Mental Health: Children and Young People

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.

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.

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.

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?

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.

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.

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.

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.