My Lords, I am delighted that today we are focusing on the mental health of children and young people. I declare an interest as principal of Somerville College, Oxford, and I am particularly pleased that the Minister replying to this debate is the noble Baroness, Lady Blackwood of North Oxford, a Somervillian.
Like everyone working in higher education in universities and colleges, I am acutely aware of and deeply disturbed by the ever-increasing number of students with mental health problems. I was glad to hear the commitment made by the Prime Minister at Prime Minister’s Questions yesterday that the Secretaries of State for Health and for Education will work together to provide a specific fund for universities to develop new and innovative ways to help students with mental health pressures. I trust that whoever is the next Prime Minister will pursue this further.
In 2012, it was in response to pressure from this House, and specifically from these Benches, that the coalition Government committed to parity of esteem between physical and mental health services but, to date, the warm words have little substance. If there were real parity of esteem for children and young people, and if there were early intervention with proper diagnosis and treatment, so much misery could be averted and so much money could be saved in the NHS and other services. For example, in Oxfordshire 40% of police time is devoted to mental health issues.
The statistics are stark. One in four of us will suffer from a mental health problem during our life. The reasons are complex but we know that many of the difficulties begin in childhood and adolescence. Fifty per cent of the problems are established by the age of 14 and 75% by the age of 24, yet only 25% of children in need of treatment receive it and, of those, only 31% referred to child and adolescent mental health services—CAMHS—last year received treatment within that year. CAMHS continues to be what Luciana Berger has described as,
“a Cinderella service within a Cinderella service”.
The House of Commons Education Committee and Health and Social Care Committee published a joint report on the Government’s Green Paper, Transforming Children and Young People’s Mental Health Provision. It was entitled Failing a Generation, and that encapsulates the state of our mental health services for young people.
Stigma continues to be a big challenge and still too many children and young people suffer in silence, sometimes because they fear stigma and sometimes because those who love them do not notice the signs. As someone who has frequently talked the talk on mental health, I have to say that I have not always walked the walk. I am ashamed to say that I failed to notice my daughter’s mental health problems when she was a teenager. She courageously sought help but later suffered the most appalling consequences of postnatal depression, some of which I believe could perhaps have been avoided. She will probably have mental health problems throughout her life but these have been contained and she is now working for a brilliant charity, Artlift, which provides arts on prescription.
My Lords, I thank the noble Baroness, Lady Royall, for this debate and for her opening speech, which was fantastic.
As the Royal College of Psychiatrists says:
“A mental health crisis in our children is developing”.
So let me ask the Minister straight off: why then are we seeing a 3.7% fall in the number of child and adolescent mental health services providers in our schools?
The Government have responded to the mental health crisis in much the same way that most Governments react to problems or crises. The NHS Long Term Plan, which includes children’s mental health, is excellent. The Government have set targets in their FiveYear Forward View for Mental Health. The Green Paper proposes to bring schools and NHS services closer together. Mental health support teams have been set up and pilot schemes rolled out. Champions have been appointed. Targets have been set. That is all very laudable, but we need action for all children and young people.
As we have heard, one in eight children and young people aged between five and 19 has a mental health disorder in England, and 400,000 children and young people are not getting any professional help or support at all. We can establish mental health champions in schools, train staff to be able to identify mental health issues and embed mental health in teacher training programmes, and it is vital that we do so, but if the resources are not there it is all for naught. It is like pulling a lever and it does not connect with anything. Nothing happens. If a child or young person is diagnosed with a mental health problem, we must have the resources to respond and to support them immediately.
The NHS Long Term Plan says:
“Mental health support for children and young people will be embedded in schools and colleges”.
My Lords, we are tight for time. I would be grateful if your Lordships could keep an eye on the clock. Is the noble Lord about to conclude? The allocated time is six minutes.
I have misjudged my time; I apologise profusely. I do not know where I got 10 minutes from, I must have been looking at the next debate. I will conclude now—my apologies.
Let me begin by congratulating my noble friend Lady Royall on having secured this debate and on introducing it so ably. I am a bit far up the list for this, but my subject is a deeply perturbing one. I want to offer some comments on suicide and suicidal behaviour in relation to the mental health of children and young people.
Is there anything more tragic? It is not just a case of lives lost; it is a case of lives foregone. We cannot respond as a society unless we grasp the dynamics of suicide more generally. Understanding suicide poses unique problems, because by definition you cannot ask the individual why she or he acted as they did. Motives have to be inferred after the event, and this is often extremely problematic. For this reason, official suicide statistics, although they influence much public policy, are always pretty suspect. Can the Minister comment on this, given that suicide rates figure very largely in the national suicide prevention strategy, which I otherwise strongly support?
I spent a good deal of my academic career studying suicide and related behaviours. In my view, we need much more in-depth and sophisticated measures than suicide statistics if we are going to monitor the success or otherwise of prevention strategies. Some aspects of suicidal behaviour are absolutely counterintuitive. People will travel hundreds, even thousands, of miles to throw themselves off the Golden Gate Bridge in California, or in this country, Beachy Head. These include substantial proportions of young people. The youngest who has jumped from the Golden Gate Bridge was only five years old—albeit egged on by her father. Many have been teenagers and young adults, as at Beachy Head.
The Golden Gate Bridge provides the closest we have been able to get to talking to people who have committed suicide, which is otherwise a complete paradox. Throwing yourself off that bridge has a 98% fatality rate. Some of the tiny minority who survived, however, have been interviewed. They all said—this is pretty gripping—that as soon as they started falling, they regretted what they had done. One said, “The second my hand left the bar, I said, ‘I don’t want to die. What am I going to do?’ So I said, ‘Maybe if I get feet first, I’ll live’”. And in fact, this person did, but statistically it is virtually impossible to achieve. Your Lordships may ask what proportion of other suicides this would apply to, if there was data for this doubly tragic act—triply tragic in the case of children and young people.
12:08 pm
The Earl of Listowel (CB)
My Lords, I also very much welcome this debate and thank the noble Baroness, Lady Royall, for bringing it. I declare an interest as a trustee of a mental health service for adolescents in north London, the Brent Centre for Young People, which began 50 years ago. It focuses on adolescents with suicidal thoughts and tries to address their needs. I am also a trustee of the Child and Family Practice Charitable Foundation, which concentrates on interventions to support post-traumatic stress disorders in young people. I am also a patron of a charity called Best Beginnings, which has been going for maybe 10 years and has developed a video, a drama re-enactment of a mother’s experience of postnatal depression. It is harrowing, but a helpful tool to health providers and others trying to understand postnatal depression. What stands out in that film is the isolation the poor young woman experienced, and the lack of assistance and understanding from the health service.
I will say a bit more about Baby Buddy and perinatal mental health. I commend the Government for their important and significant investment in perinatal mental health. Reports have clearly shown that, by failing to address the mental health needs of mothers, we can readily harm the life chances of their children. It can have a huge impact. I am immensely proud to be a patron of Best Beginnings. In the last six or seven years, it has developed an app called Baby Buddy. This was developed with the royal colleges with the relevant experience—the Royal College of Midwives, and the Royal College of Obstetricians and Gynaecologists. I am drawn most to its videos. The chief executive of the charity is a former BBC film producer, and there is a video of a mother breastfeeding her infant, showing mothers how to breastfeed, and of a father communicating with a young child, helping fathers to communicate with their children. I am proud that the evidence shows that this Baby Buddy app has increased initiation of breastfeeding by 9%, which is a significant improvement and above many other interventions. I mention this in the context of this debate because it is important that infants form secure attachments to their parents.
I will concentrate on the culture that children and young people grow up in and a few other principles lying behind the good mental health and emotional well-being of children and young people. I quote Sir William Utting, a respected social worker and perhaps the chief social work inspector of his time. He produced two reports in the late 1990s on the abuse of children in children’s homes. In his second report, People Like Us, published in 1997, he began by saying that the “best safeguard” for children is an “environment of overall excellence”. The culture in which our children grow up is very important. Perhaps we cannot always be excellent, but we can at least try to be good enough.
My Lords, at the end of King Lear, where, frankly, the stage is littered with bodies and not much to cheer one up has occurred, the Duke of Albany speaks to the few people who are left standing. He enjoins them thus:
“Speak what we feel, not what we ought to say”.
At this point, I feel that that is all I can do, because, unlike my noble friend Lady Royall who introduced this debate so extraordinarily well, and many others who are speaking, I cannot claim any expertise, whether clinical or in the work I have done in the field of child and adolescent mental health. However, I have some direct personal experience. Many people in my family, including me—I regret having to say it—have suffered from difficulties with their mental health. That includes children and one young child at the moment.
When I put my name down to speak in this debate, I knew that I wanted to speak but I was not sure how I was going to say what I wanted to say. I am still not entirely sure, so if what comes out lacks coherence or is sometimes intemperate, I apologise to the House and in particular to the Minister who has to answer this debate.
Two things have happened in the past 12 hours which have changed the way in which I thought about this subject. One was a television programme, and one was something that happened to a member of my family, a young child. The television programme was shown last night—I do not know whether anybody else saw it—and in it Nadiya Hussain talked about her own anxiety problems. The one thing that emerged from that for me more clearly than anything was that young people whose mental health problems are not diagnosed grow up into adults with mental health problems. That has already been mentioned by others, but we should never forget it. That is the risk we run: if we do not look at children’s mental health early enough, they will grow up into adults who find it much more difficult to deal with the residual problems they have.
My Lords, I too congratulate the noble Baroness, Lady Royall, on securing this important debate. I will focus on the indispensability of family support, and particularly support for parents’ relationships with each other, if we are to address major contributing factors to children’s and young people’s poor mental health. Prevention should, whenever possible, be at the heart of any mental health strategy, whether from local or national government or from the NHS. Family relationship difficulties are also provoked by mental health problems in a child or young person. Whichever comes first, the family system, not just the person with the diagnosis, needs attention.
In a letter to the Times this week, I said that,
“The breakdown of family relationships creates a plethora of social policy challenges”.
Measures to strengthen families should be on the business plans of every department of government, as families which function well are major assets to their aims and objectives. This is particularly the case here. The NHS survey Mental Health of Children and Young People in England, 2017 found that family functioning was clearly correlated with mental health problems. Almost two-fifths of children from families functioning in the least healthy ways had a mental disorder, compared to one-12th of children in the families functioning most well. Robust surveys of mental health clinicians corroborate this. Family relationship problems were cited as the biggest presenting issue by mental health clinicians in a recent study of over 43,000 children in services.
Distressed children would agree. I commissioned research from a team led by Dr Samantha Callan, my parliamentary adviser, to inform the work of the Department for Education and the Department of Health and Social Care in developing the Green Paper on CAMHS. This included a focus group with young people with mental health problems who had experienced parental relationship breakdown. They highlighted that people in general are “not at all” aware of the effects of family breakdown on children and young people. They described teachers’ and other adults’ expectations that exposure to conflict or parental separation two or more years earlier would no longer impact them. This made it very hard to express ongoing pain from the lingering effects, including the difficulties in keeping in contact with the non-resident parent.
My Lords, I too congratulate my noble friend Lady Royall on the way she introduced this debate and on giving us the opportunity to speak on such an important issue. I accept all the points made about the lack of resources in the National Health Service, the queuing for CAMHS and the need to invest there. Having said that, I do not want to talk about that aspect of well-being and how we can support young people. If our approach is that we always use an external health model to deal with this issue, we will never actually solve the problem: if we are always treating the crisis, there will always be a crisis. Whatever Government are in power, CAMHS and other mental health services through the NHS will always be rationed to some extent. At the moment, we are seeing teachers in schools spending their time queueing to get their children into the acute services of CAMHS and the health service.
I want to put forward as an example an approach to go alongside that but not replace it, because I know that for some children that level of expert clinical support will be needed. Essentially, we need public health working through schools. As a parallel, in dealing with obesity we deal with the causes of obesity; we have dentists, but we deal with the causes of children having bad teeth.
My noble friend Lady McIntosh made an incredibly powerful and effective speech. But even if we had the sort of curriculum in schools that she would like—and I wish that too—there would still be a need to make school a place where the well-being and mental health of young people are supported. That is the job of adults, whether parents, family, community or teachers. It is for us to create an environment where more young people develop the skills and knowledge to have better mental health and well-being throughout their lives.
I chair the Birmingham Education Partnership; in saying that I declare my interest in the register. Four years ago, we were approached by the clinical commissioning group in Birmingham. It wanted to do this sort of work and knew it did not have the access to the city’s children that we did through the schools system. BEP provided funding to work with schools on a public health model. With its resources, we have appointed a team led by a psychotherapist—a brilliant woman called Anna Robinson—and made up of a family therapist, a head teacher and a learning mentor. So far, the team has worked in 53 secondary schools in Birmingham, appointing a designated senior lead in each school. The job is quite simply this: to help those teachers identify vulnerable children as they come into school from primary; to develop training packages for teachers and all adults who work in the school; to work with external partners, as managed by our group, such as the excellent YoungMinds, the public health authorities and clinical commissioning groups; and, now and again, to bring together the leads from all the schools so that there is a community of interest and support for this work. We are working with 53 schools, and when we finish our fifth year of funded work we think we will be working with all 80 secondary schools in the city. We are now turning our mind to working with primary.
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Many young people today have a good understanding of mental health issues but, sadly, in many areas the welcome rise in awareness has not been matched by service improvement. Rather, greater demand is matched by fewer staff and overstretched services, while some of the causes of mental illness are ignored. Mental health is no respecter of gender, race or class, but, as ever, it is the disadvantaged who are disproportionately affected. Just last week we welcomed the Timpson report into school exclusions. It demonstrated that a huge proportion of those excluded have special educational needs and many of those will have mental health issues. Children who end up in custody are three times more likely to have mental health problems than those who do not.
In universities, there is a well-documented, exponential rise in the number of students with mental health problems. At Oxford, for example, over the past five years there has been a fivefold increase in individuals reporting long-term mental health conditions. Of course, some people who, rightly, seek advice do so due to low levels of well-being or stress, anxiety and even loneliness rather than mental illness, but we have to ensure that these issues are addressed before they escalate in some way. The university is currently consulting on a new student well-being and mental health strategy with the full participation of students and the whole university, from the vice-chancellor downwards. There is a real determination to ensure that every part of the university is committed to implementing the necessary policy changes and practices so that the needs of all students are met. At Somerville, specifically, we have what I believe to be a good system. It includes peer supporters, a part-time counsellor, a nurse, junior deans and a full-time welfare support officer, but we can always do better. We also have a development programme which helps to build resilience and addresses issues such as time management, which can be the cause of huge anxiety in the run-up to exams.
The statistics are clear but the reasons for the increase in numbers are complex. Students are sometimes referred to as “snowflakes”—delicate individuals who melt when the temperature rises. That is absolutely not the case, but it is the case that the challenges they face are increasing.
Many people arrive at university with established mental health problems, some of which have been diagnosed, but not all. Those who are already in the system may well have had a painful transition from CAMHS to adult mental health services. I know that there is great awareness in government as well as Parliament about this problem, which causes great pain and stress, but to date the need to address it in a comprehensive way has not been met and the 10-year plan lacks the necessary centralised system. The consequence is that young people, at a time of great vulnerability, fall through the net.
The transition from home to university is also a major life change and can be overwhelming. Research is being undertaken to ensure a better understanding of the health and mental health needs of first-year students, which might lead to system change. Yes, transition to university has always been challenging, but it is now more difficult than it might have been before. For some, there is a knock-on effect of a parental divorce. Parents stay together while the children are at home, then, once A-levels or the international baccalaureate are over, they announce their separation. The children, on top of other emotions, have a sense of guilt at having been responsible for keeping their parents together in an unhappy marriage.
LGBT young people experience disproportionately high rates of poor mental health. The freedom of leaving home is a time when some LGBT young people come out—a wonderful and liberating step for them, but one that can be extremely difficult emotionally and can have an impact on their mental health.
There is the stress of the unprecedented financial burden from student loans and increased tuition fees, which adds to the pressure of having to succeed. Some question this pressure, but it is undoubtedly a reality. A new poll today found that more than half of 20-somethings said that finances had taken a toll on their mental well-being. It is felt at university that to get a good job you have to get a good degree, and the pressure of succeeding sometimes throws the work/life balance out of kilter. A man who graduated in the 1950s recently commented to me that when he was at university the libraries closed at 6 pm, but many are now open and populated 24/7.
Then there is social media. The recent social media summit is welcome, but we now need to see action and results. Social media is an advance in many ways, but it is also a torment for many young people who cannot escape their foes—the people who bully them or demean them, who wreck their self-confidence and make their lives a misery. The impact of, for example, Instagram and Snapchat on self-esteem is enormous, because of the way in which they feed obsession about the way that we look and dress, our weight and our physical attributes. It is no wonder that more and more young women, and some young men, have eating disorders when they believe that their self-worth rests on the way that they look, and to be other than a size 6 is not acceptable.
I am delighted that the theme of this year’s Mental Health Awareness Week is body image. I meet many brilliant young people whose lives are blighted by eating disorders or an obsession with hours in the gym. When they are diagnosed it then takes months, perhaps years, to get into a system that is desperately overstretched and underresourced. This devastating disease strikes rich and poor alike, the difference being that if you are wealthy you can usually access treatment more swiftly, as in the case with all mental health problems.
However, money is not always the solution. We should talk about and take responsibility for our well-being, but it is absolutely clear that, despite the Government’s words and some actions, our mental health services are desperate for more investment. I am sure that the Minister will point to increased spending on CAMHS provision, but this barely scratches the surface when you consider the resources that have been taken out of the system. I would be grateful for an assurance from the Minister that the additional money going into CAMHS is reaching front-line services, and an explanation of why we are lagging so far behind other EU countries. I wonder whether she is aware of a recent report showing that we are 21st in the EU for the number of CAMHS psychiatrists, with just 4.5 psychiatrists per 100,000 young people. The top-ranking country, Finland, provides eight times as many psychiatrists for its young people.
Mental health trusts have less money to spend on patient care in real terms than they did in 2012, according to the Royal College of Psychiatrists. The IPPR has found that mental health budgets must rise by more than £4 billion by 2023-24 to achieve parity of esteem with physical health. Last month the Secretary of State announced that budgets would rise, but by only half this amount. So I ask the Minister: how do the Government intend to achieve parity of esteem?
Mental health services need proper staffing, but there are 2,000 mental health staff leaving their posts in the NHS every month, and Brexit is exacerbating the problem. There is a particular issue on in-patient wards, where many agency and bank staff are being used and specialist CAMHS practitioners are at a premium. There has been speculation that this is because of the high workload, poor work conditions and poor pay of CAMHS staff. With regard to staff, the government response to transforming children and young people’s mental health provision fails to mention social workers and the positive role that they play in improving children and young people’s mental health.
The statistics are dry, but their impact on individual lives is mighty. Young people’s lives are disintegrating because they are having to wait for diagnosis and treatment. This in turn has an impact on families, friends, schools, colleges, universities and the workplace, not to mention the economy. It also has a profound effect on charities—wonderful organisations without which the whole system would crumble. The number of charities and volunteers on whom we rely is vast, and there will always be a place for them. However, they should not be expected to fulfil tasks and obligations that are rightfully the duty of the state—a state that at the moment is abdicating its responsibilities in this and so many other areas.
In addition to more people presenting to services, their needs are increasingly complex. Across the country we have seen local authorities having to reduce their expenditure. As a result, youth services, libraries and community outreach workers have been stripped to the bone. These services traditionally provided a safety net for young people, allowing professionals to spot signs of mental ill health early, as well as giving young people a chance to build resilience skills and coping mechanisms. As more young people struggle to get help early on, more of them are approaching CAMHS at a more acute stage of their illness. Of course, some people do not at first want to address their problems face to face, either with friends or professionals, and the new mental health text messaging service launched by the young Royals is an important means of finding help, as is the invaluable, well-established initiative, Childline, founded by Dame Esther Rantzen, another Somervillian.
It is encouraging to see that the Government clearly acknowledge the significance of early years mental health provision. Poverty, neglect and exam pressure all have a role to play in children’s mental health. A YoungMinds survey showed that more than 90% of teachers have seen a rise in students with mental health problems in the last five years. I would be grateful for an update from the Minister on the rollout of the Youth Mental Health First Aid in Schools programme. What percentage of schools are now part of this programme, under which trained staff become champions for improved mental health and well-being outcomes in schools?
I pay tribute to Poppy Jaman, one of the founders of Mental Health First Aid, who led and grew the movement. Two years ago, Poppy suggested that a “wave of change” was coming in mental health, and she is still of that view, although she is concerned about funding. I trust Poppy and she makes me slightly optimistic. Change is coming, but it is coming too slowly.
In their Green Paper, the Government had good proposals, but they are rolling out their plans for only a fifth to a quarter of the country by 2022-23. This lacks not only ambition but a real understanding of the devastation that poor mental health will have on the hundreds of thousands of children and young people who will not benefit from the strategy because its implementation will come too late.
As in every other area of healthcare, innovation must be one of the keys to transforming the provision of mental health care. I know that in our universities, including Oxford, the most extraordinary research is being undertaken. So I end by asking the Minister for her assurance that there is a real joined-up approach between the NHS and our universities. I hope that she will come to Oxford in the near future to discuss innovation, especially in relation to diagnosing, treating and safeguarding the mental health of our children and young people.
The Government claim a success in that,
“We are delivering on our commitments to expand mental health services for children and young people”,
as set out in the FiveYear Forward View for Mental Health. That may be true, if success is defined as 30% of those with mental health conditions being able to benefit from treatment and support, which is still less than one-third of those who need treatment. Could noble Lords imagine the headlines and the outcry if only 30% of people with serious heart conditions were being treated?
I go back to the NHS plan. The NHS will be funding new mental health support teams working in schools and colleges, which is welcome, but not until 2023—nearly five years from now. Only one-quarter, at most, of schools and colleges will have such a team. There is no indication of when, if ever, there will be a team in every school and college. Will the Government be encouraging schools to add a section to their school prospectus and website along the lines of, “Our academy is the only one in this area to have a Mental Health Support Team. If your son or daughter has a mental health problem, or you think that he or she may develop a mental health problem in the next five years, make this academy your choice”? While this idea is obviously ridiculous, what will the 75% of schools without a mental health support team be able to tell parents when a student needs support? I look forward to the Minister’s reply.
The lack of robust data about the mental health of children and young people is a matter that should shame the Government and, indeed, all of us. The teenagers who were part of the last exercise in, I think, 2004 are now in their 30s. The Department of Health claimed repeatedly that there was not enough money to undertake a full-scale assessment, and undoubtedly money was tight. Another explanation of failure to collect robust data is that the Government were content for the true picture to remain a “known unknown”, because knowing the extent of the challenge would have proved uncomfortable and expensive.
The past decade has seen a whole range of new pressures on children and young people—we have heard some of them from the noble Baroness, Lady Royall—many of which contribute to more of them suffering from mental health issues. The internet, which admittedly has opened up the world to children and young people, also has a dark side. The ubiquity of social media can lead to children being bullied by their friends or groomed by predators. Social media also promotes an image of perfection to which no ordinary person can aspire. Those who have a poor image of themselves can easily find “help” in self-harming and encouragement to starve themselves. All of this, of course, is available 24/7 since the internet never closes, even on bank holidays.
I would like to move from the macro picture to the micro picture. We have all read what reality is like for many mentally ill children and young people, with suicide a too common occurrence. I cannot imagine what it is like to have a son or daughter with a developing mental illness, for whom support only becomes available when a crisis occurs, and only then if you are a danger to yourself or others. For those acutely ill and needing in-patient treatment, a bed is often only available hundreds of miles away, which can make it almost impossible for family and friends to be in contact at the very time when these contacts are most needed.
Training school staff to spot the early signs of mental illness—and the new programme to train all sports coaches—is welcome. However, if there is not the support needed to follow up the issues identified, it will lead to even higher levels of frustration by those teachers and other professionals who work on the front line.
The need to provide better support services is universally acknowledged. Noble Lords will probably have seen from the Treasury minutes in the briefing pack that every single recommendation in the Public Accounts Committee report on the mental health of children and young people was accepted by the Government. Let us hope that the actions really will speak louder than the words.
In concluding, I would like to say a little about what should be done to try to promote well-being and good mental health among children and young people. In February, the Secretary of State for Education and the Secretary of State for Health announced,
“one of the largest trials in the world to boost the evidence about what works to support mental health and well-being”.
This is a welcome development in prevention, and will be much more effective than even the most effective cures. However, what we really need is a study that looks at the multitude of pressures which contribute to mental illness and young people. This study could then make radical recommendations for strategies to minimise those pressures. We have heard about pressures of young people at universities and colleges, but there are pressures right—
The research also studied people who tried to jump off the Golden Gate Bridge but at the last minute were prevented from doing so by the police. Amazingly, the results showed that only 6% went on kill themselves. The rest—all 94% of them—lived out their normal lifespan. In other words, and importantly for the relationship to mental health, it is not the case that they remained suicidal personalities. In fact, that very notion is suspect.
The biggest reduction in suicides that has ever occurred in this country did not come from therapy or mental health treatment; it came when natural gas replaced coal-fired gas. Putting your head in the oven had accounted for almost 50% of suicides before that point, but then we saw a steep reduction in the suicide rate, which I am sure was real. The implications of this have to be clearly thought through. Suicide is very different from many of the things that people write about it and much more problematic in its motivation. This has to be recognised.
The suicide prevention strategy that has been rolled out at national level is a very worthwhile initiative. It is also good that substantial public funding has been allocated to organisations such as the Samaritans and the Zero Suicide Alliance. However, does the Minister think that the strategy embodies the most avant-garde thinking about suicide, in the light of research such as I have mentioned? I am not at all sure that this is the case.
In conclusion, perhaps she would like to comment on the following points. First, I know that this debate is about mental health, but it is time to move away from the mental health model of suicidal behaviour towards a more sophisticated perspective, recognising the symbolic richness of that action. Secondly, suicide, attempted and actual, is often as much a form of self-assertion as it is of despair. Thirdly, as the Harvard School of Public Health puts it:
“Intent isn’t all that determines whether an attempter lives or dies”.
The way in which it is done is often symbolically crucial, as your Lordships can see from the case of the Golden Gate Bridge. It is not often that someone says to themselves, “I just want to die and I don’t care how that happens”. More often than not, there is a deeply symbolic and rich emotional content to it.
I hope the Minister will recognise that understanding these complexities is key to the prevention strategy which the Government have quite rightly introduced.
The city of Leeds has developed a strategy based on the United Nations Convention on the Rights of the Child. Everything it does, across the whole city, is founded on those principles. It has had outstanding results from inspections of child protection by Ofsted. It has recently been successful in reducing childhood obesity in young people. Again, this is put down to the culture it has created of concern for children’s welfare.
The Minister spoke helpfully about the excellent work the Government have done with social workers in the last 10 years. I would like to talk about the importance of expertise and experience. Timothy Loughton did not have a background in child protection, but took every pains to work with social workers, listen to young people in care and develop a thorough understanding of this work. Working with the noble and learned Baroness, Lady Butler-Sloss, he produced a report called No More Blame Game, championing the status of social workers. Subsequent to Timothy Loughton we had Edward Timpson as Children’s Minister. His family had a background of fostering, he had adopted siblings and he was a practitioner in the family law courts. He had a deep understanding of the issues around supporting children and young people, particularly those who are vulnerable. From that, we have seen many good policies emerge; for instance, the appointment of chief social workers for children and families and other areas.
In terms of the culture, politicians have an important role to play. I have always been of the view that if one is going to talk about the welfare of children, one has to have worked with them to some degree. I am fortunate to have had that experience. Being a parent can be a helpful introduction, but one needs to work with children and young people, understand their vulnerabilities and difficulties, and understand that growing up is complex—we underestimate that as a culture. I see that I need to end here.
I welcome having expert practitioners at the forefront of policy as our chief social workers. Politicians need to be humble before that experience. They perhaps need to see themselves as communicators to the public of what is important, based on what they learn from those who have long experience as nurses or clinicians. That will help create a culture in which our children do much better. I look forward to the Minister’s response and apologise for speaking for so long.
This week is Mental Health Awareness Week—many of us are sporting the badges. It may be less widely known in this House that it is also SATs week; if nobody understands what that is, they should look it up. Putting the two together, the few things I want to say are about schools—schools as healthy or, in some cases, unhealthy communities. I want to make it clear that, as I say it, I intend no disrespect whatever to teachers or their students, all of whom in their different ways are trying their best to do a good job in difficult normal circumstances. I say that because I believe it but also because I have quite a lot of teachers in my family, so they would be very cross with me if I did not say it.
Good education must always strike a balance between discipline and freedom; core skills and creative range; learning to be part of a group and learning to be ourselves. Government policy over the past decade has done very little to help schools be healthy communities in that way. It has steadily narrowed the curriculum, reducing choice and imaginative aspiration, and focusing far too much on testing, which is why the SATS point is important. It has downgraded and undervalued arts subjects. I know that this is an old hobby-horse of mine, but I do not mind riding it out again when evidence shows the benefits of these subjects, including to mental health. More than anything else, government policy over the past decade has drained the joy out of education. If you cannot be joyful as a child, it is very hard to be mentally healthy.
I know that the Minister will say, with some good reason, that this is not her area of responsibility, but I ask her to consider that it is the responsibility of the Government as a whole to understand that young people spend a huge amount of their lives in school. Schools are communities, within which adults and young people need to find a way of co-existing such that the education the young people receive is good, enduring, healthy and sustainable. They cannot easily get that from adults who are themselves stressed, overworked and anxious. It is my belief and experience that many teachers in the system at the moment are in exactly that condition.
One way we can prevent our young people from becoming problems and needing mental health interventions is to try to ensure that their experience at school is nurturing, creative, safe and inspiring. That is what schools ought to be. I wish more of them were and I hope that the Minister will understand why I am putting this to her today.
One participant said: “I see girls who don’t see their dads who try to get the attention and the affection from someone much older than them. It can have a bad long-term impact on you if you end up in bad relationships”. Another described their severe problems with anger management, linked to their father leaving unexpectedly more than a decade ago. Other negative effects were attributed to one parent not having recovered from the relationship breakdown. Conflict might have ceased, but children might still be coping with their parents’ depression, bitterness or other long-term ramifications of the split, which went unsupported. One said, “I have absolutely no complaints about the care I have received, but my mum didn’t get any help at all. I might not be sitting here if she had had the same level of support”.
The importance of good interparental relationships was recognised in the 2017 Green Paper, which said:
“Children who are exposed to persistent and unresolved parental conflict are at a greater risk of early emotional and behavioural problems, anti-social behaviour as an adolescent and later mental health problems as they transition into adulthood”.
To unpack the concept of persistent and unresolved conflict, this need not mean a violent home environment but one daily characterised by overt, hostile exchanges or cold, contemptuous indifference.
Apart from citing the DWP’s reducing parental conflict programme, the Government’s response to the Green Paper consultation made no proposals to support families and interparental relationships. Similarly, the NHS LongTerm Plan merely acknowledges that a,
“stable and loving family life”
significantly influences young people’s health and life chances. Health services might argue that relationship and family support are someone else’s responsibility, but this ignores the fact that, in a phrase coined by researchers from UCL, good relationships are a health asset. Indeed, I cannot resist saying here that “The key to happiness”, according to today’s headlines from the Office for National Statistics, is to “Eat, drink — and be married”. Moreover, health budgets dwarf government funds earmarked for relationship support, so can my noble friend outline what the DHSC is doing to support family relationships?
I have a couple of recommendations. First, NHS organisations could invest directly in the provision of relationship support. Hackney child and adolescent mental health service employs a specialist to work directly with the couple while another member of the multidisciplinary team treats their child or young person who has been referred. The research found that this is rare, so to help build confidence that embedding couple counsellors in CAMHS teams is good use of scarce mental health funding, the DHSC should fund pilots of this model.
Secondly, early help for families is imperative to address the roots of mental illness and prevent children and young people developing such problems. Local councils, from Newcastle to the Isle of Wight, are making progress in repurposing children’s centres as “family hubs”, so that their expert early years services are preserved alongside services offering help for parents of children aged nought to 19. Health services and education, now both on the front line of help for children with mental health difficulties, are free and available to all, yet we cannot ignore any longer the uncomfortable truth that, without similarly accessible support for family relationships, they will fail to turn back the tide of mental illness in this and future generations.
The examples that the noble Lord, Lord Storey, talked about, of some schools having support and not others, are what I experienced and are usual. As an ex-Education Minister, I know that the most difficult thing is not to find what works but to get it into every school. The real challenge is rolling out good practice. I am cautiously excited, if that is not a contradiction in terms, to have got this model into 80 schools in Birmingham in five years and to be all ready to move to the primary schools. I wanted to bring that to the attention of this debate as something I hope we can take forward.
I know that, after we started, the Government came forward with their Green Paper, the first aid kit and measures to work with schools. I applaud that and am grateful for it, but the worry of our team in BEP is that elements of this still use the NHS-based model. If I get over one fact in this debate, it is that that by itself will not work. It has to be a model that is wrapped round, runs through and envelops the life that children have in schools, so that attention to mental health is part of how we do our job and not something that we have to refer children to.
I will finish by giving four or five points that BEP has learned and wants to bring to the attention of this debate—I am merely chair of the organisation and pay tribute to the team. First, quick wins are possible and there is nothing wrong with them, but sustained work needs time and consistency. The fact that we are going into our fifth year of this project is an important message in itself. Secondly, these lead teachers need to be confident and well trained, and have good subject knowledge and the confidence to train others. They therefore need training on an ongoing basis that will bring them together and enable them to do their job. Thirdly, schools need to be supported by an integrated team with other skills and other professionals.
I will make two points to finish about things that are not around yet but which will come. Schools need to know who to go to in order to buy or get good quality support. This will become a market. There are lots of organisations—some good and some not so good—selling or giving services. We will get to the point where we as politicians can list the organisations and resources which schools can access to support this work, but we do not give teachers the information they need to make wise decisions about what they buy or access.
Lastly, our team made a point which made me smile: you have to work within the school year. The National Health Service does not work in line with the school year. If we are to bring professionals together to create in our schools an environment where children are given the skills and knowledge to create as good mental health and well-being as possible, we have to work around the rhythms of what they do.
As I say, I am not putting this forward as something that is guaranteed to be a success, but I am confident that it is a more than valuable and important contribution to the debate, which I am delighted we are now having.