not surprise my hon. Friend to hear that I will come to the issue of funding later, but that is a chronically low figure for the number of young people and children who are suffering.

The number of suicides of teenagers has risen by two thirds since 2010. I pay tribute to my constituent, who says that she is too scared to leave her 14-year-old daughter alone anymore. Having seen her daughter try to take her own life using paracetamol, my constituent is campaigning for the sale of paracetamol to under 16-year-olds to be banned. I ask the Minister to look into that.

We should do what we can to prevent access to the means for young people to take their own lives, but even more, we should look at stemming the reasons why they are driven to such desperation and making sure that treatment can reach them far earlier. Our children are suffering under the weight of demands at the same time as the people who have always been there to support them are disappearing.

Young people suffer from exam pressure, driven by school league tables. An 11-year-old in my constituency, who had always been perfectly happy and is incredibly intelligent, had a panic attack before his standard assessment tests. He said that the children knew that if they did not do well in their exams, their small village school could be driven to close through a lack of parents applying for places. Pressures on children aged 10 and 11 are just too much. My secondary schools say that children come to them in year 7 bearing such a weight of emotional stress that it is almost impossible to support.

There are higher numbers of children with special needs at our schools and less support for them as school cuts bite. There are exclusions from schools, with thousands of children taken off the roll. With fewer support staff in our schools, there is more opportunity for bullying. As the hon. Member for Strangford (Jim Shannon) said, social media enables the continuation of that bullying throughout the day and the night.

My hon. Friend will be aware of the work that I have been doing—indeed, with the Minister—on social media and the need for more research into it to gain understanding. She mentioned the data on increased self-harm and suicide. Another correlation is that, in the past decade, social media use has rocketed and that is having an impact on our young people. The Government and the devolved Administrations need to conduct more research on the impact of social media so that we can look at early intervention and, where possible, prevention, to support young people who are addicted to social media platforms.

Absolutely. I pay tribute to my hon. Friend for his work on the matter. I hope that the Government will take up the recommendations in the report that the all-party group on social media and young people’s mental health and wellbeing, which he chairs, has produced.

We are seeing not just online but physical bullying, and rising violent crime, especially among young people. I spoke to teenagers at a college yesterday who told me that they are actually scared of the gangs of 13 and 14-year-olds who roam the streets in my area. Of course, young people are more likely to be victims of violent crime than anyone else.

Even in quiet rural areas such as mine, county lines gangs put pressure on more and more teenagers to become involved in crime. When I visited my local youth centre and talked to teenagers there, they said that, for one night a week, it is the one place they can go to escape the gangs and their peers who put pressure on them to get involved in drugs, aged just 13 and 14.

I really need to make progress—I am sorry.

At the same time, more parents are working longer hours and spending more time travelling to work. We have the longest commuting times in Europe. Those parents have less time to spend with their children. There are more demands for flexibility from employers, especially at weekends, in the evenings and in school holidays—the times that parents most need to spend with their children.

There are new demands from the state for parents to be in full-time work, whether to access free childcare places from age three or through the demands of universal credit from age 12. At the same time as parents are working harder and longer, there is an increase in child and family poverty. Increasing numbers of parents face money worries and debt and have to visit food banks—strains that their children all too often see.

Alongside all those pressures on families and our young people, the number of professionals who are there to support them is reducing. Class sizes in schools are increasing and there are fewer teaching assistants, so school staff have less time for each child and growing pressures to prove academic achievement. Our schools do a fantastic job and I pay tribute to the staff who go above and beyond to support the young people in their care, but they cannot help with the sustained, one-to-one counselling and professional support that is so often needed. On top of that, child and adolescent mental health services have huge waiting lists and are still underfunded.

Our clinical commissioning groups spend 14% of their budget on mental health, but just 0.9% on children’s mental health. Even when the Government put additional funding into CCGs, it was not ring-fenced and, too often, not spent. Although an extra £250 million a year was allocated to CAMHS, in the first year only 36% of CCGs increased their spending by as much as that allocation. In the following year, 2016-17, only half of them did so, and last year, 2017-18, the spending stayed roughly the same. In 2018-19, it increased by just £50 million. Only a small fraction of the £1.25 billion that the Government had invested in children’s mental health services and CAMHS actually reached the front line.

CCGs are under huge pressures. Derbyshire’s CCGs have had to cut their spending by £51 million this year, and, despite the promised extra £20 billion for the NHS, they face further spending cuts of £270 million over the next four years. Mental health services are on the target list. The number of psychiatrists working in CAMHS at all levels fell by 3.7% between 2011 and 2018, although the number of referrals has almost doubled, as has the number of children admitted to A&E with mental health problems. At the same time, councils are cutting their spending.

School nurses spend a great deal of time supporting families and young people on the CAMHS waiting list who are going through the agonising wait of 12 to 18 months while experiencing suicidal thoughts, but they too are being subjected to cuts because of cuts in public health spending. We are losing half our school nurses in Derbyshire. As for “early help” support for families, 200 staff are being made redundant, and there is nowhere for families to turn for support. At all levels, support services are being underfunded. The Government have made a commitment to providing more counsellors in schools, which is often the right place for them, as children may need access to support. However, the target of extra provision in just a quarter of schools in five years’ time is not good enough. Our children are being failed, and their families are being failed.

Investment in mental health support for young people would actually save the Government money—not just in the health service, which would be able to nip mental health problems in the bud, but in the education, social services and criminal justice sectors. Our young people are crying out for help. The Government have some laudable aims in the 10-year plan, but they have not enough concrete plans to implement those aims, to fund CCGs to deliver them, or to invest in the training of the staff who will be on the front line.

The huge number of people who have contacted Parliament, and me personally, about this debate shows how much concern exists out there about the terrible cases of young people who are driven past the point of despair and the families whose lives are turned upside down. This is a cry for help on behalf of all of them. I ask the Minister please to listen, and to tell us how the Government will act.

I thank the hon. Member for High Peak (Ruth George) for her speech. She spoke with characteristic passion and sincerity about an important matter that concerns many Members, which is why so many are here tonight. I have personally engaged with a number of them on these issues.

Let me say at the outset that I am not complacent about the challenges that confront us when it comes to children’s mental health. It is true that many young people find it difficult to obtain help when they need it. I readily acknowledge that we face the challenge of decades of underfunding of treatment for mental ill health, in addition to the societal challenges that have made the problem more acute. It is clearly a priority for the Government, but unfortunately we cannot solve it with just a click of the fingers. We need to reinvest in the workforce if we are to deliver the services that are needed.

However, I hope to give the hon. Lady some reassurance about the direction of travel. I hope to reassure her that we will tackle the most acute needs while at the same time investing in the upfront prevention which, as she rightly pointed out, will save the Government money—and not only in the NHS, where there will be less demand for acute mental health services. She is right to highlight the savings that could be made in the criminal justice system. We must achieve the earliest of early interventions if we are really to make a difference, and not just for those people who need support, but for society, and that lies at the heart of my approach.

Does the Minister not realise that young people actually have to try to kill themselves before they become a priority? Surely that is wrong. Early intervention is the key and we must not wait until young people reach that terrible stage before intervening.

I am sure that the right hon. Gentleman will be reassured to hear that I do not think that is good enough. I have heard anecdotal evidence that that has been said to a number of people. Clearly it is a matter of clinical judgment when people are referred to mental health services; we just need to ensure that happens. If he has specific examples, I would be happy to investigate them.

Mental health is raised with me time and again by my constituents, both young people and parents, in Clackmannanshire and in Perth and Kinross. Can my hon. Friend explain to the House how we can help champion the 111 crisis line, which is available UK-wide? It can be pre-emptive, because a young person can dial it on their mobile phone and get immediate support. Sometimes that pressure release valve is exactly what is needed.

My hon. Friend makes an important point. Just as we have the 999 service for physical health emergencies, we need the same provision for mental health emergencies, and that is what we intend to deliver through the 111 service. That is a clear ambition articulated in the forward plan.

The Minister said that this is a matter of clinical judgment, but clinicians are unable to make those choices if they lack the necessary staff and resources.

There will be cases when it comes down to a clinical decision on whether a referral to a mental health professional is needed. However, we need to ensure that mental wellbeing is embedded throughout our health services.

In my area CAMHS are supposed to accept referrals from some of the young people on level 2—that indicates their level of need—and all of the young people on levels 3 and 4. As it is, they do not have time to accept even those children on level 4, which has the highest priority. That is a result of resources, not clinical judgment.

That is not borne out by the figures from the Derby and Derbyshire clinical commissioning group, which show that 31% of children and young people with mental health needs were seen by NHS-funded mental health services. I come back to the point that it is not acceptable for children to be told that they are not yet ill enough to receive treatment, which is why we are investing in more provision. We expect at least an additional 345,000 children and young people aged nought to 25 to be able to access more direct support.

I have to say to the Minister that in this area there is a massive gap between the rhetoric and the reality on the frontline. I urge her to reconsider the whole concept of ring-fencing resources. When we have Cinderella services such as CAMHS, unless the Government decide to ring-fence that funding and insist that local commissioners give it to frontline services, they will never achieve the changes they are seeking.

In the past we have treated ring fences as a ceiling and set CCGs the clear objective that they need to increase investment in CAMHS by more than what we have been giving them. [Interruption.] However, acknowledging the hon. Member for Worsley and Eccles South (Barbara Keeley), we will look at what more control we can give, and NHS England is keeping a very close eye on how that money is being spent. As I said at the outset, I am not complacent about the challenges we face. I have to say that we are on it. Direction of travel is one thing, but we have to make sure that we are managing expectations and that we can deliver the services that people expect. That includes investment in the workforce to deliver on very clear expectations.

My hon. Friend is being characteristically generous in giving way. I would like to give her some feedback from Cornwall, where our CCG is spending more money on mental health services and I am seeing those services grow. Does she agree, however, that simple organisational changes can sometimes help? I have two universities in my constituency, Exeter and Falmouth. When young people leave home for the first time and arrive at university, it can take months for the NHS to get their records and services sorted out, but young people with existing poor mental health conditions need those services to be in place when they arrive.

My hon. Friend makes a good point. Transition is clearly an area that we need to address, and she is right to highlight the importance of this in universities.

The hon. Member for High Peak made a number of points in her speech. She referred to people with ADHD and ASD, and I could not agree with her more that there is a real issue with the failure to diagnose people with those conditions early enough. We know that those people are more likely to suffer from mental ill health, so early diagnosis is absolutely crucial if we are to equip those young people with the tools to look after themselves. I am pleased that that has been a target in the forward plan that we will roll out. The hon. Lady also rightly highlighted the issues surrounding county lines and knife crime, and there is no doubt that the increased incidence of trauma in communities will bring with it more demand for mental health services. That is something that we are very much tackling as part of the Prime Minister’s summit, which took place just last week.

I have been very pleased to work with the hon. Member for Ogmore (Chris Elmore) on this, and I welcome his all-party parliamentary group’s report on the impact of social media. The impact of social media brings with it a whole new set of pressures on children’s and young people’s mental health. It brings greater intensity to relationships, for example. We think our children are safe in their bedrooms, but they are not necessarily, and we need to be vigilant about how we hold social media and internet providers accountable for the content that they host on their sites.

The Childline charity has reported a 30% increase in referrals in the past year. That is an indication of the pressure being put on our children. Has the Minister had an opportunity to speak to Childline?

I have not had that opportunity yet, but I am sure I will.

I could say an awful lot more, but I do not have much time remaining. It is clear from hon. Members’ contributions to the debate that we all recognise that this is perhaps one of the biggest challenges facing our young people right now. It is heartening to see that so many people are really seizing those challenges, whether by demanding better services or by asking for changes to Government policy to deal with some of the threats. That is all very welcome, and I have no doubt that all Members will continue to challenge me on this important issue.

Question put and agreed to.

House adjourned.