Mental Health: Children and Young People - Motion to Take Note

– in the House of Lords am 11:51 am ar 23 Tachwedd 2023.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Earl Russell:

Moved by Earl Russell

That this House takes note of the current state of mental health support for children and young people in England.

Photo of Earl Russell Earl Russell Democratiaid Rhyddfrydol

My Lords, I am delighted to have secured this debate. There is no more important issue, to my mind, than ensuring that we are adequately supporting our children and young people when they are not well and at their most vulnerable. I thank the Members of your Lordships’ House who have put their names on the speakers’ list for today.

I have been moved to bring this debate as I have personal experience of poor mental health and the impact it has on young people, following my own daughter’s five years of struggle. As a parent, it has been one of the most challenging periods of my life. No parent ever wants to see their child unable to keep themselves safe. It is important that we, as politicians, share our personal experiences as part of the fight for change. I am proud of the progress she has made. I wish to use my experience to help fight for better outcomes for other children who find themselves in similar positions. I know that others in this Chamber will have had similar personal experiences.

I have also brought this debate as I want all children out there who are struggling to keep themselves safe and well right now to know that everyone in this House and across government are working together to help make things better for them. This is not a political issue nor is this a political debate; I know we are all united in wanting to improve services and outcomes for children and young people. As my daughter might say, “We got you”.

I will make three key points. First, children and young people are facing an expediential crisis from the combination of the impacts of Covid and a general increase in poverty that has overwhelmed previously overstrained systems, so real and immediate action is needed. We are facing a young persons’ mental health emergency. Secondly, the systems in place are not working; there is a need for a full root-and-branch review and reform of the systems and services. Thirdly, I will call for a more integrated national mental health service for children and young people to be established, with an emphasis on early intervention, extra support in schools and a call on the Government to take urgent measures to provide additional funding. I note the Government’s decision not to bring forward the promised mental health Bill in the King’s Speech. It is disappointing that the mental health Bill has been dropped and parliamentary time has been diverted to other measures.

There has been an 89% increase in the number of children and young people coming into contact with mental health services between August 2022 and August this year. NHS Digital conducts a regular survey of children and young people, with results published between 2017 and 2022, and the fourth wave published just this week. The most recent key findings show that one in five of our young people aged eight to 25 had a probable mental health disorder. Rates remain at elevated levels following the pandemic and for 17 to 25 year-olds, rates were twice as high for young women as they were for young men. In 2023, 20.3% of children in England aged seven to 16 had a probable mental health disorder, up from 18% in 2022 and 12% in 2017. Rates among young people aged 17 to 19 with a probable mental health disorder rose from 10.1% in 2017 to 17.7% in 2020 and 25.7% in 2022, and they remain high at 21.7% now.

Not only are we seeing rising numbers; we are also seeing increases in the severity and complexity of the mental health needs of our children and young people. For example, we are treating double the numbers of children and young people with eating disorders who need urgent care than before the pandemic. This is a staggering and highly alarming increase. The reasons and causes for this rise in cases are many and complex, as are the solutions. We have very little understanding of the real root causes; more research must be done and young people themselves must be given greater opportunities to have their voices properly heard and understood. Isolation during Covid was a serious shock, taking away the normality of everyday life and children’s own sense of autonomy over their daily lives. Home education was a challenge for us all.

The rise in poverty and the collapse of youth services are also relevant. Poverty brings family stress and an increased prevalence of family breakdown. For children, poverty all too often creates feelings of shame. More than one in four children aged eight to 16 with a probable mental health disorder had a parent who could not afford for their child to take part in activities outside of school or college.

Social media is also to blame. Our children are constantly plugged in and susceptible to harmful content, bullying and harassment. Pernicious phones get in the way of real family quality time, often leading to social isolation in the home and an increased sense of worthlessness. The modern world we are creating for our children is undoubtedly toxic. Pressures at school are ever-growing and many children feel that they are already failures before they are even at the starting line. The transition from primary to secondary school is a crucial time in young people’s development and not enough is done to support it.

Waiting times for treatment are skyrocketing. Research conducted by the House magazine, based on FoI requests to 70 UK NHS trusts and boards published this year, found that a quarter of a million children in the UK with mental health problems have been denied help, with some NHS trusts failing to offer treatment to 60% of those referred by GPs. The research also uncovered a postcode lottery, with spending per child four times higher in some parts of the country than others. Average wait times varied from 10 days to three years. In 2021-22, trusts were forced to raise thresholds for treatment to tackle backlogs, resulting in hundreds of thousands of children being turned away altogether. The research showed that, overall, 32% of all GP referrals were denied treatment. I ask your Lordships to reflect on that shocking statistic for a moment.

Young people who are seriously ill are routinely being denied any access to treatment. Research from YoungMinds has indicated that a third of children and young people are not seeking support for their poor mental health, despite acknowledging that they are struggling. Stigma around mental health issues continues to be s problem, and these figures indicate a further unmet demand. An estimated 1.5 million children and teenagers will need new and additional support for their mental health over the next three to five years, including seeking treatment for eating disorders.

Research conducted by the Children’s Commissioner for England has shown that the threshold for any treatment is now so high that, in many areas of the country, the first help children receive is only after they have made multiple attempts at suicide. The first attempt does not always provide access to any support. If parents acted in that way, it would rightly be classed as child neglect.

Young people are left self-harming and attempting suicide for months, without support. While they are struggling to stay safe, many of them end up engaging in risky behaviours such as self-medicating with illegal drugs. New data from YoungMinds has revealed that urgent referrals of children to emergency mental health services have tripled since 2019. There is no early intervention or support. We only help when cases are extreme and children are in imminent danger. By this point, much damage has already been done.

This is a cruel and inefficient way to provide essential health services. We do little or no prevention work and ignore alarming presenting symptoms. This failure to provide treatment causes pain and long-term damage, leaves lasting psychological scars and damages children’s long-term life chances. Vital self-development, education and life chances are permanently missed. This also places increased pressures and costs on other health and educational services.

Another impact is the huge increase in long-term absences from schools’ rolls since Covid. The Children’s Commissioner for England, Rachel de Souza, said in a recent report:

“I fear that attendance has become the issue of our time. The number of children regularly missing school has more than doubled compared to pre-pandemic … Worryingly, over 120,000 children are missing at least half of their time in school.”

While the causes of persistent absence from school are complex, one key factor is the lack of mental health support. Indeed, her report calls for the rollout of mental health support teams to be expedited, to reach all children by 2025.

Delaying or denying treatment and providing treatment that is too little and often too late is unfair on our children and young people. It fails to meet basic needs or to protect the welfare and well-being of children. Prevention is better than cure. Even when first appointments are given, they are often highly administrative, providing little or no treatment. The waits for second appointments are often even longer. Even when treatment is provided, it often results only in the prescription of medication. I am not against medication—it has a valuable role in treating children—but medication alone is not an adequate treatment plan in most cases.

We need more talking therapies. Evidence increasingly suggests that trauma and feelings of shame and worthlessness need to be discussed in order to be processed by the human brain and thus resolved. We need whole-family-based approaches; we need family therapy to be made available; we need dedicated support in schools to help keep children in school and turning up for life.

I welcome the steps the Government have already taken to increase funding, including the introduction of the mental health care standard in 2018. I recognise that government spending on CAMHS has gone up year on year. I am delighted that my party has put forward detailed proposals to provide a dedicated mental health professional in all 22,000 state-funded schools in England, so that every child has someone to turn to. The estimated cost is £620 million per year. My party has proposed that this be funded by trebling the digital services tax.

I kindly ask the Minister to acknowledge the scale of the problems and inadequacies of service provision that children and young people face. I ask him also to ring-fence CAMHS funding and work to provide equality of service provision. The Government must provide additional funding and work urgently, in the words of YoungMinds, to “end the wait”. The Government must provide mental health services with long-term and sustained investment to help meet demand. According to the NHS Confederation, that means an extra £900 million per year by 2024-25.

The rollout of mental health support teams in schools and colleges nationwide must be accelerated. I call on the Government to commit to bringing forward their target of 50% access by 2024-25 and make it 100%. I believe this is one of the most urgent and achievable things they can do. It is essential that children have access quickly and that there is a triage service available to children who are in crisis. This is one of the easiest ways the Government could really make a difference to a huge number of young people’s lives.

Finally, I call on the Government to commit to a full implementation of the four-week piloted clinical access standard for children and young people’s community mental health services, and to produce a fully funded plan for the sector to show how they plan to reach this target.

This issue is personal to me, but I really wish to work with the Minister and across the House to raise these issues for our children and young people. It is not right that our children are suffering in these ways. We must do more to help them. It is not beyond our capabilities to do more to make sure that their needs are met and that they are supported. We should not be leaving them to suffer. I beg to move.

Photo of Baroness Hale of Richmond Baroness Hale of Richmond Judge 12:05, 23 Tachwedd 2023

My Lords, I am so grateful to the noble Earl, Lord Russell, for giving us the opportunity to debate this most important subject, one in which I have taken a close personal interest in my professional career. But first, I owe you an apology. This is my maiden speech, yet I was sworn in as a Member of this House as long ago as 12 January 2004. I am rushing to remedy the defect before the 20th anniversary. Please allow me to offer your Lordships an explanation, if not an excuse.

I was sworn in to hold office as a Lord of Appeal in Ordinary,

“so long as she shall well behave herself therein”.

This caused much merriment on the day. It also caused some puzzlement to one of my guests, the Chief Justice of Alberta, because the noble Lord, Lord Triesman, who was sworn in at the same time, did not have to promise to behave himself—although I am sure he has. She wondered whether it was because I am a woman, but of course, it was not: it was because I was a judge and, since the Act of Settlement of 1701, it has been a guarantee of judicial independence that we hold office during good behaviour and not during His Majesty’s pleasure.

I have tried throughout my judicial career to uphold the rule of law and the independence of the judiciary on which it depends, and it is for that reason that I never made a maiden speech during the five and a half happy years that I spent in this House as a Law Lord. Your Lordships were very friendly and welcoming, but I did not think that we should be here. Making laws and holding the Government to account are constitutionally different functions from applying and interpreting the laws and adjudicating disputes. So, I was glad when we crossed the square to become the Supreme Court of the United Kingdom. This has, I believe, turned out to be a thoroughly good thing. It also meant that for more than 10 years I was disqualified from taking part in parliamentary business.

That is all very well, you may say, but that disqualification was lifted when I retired in January 2020. If the noble and learned Lord, Lord Burnett of Maldon, could make his maiden speech so soon after his retirement, why could not I? I have no real excuse, other than the disruption caused by Covid and my own diffidence about whether I could make a useful contribution.

I saw, and see, myself as a lawyer and judge rather than a parliamentarian, but I have long taken a professional interest in mental health. My very first book, in 1975, was on mental health law. My very first judicial appointment, in 1989, was as a presiding legal member of mental health review tribunals; and in 2007, the noble Baroness, Lady Hollins, conferred on me one of my most treasured honours, the Fellowship of the Royal College of Psychiatrists, for which I am so grateful. So, I am emboldened to make two short points about mental health services for children and young people, conscious that those who follow me will have much more important things to say.

First, I share the disappointment of the noble Earl, Lord Russell, at the omission from the King’s Speech of the proposed mental health Bill, which has already undergone pre-legislative scrutiny and been widely welcomed. It would have provided an opportunity to address some serious issues affecting children and young people, not least by excluding learning disabilities and autism from the compulsory procedures in the Act, something which I know is of deep concern to the noble Baroness, Lady Hollins.

It might also have given us the opportunity to solve some difficult legal questions around consent to psychiatric treatment for children and young people. When can they give consent themselves? When can their parents or others with parental responsibility—such as local authorities—give consent on their behalf? Most important of all, when can they refuse consent to treatment? These are all very important issues, and they are not easy questions. The answers are not as clear as they might be, as I learned when I was speaking with psychiatrists in Northern Ireland only the other week.

Secondly, I speak as a member of the Commission on the Integration of Refugees, set up by the Woolf Institute in Cambridge. The evidence we have received has made us very well aware of the special mental health needs of young people seeking and granted asylum in this country, especially but not only those who have come here on their own, unaccompanied by adult family or friends. Many have suffered appalling experiences in their home country and on the way here. Many have missed significant amounts of education. Many suffer from mental disorders as a result. Yet they face considerable barriers, additional to those of other people, in gaining access to the trauma-informed and culturally sensitive services they need. Addressing these needs is essential if they are to become the fully integrated members of our society that we all hope they will be.

Photo of Baroness Hollins Baroness Hollins Crossbench 12:11, 23 Tachwedd 2023

My Lords, it is my honour to follow my noble and learned friend Lady Hale, whose eminent career has included, of course, serving as President of the Supreme Court of the United Kingdom, and being the first woman appointed President of the Supreme Court.

We were brought up in different parts of the West Riding of Yorkshire, and both ended up being head girl in our different grammar schools—Yorkshire grit. I am particularly proud to have presented my noble and learned friend with her honorary fellowship of the Royal College of Psychiatrists. Noble Lords will be grateful to my noble and learned friend for explaining why her membership had to cease in 2009. This of course included a period as a non-permanent judge at the Court of Final Appeal in Hong Kong, where I am sure her wisdom benefited their system greatly.

Noble Lords will also recall when, in September 2019, as President of the Supreme Court of the United Kingdom, the noble and learned Baroness, Lady Hale, found Boris Johnson’s prorogation of Parliament to be unlawful, thus terminating the suspension of Parliament.

I congratulate my noble and learned friend on her remarkable maiden speech, of no less interest given the time since her introduction. It is so fitting that it should be about children’s mental health. I also congratulate the noble Earl, Lord Russell, for speaking so honestly, openly and movingly about the subject of children’s mental health.

I declare my interests and experience. I trained as a child and family psychiatrist and later specialised in the psychiatry of learning disability. I have served as President of the Royal College of Psychiatrists. His Majesty’s Government has just published my report My Heart Breaks—Solitary Confinement in Hospital Has No Therapeutic Benefit for People with a Learning Disability and Autistic People. We will be debating this in the topical debate to follow. I have also devoted several years to addressing child protection in families and institutions, and to considering the long-term mental health consequences of child abuse.

Why is this all so important? Childhood is a period of extraordinary potential. If we get it right, we are investing in the whole of society’s future. Pregnancy and the first five years of a child’s life are the time when the foundations of healthy development are laid. Our relationship patterns are formed in the first few years of our lives, which also impacts on our future mental health. We know that adverse childhood experiences—ACEs—are key predictors of poor physical and mental health across the lifespan, and that poverty increases the risk that ACEs will occur during childhood. Half of all mental health problems present the first time before the age of 14, which is why prevention and population health really matter.

There are rising rates of referral to mental health services. These services are overwhelmed. Social care and school staff are feeling overstretched. We know that burnout is higher in those who work with children. There are rising rates of self-harm and suicide, particularly in teenage girls. Families are struggling with the cost of living crisis. To understand the current state of children’s mental health, I suggest we need to look at their relational and physical environments. Let us think about the post-pandemic world that children are growing up in right now. What is it like for them at home, at school, online, in their local communities and in the wider world?

Thinking about a child’s home environment, we need to acknowledge parents’ own significant social and mental health needs. Many are anxious and stressed; they are worried about money, their jobs, their families and the world. But when parents feel calm, safe and connected, their emotional availability to their children increases. This enables them to listen to their children and recognise their needs and helps them develop their emotional resilience and mental health for life. Let us not underestimate the power of accompanying parents in the tough and important journey of parenthood.

Thinking about a child’s school environment, we need to develop a culture of nurture as the foundation for learning. Nurture means creating a safe environment in which all behaviours are understood as a communication of underlying needs. When we realise this, we can transform a child’s experience in school and find ways of unlocking their love of learning and forming friendships.

Thinking of a child’s online environment, we see that it is one of the biggest current dangers to a child’s mental health. The Online Safety Act will help, but it requires society to support parents and schools in making a radical change to the current status quo. Children’s friendships and the social media environment in which they meet have a toxic potential, with some children never able to switch off. The physical environment, including housing, school and transport, may all contribute to our mental health, and we often overlook chemical factors—I am thinking about a healthy diet and reducing the impact of pollution and climate change.

We need to invest time and resources in building a population health approach that addresses the huge impact of health inequalities and the social determinants of health on the mental health of children. This requires a local, skilled workforce in population and public health too. We need an attachment, family-based approach that supports early relationships and secure attachments between parents and their babies. We need universally available family hubs and local community settings where parents can meet and share the ups and downs of family life and relationships.

We need early diagnosis for autism. Too many authorities are delaying assessment of autism at the moment. It is a mistake. It is not cost-effective. We need a skilled, supported and well-paid workforce for children, including early years childcare workers, midwives and health visitors, pre-school, primary school and secondary school teachers—all the practitioners who support children’s health and development in our communities and education settings. I agree with the noble Earl that we need more psychotherapy and more family therapy.

Focus on waiting lists for treatment misses the point. I suggest that we need less focus on mental health problems and more on emotional intelligence and resilience; more on understanding that it is normal to have strong feelings of sadness, grief and anger; more in relation to life and being human; and perhaps less focus on isolation and loneliness and more focus on human connection. A child’s emotional well-being and mental health cannot be considered, however, in isolation from their family’s health and well-being, and support for parents’ mental health must also be prioritised.

For those with milder problems, respectful, relational, family, school and community-based care is more effective than medicalising individuals. Mental health needs in schools can make a huge difference, and they should be there in every school. There are some excellent school-based initiatives. For example, nurture groups and whole-school nurture programmes are being planned across Surrey next year. The charity Place2Be offers one-to-one therapies in several hundred primary schools. I declare an interest in that feelings groups in mainstream primary schools in South Yorkshire and in special schools are transforming children’s lives, using resources provided by Books Beyond Words, a charity that I founded and chair.

CAMH services are needed to help children who are more seriously unwell. There is a move away from in-patient services to services being able to offer intensive community treatment, which I welcome. They need to offer long-term continuity of care, working closely with primary care and all agencies, and to support children at home or close to home. If required, in-patient admissions should be short, focused and timely to help prevent any problems developing further.

I have been told about a young teenage girl, whom I shall call Emma. She started struggling with her mental health during her transition to secondary school; such a transition is a very difficult time. Her way of coping with difficult feelings was to stop eating. She lost weight rapidly. Despite attempts to treat her at home, she was admitted to a psychiatric ward against her will for refeeding. On the ward, she developed self-harming behaviours, in part influenced by her peers’ self-harming behaviours around her. She was then diagnosed as autistic; it was a late diagnosis.

After five months, Emma’s weight improved and an intensive community team agreed to support her within the hospital, including in a small school and a therapy group as well as during her transition back to the community. The community team supported her parents in their fight for her place at school to be restored. She has developed hobbies again and the whole trajectory of her life has been altered. Teams such as this, which can help children and young people with complex needs to recover, must be able to work in a thoughtful and flexible way. It takes commitment and perseverance from the team members, who need to provide powerful advocacy for both the child or young people and their family. Could more have been done to keep Emma at home?

In my work looking at the reasons for people with learning disabilities and autistic people being detained in long-term segregation and the reasons for delayed discharges, risk aversion in the community seemed to be a key factor. At a round table yesterday, Dr Mezzina, a leading psychiatrist in the acclaimed mental health services in Trieste, Italy, challenged our concept of risk and suggested that institutionalisation is the main risk in mental health services. He questioned why we admit so many children and young people and why we do not have an open-door policy.

What is the way forward? A number of key initiatives would make a difference, including investing in early years services, developing support hubs for young families and schools-based interventions for at-risk individuals. We also need a robust workforce plan to address serious recruitment and retention issues; that workforce must have competencies in working with children and young people with learning disabilities and autistic children.

This Monday was World Children’s Day. The United Nations annual day of action for children, by children, it marks the adoption of the Convention on the Rights of the Child in 1989 and attends to the social determinants of health and well-being, including poverty. Let us look forward to the day when every child can have a happy childhood, and let us remember that there is no health without mental health.

Photo of Lord Allan of Hallam Lord Allan of Hallam Liberal Democrat Lords Spokesperson (Health) 12:23, 23 Tachwedd 2023

My Lords, I am grateful to my noble friend Lord Russell for securing this debate. Like many others, I am impressed by how quickly he has brought value to the work of this House and by the combination of passion and reasoned argument that he brought to today’s debate.

I congratulate the noble and learned Baroness, Lady Hale, on her maiden speech. I had not realised that she is from Yorkshire but, based on the comments of the noble Baroness, Lady Hollins, I can say, as a Sheffielder, that we are now on a Yorkshire hat trick as a group of three speakers. In my household, it is not often that we talk about the law as a cool and attractive profession, but the activities of the noble and learned Baroness in her previous role triggered such comments. Based on her contribution today, I am sure that, in future, she will provide examples of how our words here can be both impactful and entertaining. I hope that she does not let her natural diffidence get the better of her too often.

Turning to the subject of the debate, I start with a question: what do we call a family with experience of child mental health issues? The answer is “a normal family”. That has been reflected in the debate, as well as in my noble friend’s contribution as he related his own experience, but I suspect that every person sitting here today has their own direct personal experience of a young person suffering from mental health issues during their childhood, whether through their children, their nieces and nephews, their grandchildren or those children’s cousins. This understanding is necessary not to trivialise the matter—quite the opposite. If we normalise it, we may get to a position where we understand that child mental health issues need to be treated as seriously as other child health conditions, with an infrastructure and an understanding that, as my noble friend said, it is unacceptable to ignore them or somehow treat them as less serious.

The tools that we need to help people are common to all kinds of healthcare. First, we need early and accurate identification of problems. Secondly, we need good availability of the right treatment options; that is the case whether it is a physical issue or a mental health one. There are also four settings that need to work for young people in order to achieve these goals of the identification and treatment of the issues with which they present. The first is families themselves; the noble Baroness, Lady Hollins, referred to the importance of family as the primary setting. The second is the educational institutions in which children find themselves; the third is primary healthcare; and then there are the acute services to which children may need to turn. I will not go into the issues around family support in any depth today other than to flag the fact that families and the care they provide must be recognised and supported. There is an important objective for government in supporting families who provide care for somebody, whether they have a physical condition or a mental health one; that care provides enormous value to the individual but also to society. There are questions around the extent to which, today, government provides the support that those families need.

I turn to educational settings. These are generally schools for younger children but we should not forget the significant role of universities and colleges. That is important because we are talking today about children and young people; to me, that extends through into those university years. It is another period of transition. For many of the young people who reach the age of 18 or 19 and transition to university, that is when the crisis hits. Again, universities have a critical role to play in this.

Major shifts are needed to improve staff training. Staff across all these different kinds of establishment need to be trained in such a way that they can help identify problems, because problems may first present themselves in an interaction between a young person and a professional in an institution. We also need to make sure that counsellors are available when they represent an appropriate form of treatment; they are frequently the first line. The Minister has made commitments around both those aspects previously—the training of all staff in educational establishments where that may be useful in identifying problems; and the provision of counselling services to the right degree so that, when issues have presented themselves, that first line of treatment is available—so I hope that he will be able to demonstrate progress.

I am interested to understand from the Minister how budgets will operate in this space given that it sits between different government departments. The young person does not care that one thing sits with DHSC and another sits with DfE, or whatever acronyms we are using now; they care about whether treatment is available. I hope that the Minister can indicate how we will ensure that budgets follow need rather than being stuck in departmental silos.

I want to touch on bullying, which can be both a cause and an exacerbating factor for somebody with mental health issues: it can trigger the mental health issue but, sadly, the start of bullying can also sometimes be the response of young people to someone in their school who has a mental health issue. It then compounds the crisis that a young person is suffering. The challenge is to have an effective response because these issues are often labour intensive, requiring engagement—often over a long period—with the children and families involved.

As noble Lords may be aware, I have professional experience of the online component of this as I spent many years working at a large online platform. It seems obvious that the nature of bullying has changed with ubiquitous connectivity. However, sometimes, there is also the risk of us seeing the solutions as entirely within the domain of technology. People report bullying to a platform, which can result in the removal of the content and sometimes the closure of the bullying account, but it rarely solves the underlying problem.

In some cases, the bullying is entirely within an online community, but much more typically the online activity is an extension of something that is happening offline in the real world. The intervention that resolves the problem is one that brings young people, parents and others together to discuss the offline and online activity. I understand the challenges for school staff in resourcing this, but some option will have to be found or we will simply be playing whack-a-mole on the online platforms, knocking down individual instances while the young person’s mental health continues to deteriorate because the bullying is moving from place to place and never being addressed at its root causes.

Some of the best work that I have seen on this involves civil society organisations working with schools. I cite one young person, Alex Holmes, an individual who experienced online bullying in large part because of a racial dimension. He came to me when I worked at an online platform to try to turn his experience into something positive. He went on to work for the Diana Award and he now works for the BBC Children in Need foundation. I saw the work that he did, and that similar organisations do, complementing the work that is being done in schools, running effective anti-bullying programmes and getting the kind of intervention that we need to deal with those root causes. I hope that the Minister will agree that this kind of approach, bringing together schools, platforms, online platforms, which do have their responsibilities, and also civil society organisations with anti-bullying expertise, is a smart way to reduce the risk of bullying affecting young people’s mental health.

The other natural choice for people who are seeking help is to look to primary care, particularly their GP. The response is likely to vary considerably, as not all general practices have the skills to offer specialist mental health support. This is not to criticise or blame GPs but is a simple recognition of the limitation in capacities in most practices and that the support needed may go beyond that which the GP contract was designed to deliver. GPs are bound within a particular framework. This may result in the GP referring someone to a mental health service, but it is worth asking whether more could be done in the primary care setting itself. This might be better for the patient, it might involve shorter waiting times and, from the Minister’s point of view, it may well be more cost effective, which the department would see as a positive take.

Recently, I met with a group of mental health nurses working in primary care at the Royal College of Nursing who made a very strong case for developing their profession. At the moment, there are not mental health nurses in all practices, but some of the best practices do have them. This could happen on a group basis—for example, where a primary care network contracts together to ensure that there is a mental health nurse available so that, whichever GP you go to, you get the benefit of that mental health nurse; it does not necessarily require every practice to have one. The noble Baroness, Lady Hollins, referred to the need for public health support. Understanding the pattern of need and ensuring that you resource appropriately is critical and something that public health professionals really can help with. This could also be delivered through specialist centres. We propose that there should be youth mental health drop-in centres. This is something that we need to ask young people about. It may be that they would prefer a different setting from the general practice setting if they want to talk about something as sensitive as this. In either case, the critical thing is that there is some trained professional available to that individual if they present within the primary care system. Today, we must recognise that support is very patchy.

The acute sector will be necessary for some young people as other interventions have proved insufficient. I think that we will come back to one aspect of this in our next debate, but I have some questions for the Government now. The first is whether there is sufficient investment in community-based treatment for people with serious mental health that allows them not to be moved into in-patient settings except where this is strictly necessary. Some of the stories that are reported to us suggest that people are being taken to an in-patient setting not because that is the best treatment option but simply because their complex needs cannot be treated in a community setting due to resources, not due to the fact there is no treatment available. It is a shame if we are moving people to in-patient settings where it is not necessary. I would be interested in the Minister’s view on whether the test is being met or whether too many young people are still being treated as in-patients only because of that lack of appropriate out-patient support.

Secondly, and somewhat related, there is the question of where young people go when they need a place in a hospital. It is usually beneficial for all patients, but especially for young people, to be near to their home area, for the family visits and support and, crucially, because of their reintegration into the community on discharge. Being taken far away and then moved back is clearly more disruptive, particularly if you are going through a process of phased discharge from an institution, when it is much more helpful to be in your home community normally. There are exceptions, but typically we would want to see that. I am keen to understand the Minister’s views on out-of-area placements and how these can be minimised where they are not helpful from a treatment point of view.

Once again, I thank my noble friend Lord Russell for securing this debate, and I congratulate the noble and learned Baroness, Lady Hale, on her maiden speech. I close with a ready reckoner reminding the Minister of the issues which I hope that he can address in his response. Are the Government committed to building a culture where we treat mental health on a par with other forms of childhood illness? How are the Government ensuring that educational institutions can provide the support that their students need, especially around anti-bullying where that is a significant component in mental health problems? What is the department doing to provide more specialist support in primary care settings, whether that is by GPs or dedicated centres? What is the NHS doing to minimise the need for in-patient treatment where there are out-patient alternatives available but it is simply a question of resourcing? Finally, what are the Government doing to ensure that placements are not out-of-area where in-patient treatment is unavoidable?

Photo of The Bishop of St Albans The Bishop of St Albans Convenor of the Lords Spiritual 12:36, 23 Tachwedd 2023

My Lords, I too congratulate the noble and learned Baroness, Lady Hale, on her excellent maiden speech, and the noble Earl, Lord Russell, on securing this debate on an area of huge importance for all of us. As has been noted by many noble Lords already, and raised in the Question asked in the House by the noble Lord, Lord Bradley, on Tuesday, the omission of the mental health Bill from the King’s Speech has caused a great deal of worry and concern. It seems that we have time to debate pedicabs but not the urgent need for this review of our mental health provision.

With the number of children and young people being referred to mental health services increasing, alongside increasing waiting times for treatment, it is clear how urgent and pressing the reform of the Mental Health Act is. The Government have said that the Bill would be published when parliamentary time allows. I would argue that this is of the highest priority. Improved mental health in our young people and children—and the rest of the population, more broadly—would not only decrease the huge levels of suffering and anguish but bring immense economic benefits, saving taxpayers’ money and bringing more people into the workforce.

Mental Health Foundation research shows higher levels of unemployment and in-patient stays and a higher likelihood of contact with criminal justice for those with mental health problems. The annual mean cost to the public purse is 16 times greater for those with mental health problems. We on these Benches and Members in the other place can all agree that mental ill health is extremely costly for our nation. At the end of August 2023, 414,550 children and young people were in contact with children and young people’s mental health services and waiting times have increased, as have the number of children referred who do not end up ever receiving treatment. The scale of the problem is not the only concern. The quality of care, and the conditions under which our children and young people are being detained, urgently need to be rethought, according to the recommendations set out in the Health and Social Care Committee’s report, many of which the Government have accepted but which have not yet been implemented.

Given that over 50,000 people were detained under the Mental Health Act last year, there are clear arguments that reforming the Act needs to be a government priority. Concerns that the report raised included inappropriate use of restrictive practices and many children and young people facing long stays in adult wards, or, as we already heard from the noble Lord, Lord Allan, in wards far away from their homes where they are not being visited. I ask the Government to consider how traumatising these conditions must be for children and young people who are already mentally unwell enough to be admitted to a mental health care ward.

The Commons Health and Social Care Committee report comments:

“The use of restraint against children and young people can be humiliating and cause unnecessary distress”.

This is the case for any child or young person, let alone a child who is already extremely distressed and suffering from a mental health condition. I am sure that His Majesty’s Government are aware, having responded to this report, that the use of restrictive practices remains very high in children and young people’s mental health services, with the use of restraint on children and young people being on average five times the level of the adult equivalent. This is deeply worrying.

There are also deep injustices embedded in the implementation of the Mental Health Act, with black people four times more likely to be detained, and, in 2021-22, girls making up 71% of all children detained. We desperately need to address these problems to ensure that our staff and services are educated in trauma-informed practice and to ensure that we are not retraumatising these children and young people during their treatment.

Many of these issues could be addressed, as was recommended, by expanding the legal right to support from an independent mental health advocate to all children and young people. The Government accepted this recommendation in their 2021 mental health White Paper, but even then this was subject to future funding availability. Children’s rights expert, Kamena Dorling, highlights how serious these current conditions are. As it stands, we have mentally unwell children as in-patients who do not have the right to advocacy, and many of whom do not understand their rights and worry that they must do as they are told or they may end up being sectioned. She writes:

“There is a real question about whether we have a section of children who are unlawfully deprived of their liberty”.

This is a very serious and deeply worrying situation, and one that I hope the Minister will reflect on.

Finally, I will stray into a related area which no one has mentioned so far but on which I have been campaigning for a number of years. I want to comment briefly on some of the problems encountered due to the lack of regulation of online gambling and gaming. Some 60,000 to 62,000 young people in this country are classified as having a gambling disorder—according to law they should not even be gambling. If 60,000 to 62,000 young people have been diagnosed with these problems, how many are gambling? Presumably hundreds and hundreds of thousands, which shows the level of the problem that we are facing.

Of the 15 gambling clinics that have now been opened, funded by the NHS, at a time of huge financial constraints, 12 are facing huge waiting lists for people to get specialist treatment—they simply cannot access this treatment. Fortunately, the Government are now moving on the need for better regulation, but this really is needed to protect vulnerable young people. We have evidence that there are aspects of the gambling industry taking advice on how to produce games that are very addictive and encourage people to keep returning to them. If you talk to a family who have a teenager with a gambling addiction, they will tell you it can ruin the whole family. It is so compulsive that children can be stealing and lying to feed this devastating addiction.

I turn briefly to gaming. The WHO has classified gaming disorder as a mental health disorder. In 2019, the National Centre for Gaming Disorders opened a clinic in London, again funded by the very hard-pressed NHS, and 70% of the patients are under 18 years old. Noble Lords will have seen, as I have, a series of stories in the papers about the devastating damage that this is causing in families, where children really cannot tear themselves away from these, in some cases, highly addictive games. We need to support our world-leading, brilliant gaming industry—it brings a lot of pleasure which many people enjoy, so I am told—but there is, nevertheless, a downside, which urgently need regulation. Surely the gambling and gaming industry needs to pay a compulsory levy on the principle that the polluter pays. The industry has brilliantly privatised the profits and nationalised the costs. We as taxpayers are picking up the problem, and although this is a much smaller and niche problem, it is growing and we need to attend to it.

Polling shows that the population now ranks mental health as a more important issue than unemployment, industrial action and Brexit. Those under 40 rank it as more important even than climate change. I believe this shows that the public are telling the Government what their priorities are, and I hope His Majesty’s Government will listen. I look forward to hearing the Minister’s reply on many of these complex but deeply worrying issues.

Photo of Lord Storey Lord Storey Liberal Democrat Lords Spokesperson (Education) 12:47, 23 Tachwedd 2023

My Lords, I want to look at mental health in the context of schools. Before I do, I congratulate the noble Baroness, Lady Hale, on her maiden speech. She is wearing a butterfly brooch, as opposed to a spider, and I feel more relaxed seeing that. I also congratulate my noble friend Lord Russell on his speech. I thought it was very honest, and perhaps brave of him, to reference his own family and his daughter in an open Chamber.

I will give two brief examples before I turn to children. Four years ago, as part of Learn with the Lords, I went to speak to some secondary pupils at a school in Cheshire. The school was on a large council estate. I went into the school and the head sort of pushed me off with one of her teachers, and so I went in and spoke to the pupils. When I came out, the head asked me if I would like a cup of tea, and I said yes. I got into her office and she just burst into tears. I did not see it coming and I did not know what to do. She just stood there crying, so I naturally gave her a cuddle. She pulled herself together and said, “I’m really sorry about that. I have just had a letter from Ofsted telling me that we are a failed school, and I don’t know how to tell my staff. My staff are so hard-working. This is a very difficult circumstance for the school and I just don’t know what to do.”. We talked it through, and that made it clear to me that when we talk about mental health in schools, we should think about the teaching and non-teaching staff as well.

Interestingly, a friend of mine is head teacher of a three-form entry primary school of more than 500 pupils in a very deprived part of Liverpool. I asked—I will call him by his first name—Andrew how he is coping in his community. He said, “Well, I see my job not as a head teacher but as a social worker, quite honestly”. I turned to the subject of mental health and how he supports the pupils in that school. He said that from his school budget, he is able to spend £10,000 on one person to support the probably hundreds of pupils in his school who need mental health support. He said that the problem is that professionals are in high demand and other schools will pay more to poach them. He said, “I am lucky to get somebody to stay with me for a year”. That is a major problem. If we are to support pupils, children and staff in schools, we will need to be sure that professionals are available to do that and that they will not suddenly leave, leaving disappointed pupils and a case load of other children for somebody else to deal with.

My noble friend Lord Allan mentioned the second problem we face in education. There are literally—this is no exaggeration—hundreds of thousands of children missing from our school registers. They are missing because they were at home during Covid, they came back to school and they could not cope. They went back to their parents, mainly in deprived communities, and said, “Mum, dad, I don’t want to go to school. I can’t cope”. “Oh, stay at home. We will have home education”, they were told. As we know, home education is not registered. After a brief period, those children increasingly do no home education at all.

Imagine the strain that puts on the parent and the mental problems it will create for those children in the future. We can see that in the published figures and the increasing numbers of children who are permanently excluded from school. We have hundreds of thousands of children missing from our school registers, and there are even children who have been put on education healthcare plans who are permanently excluded from school, so we cannot implement those plans. That does not seem in the best interests of our pupils’ education.

Why has the number of children with mental health problems in school increased? Perhaps we have always had children with mental health problems in our schools but have never recognised or realised it. Perhaps we thought, “This is a disruptive child” or “This is a child with behavioural problems”. Thankfully, that is not the case now.

We know why there has been such a dramatic increase: Covid was one reason. I was also interested in my noble friend Lord Allan’s comments on social media, but the pressures of it—of having to respond, and the potential bullying—all create mental anguish and problems.

Our school system does not help. We are the most tested country in the world. We subject our children and young people to more tests than any other country does. Imagine the pressure that puts on young children. Imagine the pressures of Ofsted: I mentioned the example of the head teacher I met, and we know the tragic circumstances of the head teacher who took her own life as the result of an Ofsted inspection. All those pressures are happening at schools, with the high grades that schools require their pupils to achieve. What happened to the enjoyment of school? What happened to discovery and fun in school? It is all focused on a results outcome.

We name and shame. We put banners outside schools saying, “We are a good school”. In schools that do not have that banner, do parents and children feel a sort of anguish as a result? Our education system is not conducive to people’s well-being.

As has been said, we need to ensure that teachers are properly trained. As I have said on so many occasions, I do not think that Teach First, which takes a graduate, gives them a few weeks’ intensive training and then puts them in a school with a mentor, is the best possible way to train a teacher. It took me three years and when I started teaching, I was still learning. There needs to be an understanding of child development, for example, and of how to identify special educational needs. Part of that training should also include an understanding and recognition of mental health problems.

Finally, we need to support parents. We also need parents to understand what they can do to support their children. They need to bring routine to their children’s lives, to talk to their children, to ask how they are doing, to encourage them and be able to speak to them.

Mental health is a very serious issue in education and schooling. If we think that we can just put in a few million pounds here and make a promise there, it will not go away. We need dedicated, well-trained professionals in our schools who know what they are doing and how to support those pupils.

Photo of Lord Laming Lord Laming Chair, Accommodation Steering Group Committee 12:57, 23 Tachwedd 2023

My Lords, I add my welcome to the most distinguished noble and learned Baroness and congratulate her on an outstanding maiden speech. The House is the richer for having her, and I hope she visits us much more frequently in the future.

We are indebted to the noble Earl, Lord Russell, for enabling the House to debate this subject, which, as previous speakers have said, is of great importance not only to children but to our wider society. It is generally agreed that this generation of young people have had, and are still having, a rather hard time. While many of these young people are able to rise to the challenge and are inspiring, both in their values and achievements, we must nevertheless recognise that the development of many has been badly affected in recent years and that they now need considerable help.

This generation of youngsters has unexpectedly experienced many changes. For example, in the decade following 2010, there were cuts in local government finances. As a result, many of the programmes that were designed to support young people and their families were cut and some, sadly, disappeared altogether, especially in the preventive and support services. We have not recovered from that situation. While the recent increase in funding is most welcome, I am advised that, in many areas, today’s budgets have not returned to where they were a decade ago, in real terms.

What had an even bigger impact on the well-being of young people, however, were the decisions related to Covid. The lockdown of schools and all other related activities not only interrupted their education but, in its wake, created their isolation, which had a marked impact on their intellectual, social and emotional development. As a result, very many young people became anxious, withdrawn and lacking in self-confidence. Here, we are not referring to just a small number of children and young people but, as has already been said, to many thousands.

The Children’s Commissioner’s recently published excellent report on school absences in England supports this. She says that absence figures have risen to “crisis levels” and are not recovering quickly enough. In Spring 2022, the last term for which we have data, 2% of all children were not just occasionally but severely absent. This is equivalent to 140,700 children. Her briefing goes on to say that:

“For some, the pandemic has led to disengagement. Schools and families have said that they feel like the … contract between parents and schools has been broken”.

That is a serious matter.

The fact that these issues are persisting into adolescence is well illustrated in the very helpful report by the Prince’s Trust from 2022 entitled The Power of Potential. That report makes it clear that:

Young people were hit especially hard by the economic impact of the pandemic. In March 2021, young people accounted for around two thirds of the total fall in employment since the start of the pandemic, and youth unemployment was almost four times higher than the rest of the working-age population”.

Sometimes these children who are seriously absent from school are referred to as “ghost children”. What a terrible expression—and what a terrible situation they find themselves in: they are basically lost to the system and no longer known.

The difficulties of these young people taking these problems into adolescence means that the number who are not in employment, education or training continues to increase to an alarming degree. That is despite the increase in job vacancies. To reinforce this situation, the recently published report by several childcare charities, entitled Children at the Table, makes it clear that:

“Babies, children and young people have been overlooked by policy makers for too long and the impact is clear: more children are living in poverty, they face a growing mental health crisis, and are waiting too long to receive urgently needed support.”

This is what this debate is about: among young people, we are facing a growing number who have mental health problems now but are waiting far too long for the help that they need to be delivered.

It is clear from the number of young people who are not in school, employment or training that they are vulnerable to exploitation from organisations such as county lines and other disturbing influences. We owe it to these children and young people to have them properly supported and protected at this critical stage in their development. This picture emerges at a time when children’s mental health services have never been so overwhelmed and ill-equipped to meet the needs of these children and young people. I recently heard that one family had been told that the gap between referral to those services and the beginning of assessment was longer than a year and could even be much longer in reality. Just imagine what it is like for the child with these problems: a year in this child’s life at a very formative stage is of immense importance. What is it like for their parents, because what can they do? I am told that they just said, “We are waiting. There is nothing that can be done.” That is a sad situation.

The charity Beat said that a report on the mental health of children and young people in England found large increases in the number suffering from eating disorders, which have already been mentioned. The Times reported:

“Between 2017 and this year … Among 11 to 16-year-olds, the prevalence had jumped from 0.5 per cent to 2.6 per cent, and among 17 to 19-year-olds from 0.8 per cent to 12.5 per cent”.

This clearly represents a huge increase. This is not about fads but recognised and serious eating problems.

Whatever standpoint we take to approach this serious subject, the evidence is starkly clear—and the evidence we have heard from each contributor to the debate so far is in one direction. There is no conflict about this. The number of children in need of the mental health services is seriously increasing, while the service is less able to respond. These children did not invite lockdown or the disruption to their education and their normal social development. They should not be left behind. If we do not respond to their needs now, they will take these problems into adulthood and society will be the poorer for it. So, let us do all we can together to ensure that these children and young people get the help that they need from the specialist mental health services when they need it. We will all be the better for that.

Photo of Baroness Tyler of Enfield Baroness Tyler of Enfield Democratiaid Rhyddfrydol 1:08, 23 Tachwedd 2023

My Lords, it is always a great pleasure to follow on from the wise words of the noble Lord, Lord Laming. I congratulate my noble friend Lord Russell on securing and introducing this debate in such a moving and comprehensive way. It is such an important issue and is very dear to my heart. I also congratulate the noble and learned Baroness, Lady Hale, on her excellent and highly entertaining maiden speech. I was a bit perplexed when I saw that it was her maiden speech, but now I understand. I also thank the many charities and others in the sector who have sent me excellent briefings.

It has been an excellent and very well-informed debate. I will pick up on some of the main themes covered. Quite rightly, we have heard a lot about the state of children’s mental health in this country, and many of the statistics are indeed bleak. To summarise a complex picture, an increasing number of young people are experiencing mental health problems for a wide range of reasons, which have been highlighted compellingly today. Yet far too many are unable to access the help that they desperately need, either through school or NHS services.

Without doubt, young people’s mental health services are struggling to meet demand. As a result, thresholds for treatment are very high, with many young people turned away because they are “not well enough”. Those who do get accepted into CAMHS are often left waiting many months, if not years, for treatment, during which time their mental health often deteriorates.

I will say a few more things about demand for, and access to, services. Mental health providers are concerned that they are seeing an increase in both the severity and complexity of the mental health needs of children and young people—exacerbated by both Covid and the cost of living crisis, which we have heard about today. The NHS Confederation estimates that demand has increased by 89% and that mental health services are treating double the number of children and young people with eating disorders who need urgent care than before the pandemic—which we just heard about. That is the equivalent of six children in a class of 30. The number of referrals to CAMHS reached a record number in May of this year and the number of urgent referrals of children to crisis teams has also reached a record high. Particularly worryingly, suicide rates among young females have been steadily increasing.

Looking ahead, it is pretty daunting. It has been estimated that 1.5 million children and teenagers will need new or additional support for their mental health over the next three to five years. That is going to take a very different approach. The unpalatable fact is that only around a third of children with a probable mental health problem are, at the moment, able to access treatment. I think that shows how far away from parity of esteem with physical health we really are.

I am particularly concerned about the huge regional inequalities and the lottery of what support is available depending on where you live. My noble friend Earl Russell referred to an FoI investigation by the journalist Justine Smith, published in the House magazine in April. It revealed a postcode lottery in child mental health care, with some desperate young people waiting up to four years for help. Results from the 58 trusts and boards that responded to the request showed that the position in England was considerably worse than in Scotland and particularly Wales. Almost three-quarters of the English trusts said that they currently had at least one young person who had been waiting at least a year, and two-fifths had someone waiting at least two years. Funding ranged from £35 per child under the former Doncaster clinical commissioning group—0.5% of its total budget—to £135 per child in Salford, or 2.2% of its budget. That is a huge difference. I think variations of this scale are simply unacceptable. This data needs to be tracked and published regularly to throw a spotlight on what is going on locally.

On funding, years of underfunding and neglect of children's mental health services have taken their toll, as we have heard loud and clear. They have been subject to what I call the “double Cinderella syndrome”, or indeed the “double-8 syndrome”—by which I mean that only 8% of mental health services spending was spent on children and young people's mental health in 2021-22, and in 2022-23 just over 8% of the NHS budget was spent on mental health generally. To meet increasing demand, it has been estimated that funding for mental health services would have to rise to as much as £27 billion by 2033-34. That is the backdrop against which the very welcome but, frankly, relatively modest increases in government funding since 2017 should be viewed.

The NHS Long Term Plan, published in January 2019, included a welcome commitment that funding for children and young people’s mental health services should grow faster than both overall NHS funding and total mental health spending. But it has become harder to track whether this has happened in the switch from CCGs to integrated care boards, and with the changes to how the mental health investment standard and the dashboard operate. So could the Minister say when the NHS mental health dashboard is next due to be updated and whether, and by how much, the commitment in the NHS Long Term Plan has been met? If he does not have those figures to hand, could he please write to me.

A point not covered so far in our debate relates to the fact that mental health is now part of a new major conditions strategy, rather than having its own stand-alone strategy. I know that many consider that a regressive step. This occurred following the cancellation of the previous long-term mental health and well-being plan that had been proposed by the Government. With the new major conditions strategy focusing on a range of conditions such as cancer, heart disease, musculoskeletal disorders, dementia and respiratory diseases, there is a clear risk that it will focus mainly on middle-aged and older people and that the mental health of infants, children and young people will be neglected.

So, what is needed? A lot of it has been covered in today’s debate and I support others who have been calling for a comprehensive cross-government strategy, looking at all aspects of mental health support. There are a number of things that need to be included.

I will start with prevention; any good strategy should start with prevention. The Royal College of Psychiatrists has recently published a report calling on the Government to prioritise the mental health of babies and children. It set out evidence showing that intervening very early on may help stop conditions arising or worsening, and prevent babies and young children developing mental health problems in later life. This might include support for mothers in pregnancy, working with parents to promote attachment to their children and recommending parenting programmes in the early stages—many of the things that the noble Baroness, Lady Hollins, talked about. I very much hope that family hubs will develop such services so that they are available wherever people live. Could the Minister say whether this is the case? I fully endorse the calls today for the family to be supported as the primary source of emotional support and well-being.

I turn next to early intervention services. Again, we have heard today how crucial early intervention is to stop problems escalating. In other words, the earlier a young person can get support for their mental health, the more effective it is likely to be. That is why I have been a strong backer of the early drop-in support hubs for 11 to 25 year-olds. They are on a self-referral basis, which I think is exactly what is needed, and are embedded in the community. They have been championed by YoungMinds and many others. I very much welcome the £5 million announced by the Government last month for 10 existing hubs and I strongly support the call for a national network of hubs to support young people who do not meet the threshold for CAMHS support.

I move on to schools, which have an absolutely vital role to play, as my noble friend Lord Storey set out so eloquently. I have always supported the creation of mental health support teams in schools. I was struck by research evidence earlier this year from Barnardo’s, which delivers 12 such teams. The research found that the teams are effective at supporting children and young people with mild to moderate mental health problems. They improve their outcomes and, critically, are cost effective; they say that they save the Government £1.90 for every £1 invested. But, as we all know, the problem has been the frankly glacial rollout of this programme.

The high demand and long waiting lists for CAMHS that I talked about earlier place real pressure on these mental health support teams, which were not really set up to deal with the more severe issues. The Barnardo’s research identified a gap in the current model to address the needs of children with moderate or more complex needs, children with special educational needs and younger children. It recommended that the rollout should include school counsellors to fill this gap. I support this recommendation and am delighted that next Monday I will be introducing my Private Member’s Bill, which is designed to ensure that every school has access to a qualified mental health professional or school counsellor—a key Lib Dem policy, as we heard earlier. I hope that this will provide a much-needed boost to ensure that all schools are able to provide their pupils with the mental health support they need.

I turn briefly to CAMHS services. As the Children’s Commissioner pointed out in her annual report, the stark reality is that too many children still face high access thresholds, rejected referrals and long waiting times. Children’s mental health was looked at by the Lords Select Committee examining the implementation of the Children and Families Act 2014, which I had the honour to chair. We were shocked by the results of a survey we commissioned, which showed that in many places CAMHS had reached crisis point. I vividly remember one mother, who told us:

“Having had a seven-year-old son who was so dysregulated he was trying to throw himself out of windows and grabbing knives, there was no support for him (or us). The GP, after two failed CAMHS referrals as he ‘didn't meet the threshold’ told us, if we could at all afford it, even if it means borrowing money, to find support privately. That CAMHS will not accept a child unless they have made two viable attempts on their own life”.

I join my noble friend Lord Russell in asking the Minister what plans the Government have to implement the four-week clinical access standards for children and young people’s community health services, which have already been piloted? What have those pilots found? Will a fully funded plan be introduced to reach those standards?

In-patient care is another key area of concern that has come up today. It is estimated that some 3,500 children under the age of 18 are admitted to mental health in-patient facilities. As my noble friend Lord Allan said, despite the commitment to eliminate out-of-area placements, too often children are still being admitted to places far from home without a clear understanding of their rights and subject to restrictive interventions and inappropriate care. The right reverend Prelate the Bishop of St Albans made that point compellingly.

The transition to adult mental health services is just not working for too many young people. The NHS long-term plan set out an ambition to move to a nought to 25 model for young people. I supported that, but it is not clear what progress has been made towards it. Is the Minister able to say more about this? There is significant variation across the country in the age at which young people are expected to move to adult services. This transition is often abrupt and based on a person’s age rather than their readiness. Differences in threshold also mean that young people getting support from CAMHS may not meet the threshold for support for adult services, so yet again they fall through gaps.

I finish with a number of questions for the Minister. I ask him to write to me if he is unable to answer them now. What plans do the Government have to expand access to mental health support teams to children and young people across all schools and colleges in the country as quickly as possible? How do the Government intend to tackle the major regional inequalities in spending and wait times for CAMHS? Given the Government’s regrettable decision to roll back on previous plans to publish a stand-alone 10-year mental health plan, can the Minister say how the Government will ensure that the inclusion of mental health in the forthcoming major conditions strategy will properly tackle the huge challenges in children and young people’s mental health? Given the recent funding for the 10 innovative early support hubs, can the Minister clarify when this programme will report, what the evaluation will entail, and whether Ministers will commit to a rollout if findings are favourable? Given the postponement, yet again, of the long overdue reforms to the Mental Health Act, what immediate action are the Government taking to improve the plight of under-18s admitted to in-patient care units to ensure they and their families are aware of their rights and receiving appropriate care?

Today’s debate has shown that there is a lot of consensus on what we need to do. I hope the policymakers will listen to us so that we can make real progress.

Photo of Baroness Wheeler Baroness Wheeler Shadow Spokesperson (Health and Social Care), Opposition Deputy Chief Whip (Lords) 1:22, 23 Tachwedd 2023

My Lords, this has been an excellent debate, with the knowledge and expertise we expect from across the House and from the very moving and comprehensive introduction from the noble Earl, Lord Russell, in particular on the consequences of family poverty for children’s and young people’s mental health. I too I congratulate the noble and learned Baroness, Lady Hale, on her powerful maiden speech. This is an appropriate debate for her to make her first Chamber contribution to the work of the House. We fully understand the reasons for the long wait to hear her.

As we have heard, this debate is taking place in the context of deep concern over the realities and consequences of the Government’s failure to provide for the genuinely “oven-ready” update of the Mental Health Act in their legislative programme for the rest of their time in office. We are also considering the mental health of children and young people, with the timely report from the noble Baroness, Lady Hollins, on the impact of the long-term segregation of people with learning difficulties and autistic people in mental health settings and in assessment and treatment units in the forefront of our minds.

The updated Bill provides clear provisions for improving recognition of and information on the legal rights of detained children and adults in terms of treatment choices and information that must be provided to them, their parents, carers and families. Patients’ choices would have been given greater weight and it would have been easier for people with learning difficulties and autism to be discharged from hospital. As we have heard underlined by the right reverend Prelate the Bishop of St Albans, the discrimination and inequalities that leave black people four times more likely to be detained under the 1983 Act would have been addressed.

I look forward to hearing from the Minister how these and other steps can be implemented in the absence of the framework of the new Bill and within the continued constraints, approaches and outdated attitudes in the current 40 year-old Act. How will care and treatment of people detained under this Act be “improved” by the “‘non-legislative commitments” that Ministers promised in the King’s Speech and in response to the continuing concerns raised by noble Lords about the impact and consequences of the Government’s decision?

The noble Baroness’s report is the subject of the short debate following this one, so we will revisit this later. I welcomed the Minister’s promise last week during the Oral Question on mental health to meet with the noble Baroness, my noble friend Lord Touhig and others from these Benches, including me, on this very serious issue.

As the House will know, Labour, if it wins the next election, is firmly pledged to reform the Mental Health Act in its first Session of Parliament in the King’s Speech. We have had the expert pre-legislative scrutiny by a Joint Committee on the draft Bill that should have been laid before us—the result of a huge amount of valuable and informed cross-party work and wide consultation among stakeholders. The Government have run out of time on this, and we stand ready, if elected, to meet this pledge, to recruit the thousands more mental health professionals to cut waiting lists and ensure more people can access treatment, and to guarantee treatment inside four weeks for anyone who needs it. We will create an open access mental health hub for children and young people in every community and expand mental health support in schools.

Many noble Lords have rightly underlined the importance of the workforce and the need for more staff across the range of CAMHS, including nurses, psychologists, therapists, social workers and other professionals who specialise in working with children and families. The CQC’s recent annual State of Care report identifies that almost one in five mental health nursing posts is vacant, and that this contributes to an overuse of restrictive practices in mental health settings and ATUs, including restraint, seclusion and segregation.

We have heard how the Government’s failure to honour their pledge on the mental health Bill has caused widespread consternation among key stakeholders, parliamentarians and the wider public—all of us expecting, after such a long wait, the Bill to be a key part of the King’s Speech. As the mental health charity Mind summed it up, the Government have missed the chance to

“overhaul the way the system works when people are in a mental health crisis” and to

“prevent people being stripped of their dignity, voice and independence when they are sectioned”.

What are the Government’s plans for their formal response to the Joint Committee, which is still awaited? Will they detail exactly how the Bill’s provisions will be taken forward and implemented without new legislation? How, for example, will the proposed new duties on ICBs, local authorities and commissioners to strengthen community provision and services, the new powers for mental health tribunals to direct services in the community, and access to independent mental capacity advocates to support people with autism and learning disabilities, be acted on and enforced?

Emphasising the very serious consequences of the delay is important because the Bill is essential to help reset the culture, tone and attitudes that are needed right across the provision of services in NHS mental health settings, ATUs and local authority education and social care. The CQC’s annual report is the latest of many acknowledging the depth of the crisis in mental health. The continuing impact of the pandemic on the mental health of children—highlighted by every speaker today—the record number of urgent referrals of children to crisis teams, and the NHS Confederation’s estimate that, in the next three to five years, 1.5 million children and young people will need new or additional support for their mental health, as the noble Earl underlined, all reinforce the CQC’s warning that services across the country face one of their most challenging years.

Access to mental health services and the quality of care remain a key area of concern for the CQC, with providers struggling to keep pace with surging demand, alongside staffing shortages and a lack of capacity in community and in-patient care. Long waits for services for children and young people, and children presenting with more complex or specialist needs, are particularly emphasised as worse than before the pandemic.

This impact has been reinforced by speeches today addressing what is behind the huge numbers, with a unique set of pressures for a generation growing up: the pandemic, the cost of living crisis and ongoing global instability. A wide range of emotional and behavioural problems—anxiety, depression, self-harm, eating disorders, bullying at school, and children embroiled in gambling, as the right reverend Prelate underlined—are all in play at a time of ever-increasing demand for mental health services across the NHS and local government. In the last two years, the number of children and young people being referred for urgent support for eating disorders has increased by nearly three-quarters. The noble Baroness, Lady Hollins, spoke very movingly about the experience of a teenager she is aware of, and the noble Earl, Lord Russell, and the noble Lord, Lord Laming, both referred to this issue.

Under the circumstances, the crucial importance of early intervention in an individual’s childhood and teenage years to avoid future mental health difficulties has been emphasised by all noble Lords. The report in June this year from the LGA and Children and Young People’s Mental Health Coalition called for community-based early support hubs, along with a full national rollout of mental health support teams in schools and colleges. The recent Children’s Commissioner’s mental health annual briefing on early intervention is also an important contribution to charting the way forward on this; the noble Baroness, Lady Tyler, underlined that.

However, the LGA and the coalition warned that progress in expanding support provided to families, children and young people is at the risk of being undermined by

“a lack of coordinated vision and action both locally and nationally”.

Can the Minister tell the House what action, particularly cross-government, is being taken to address these concerns and to ensure that early intervention support will be provided?

Finally, earlier this year, the Government shelved their 10-year plan for mental health and well-being, with the focus instead on the major conditions strategy, wrapping up mental health with several physical health conditions. This was cited by the charity YoungMinds as having further delayed the Government’s action for young people’s mental health, which could have paved the way for reforms that support young people and reduce the prevalence of poor mental health. The noble Baroness, Lady Tyler, mentioned this important strategy, but the Government do not seem to fully understand the widespread concern across the mental health sector that abandoning the 10-year strategy has caused. Added to abandoning the mental health Bill, small wonder that they are questioning the Government’s commitment to mental health as a key priority.

We have had the interim report on the major conditions strategy, but it remains very unclear how the full strategy will address and reduce the highest number of open referrals to CAMHS of children and young people undergoing treatment or waiting to start care—as we have heard, a record 466,250 referrals in May. When will the full strategy be published? Can the Minister explain how it will address the issues that were expected to be outlined in the previous mental health and well-being plan?

Labour’s shadow Health Secretary, Wes Streeting, has stressed that Labour, if elected, intends to revolutionise mental health treatment in this country. We are determined to deliver on this and keep every promise we make. I look forward to the Minister’s response to this excellent debate.

Photo of Lord Markham Lord Markham The Parliamentary Under-Secretary for Health and Social Care 1:33, 23 Tachwedd 2023

I thank all noble Lords for their contributions to this debate. Before replying, I add my congratulations to the noble and learned Baroness, Lady Hale, on her maiden speech. I am sorry that no one was able to add to the Yorkshire hat trick and, speaking as a Brighton boy, I cannot get much further away than that. I found the reasons for the delay fascinating; it was an education for me, as I did not quite realise her involvement in so many things. For me, it was well worth the wait, and it is a personal honour to be able to reply after such a distinguished and accomplished speaker. I invite her, along with all other speakers, to join—as the noble Baroness, Lady Wheeler, mentioned—the round table that I have organised with the Minister, Maria Caulfield, where we can follow up some of the themes brought out today in more detail. I would be delighted if the noble and learned Baroness were able to add her experience to that round table.

I also thank the noble Earl, Lord Russell, for enabling us to have this debate. He has heartfelt and personal reasons for the debate; as many noble Lords will know, I have my own personal experience and reasons. As the noble Lord, Lord Allan, said, it is normal. I had the misfortune of going to a funeral last week of one of my school friends, whose brother had mental health issues. As we were talking on the way down in the car, we were updating each other on all our families, and we realised that every single one of our families had one of their children or someone in the household with mental health issues.

Is the reason for that Covid, as the noble Lord, Lord Laming, mentioned? Is it some of the online reasons, as mentioned by the noble Baroness, Lady Hollins, and the noble Lord, Lord Allan? Is it gambling? I have to say to the right reverend Prelate the Bishop of St Albans that the gambling aspect of it all was something that I had not probably thought through enough, but I found that fascinating as well. Is it the cost of living, as mentioned by the noble Baroness, Lady Tyler? Is it the increase in the number of ghost children—I apologise for using that phrase, but it is the easiest way to sum it up—as mentioned by the noble Lords, Lord Storey and Lord Laming? Is it eating disorders?

I always like these debates to result in substantive action rather than being a talking shop, so that really led me to take away an action point. I was proud to be titled the Minister of Follow-through by the noble Lord, Lord Allan, yesterday, so I will follow that up. I would like to see whether we have done any research, through the NIHR, to really understand what factors and causes are behind what is a massive increase in the number of young people requiring mental health support, as the noble Earl, Lord Russell, says and we all acknowledge. I have seen various figures; the one I was cited was that it had gone from one in nine to one in six. Whichever way you look at it, it is a massive increase. We really need to understand those reasons, because it is often only when you understand the causes that you can look at how to address them. I will do some personal work, but if the research is not there I propose—and I will speak to people about this—that this is something that the NIHR should do, because it is vital that we understand those reasons. As all noble Lords have said, prevention is of course key to this.

Obviously, I hope that many of the reasons are transitory—maybe many were caused by Covid so we are seeing a big jump up now but will see a reduction afterwards. But the reason for needing to understand it is that it goes to the long-term funding we might need. If they are not just transitory reasons, and this is now the new normal, so to speak, then we need to do exactly as the noble Lord, Lord Allan, said, and think about a whole provision of child services in the mental health space, in the same way we do in the physical health space. I think we all agree that we need to do that to a degree regardless, but it is the level of that. That goes again to the points made by the noble Baronesses, Lady Wheeler and Lady Tyler, about the long-term workforce plan and understanding how many mental health staff we need to make sure we are training and equipping. Specifically, while I mention that, I will write to noble Lords on the mental health dashboard and when that is being updated.

I think we are absolutely united on the need for early detection in all this. The noble Baroness, Lady Hollins, gave the example of Emma, in the autism space, but we have all said it in various guises. We have made good progress on mental health provision and identification in schools, which has gone up from about a quarter to over a third of schools, with a target of over 50% in the next year to 18 months. However, I think we all agree that we need to go further and that it needs to be 100% of schools.

Also on early detection, I have been interested in some of the pilots in Bradford, which are starting to look at children’s school results and how they respond to the SATs and other things to see whether that could be an early indicator of some of the issues. I recently saw a fantastic example in the Boston children’s hospital, where they look at how children play online, digitally, on their iPads. With dyslexia, for example, the problem is often that it is only when children are five or six and have been taught to read that such things show up, but there they have started to see how children of two or three interact through pattern recognition, with blocks and other games devised for that. They look at their playing patterns to see whether those can be good early indicators.

I have personal experience of this. I am fortunate that my wife was an early years special needs schoolteacher, and she was able to identify very early on and make sure that our son had that early support. I firmly believe that that stood him in good stead in later life. So early detection starts with the parents. If I had not been so fortunate, 25 years ago, to have a wife who understood these sorts of things, I would not have known. As the noble Baroness, Lady Hollins, said, it starts with parenting programmes and making sure that the early support hubs are a good way into that. I echo and support our commitment to early detection.

You also need early support, as all speakers have said. The ICSs are the right place to do that because they look system-wide. As we know, schools are also a vital part of this, and the £2.3 billion of funding that we put into this space is designed specifically for 350,000 extra places for young people in the community—and I think we all agree that the community is the right place. Obviously, in the next debate, tabled by the noble Baroness, Lady Hollins, we will talk about some of the issues around in-patient treatment, but I think we all absolutely agree about the need for community treatment. My understanding is that these early support hubs are very much like mental health drop-in centres, as the noble Lord, Lord Allan, mentioned, and that is what they are designed to do. As the noble Baroness, Lady Tyler, said, the innovation programme looks promising, but we need to make sure that this is rolled out. ICB early support hubs are very much part of the first line of defence, for want of a better phrase. To me, the 350,000 extra spaces and the funding we are trying to put in are a very important part of that.

As the right reverend Prelate the Bishop of St Albans said, we have set up gambling clinics to try to address this from some of those angles. However—and this goes back to the research—we need to look at some of the wider angles. My noble friend Lord Evans was just saying that AFC Wimbledon has tried to get football clubs to remove the sponsorship of gambling companies, which a load of Premier League clubs have. Straightaway, that normalises gambling from a very young age. Those are some of the wider society solutions that we need to look at in all of this.

We have 70 eating disorder teams, and we need to look at whether we need to expand that, given what we know about the issues involved in a lot of eating disorders. This all comes back to the long-term workforce plan, which many Members mentioned, and making sure that we have the support there.

A couple of noble Lords mentioned the Major Conditions Strategy. My understanding is that it is not supposed to be seen as an either/or. It is about trying to understand that, because a lot of people have more than one major condition, instead of us approaching things as silos we have to look at a whole-person solution, and so we would look at their mental health as much as their physical health. I accept the perception that any major conditions strategy generally focuses more on the elderly, so I will take back that we need to make sure that it is not delivered in that way and does not prevent the sorts of things we need to do for young people.

The noble Baroness, Lady Tyler, asked about CAMHS. A lot of the funding I was speaking about and the 350,000 extra spaces are all about trying to make sure that we meet that four-week target. It is recognised that the sooner you can get people mental health support, the better; that is obviously even more important for a young person in that context. I will look into the points raised about support into adulthood, to make sure that that handover happens properly.

I hope I have given a flavour of what we are trying to do. As the noble Earl, Lord Russell, said right at the beginning, it starts with recognising that there has been a fundamental change. That needs to be reflected in our response. As I was saying earlier, I am attempting to try and understand what is behind that so we can get to some of the root causes.

I encourage all speakers to join the round table with the Minister, so I will invite people to that. I know I am never able to respond to all the points in my speech, so I will write to all the speakers, covering all the points raised in the questions. I thank the noble and learned Baroness, Lady Hale, for making her maiden speech, the noble Earl, Lord Russell, in particular for his words, and all noble Lords for their contributions. I have learned a lot from the debate and thoroughly enjoyed it.

My understanding is that we are going straight into the next debate, so I hope noble Lords will excuse me for taking a quick bathroom break beforehand.

Photo of Earl Russell Earl Russell Democratiaid Rhyddfrydol 1:48, 23 Tachwedd 2023

My Lords, it has been a pleasure to bring the debate to the House today. I thank everyone who has spoken. It is an immense privilege and honour to have heard the wonderful maiden speech from the noble and learned Baroness, Lady Hale, on which I congratulate her.

I am new to this place, but I have been struck today by the uniformity of feeling and desire for change and to work together cross-party, in the interests of helping our children and young people and of getting a better understanding of the causes of this rapid increase so that we can plan budgets and provide help. I thank the Minister for his response. I recognise him to be a deeply thoughtful and caring Minister. I appreciate his talking about his family experiences in the issues of mental health. I welcome his offer of continuing this debate at the round table, and I welcome the fact that he will report back to us on the points raised today.

One thing that has not been mentioned that I would like to mention is the particular mental health concerns of LGBT+ people, and young LGBT+ people, of which there is increasing evidence.

It has been a privilege to introduce the debate. I hope that it helps to galvanise the Government into further action, and that some of that action results in further funding. I thank all those who have taken part.

Motion agreed.

Sitting suspended.