Special Educational Needs and Children’s Mental Health Services

The first is Steffi Whelan, who told me about her 11-year-old son. He has been waiting more than two years for a CAMHS appointment. His problems began seriously in year 4. What began as outbursts of screaming in class evolved into something more disruptive. Sometimes he would tear up work or behave in a way that was completely unsustainable for the teacher. In time, he was moved from that primary school to another, and his parents have been told that he will not be emotionally able to move on to an ordinary secondary school. He is now nearing the end of year 6, and despite all of that, the family are still waiting for their first appointment.

Melanie Fenemore told me about her nine-year-old son, Archie, who was strongly suspected to have autism. Melanie was first referred to CAMHS in October 2018. She filled out a load of complicated forms, and in January 2019 was told that her son was on the waiting list and to expect a 20-month delay. In fact, she waited 27 months before he was seen in April last year. At the time of the assessment, the view was formed that he probably did not have autism spectrum disorder but had something more equivalent to attention deficit hyperactivity disorder, and he was referred to the ADHD team. Again, Melanie was sent a bunch of forms, which she described as “pretty much identical” to the previous ones, and her son was sent back to the bottom of a waiting list. The family have been told to expect a 36-month wait. If that projection is correct, Archie will have been on a waiting list for six years, from the age of six to 12, by the time he receives his first appointment. During this time, Archie’s mum tells me, he has

“expressed a desire not to be alive.”

He has a tendency towards violence, born out of frustration. She says:

“I am sometimes at the receiving end of Archie’s violent outbursts which hurt more as he gets older.”

The Buller family’s young daughter, Daisy, has been waiting more than two years for an autism diagnosis. By the time her mum contacted me last July, her daughter was self-harming and barely attending school, even though she was in the crucial year 10. Her mum wrote to me:

“This is 5 years since we first started struggling and we are no closer to helping my daughter. Simply one question Laura, in today’s age, how is this Ok.”

One headteacher of a primary school described the waiting times as “absolutely awful”, with another saying that the situation has got worse in recent years. Valiant efforts are made by West Berkshire Council to offer support through its Emotional Health Academy, but that is not a substitute for a clear diagnosis. A head at a primary told me that until they get a CAMHS diagnosis,

“The child may be excluded or at risk of exclusion, their anxiety will often worsen and they don’t attend school, the school can try but it cannot put in the support that it is required until there is an Educational Health Care Plan in place and CAMHS diagnoses are critical to this.”

The headteacher of Kennet School in Thatcham said,

“While schools will have an indication of what a pupils needs may be, a diagnosis through CAMHS leads to targeted work and accessing additional services to further support the child and their family. A huge part of a SEND diagnosis is the support”.

It enables the young person to

“understand themselves. Where a diagnosis is not yet given, this delays the essential step for the young person, causing more erratic behaviours and often fall-out at home as well as at school.”

The short point is that a timely CAMHS diagnosis is often crucial for life chances. It hardly needs to be said that a child who is repeatedly excluded can easily end up in a pupil referral unit. People with neurodiverse conditions are significantly over-represented in the prison estate and the youth estate. Their employment opportunities are often compromised, anyway—it is said that only one in five people with autism sustain full-time employment—and in teenagers there is a significant correlation with depression and self-harm. Timely diagnosis and the correct support is crucial for addressing that.

I want to focus on the Government response so that my speech does not sound like a barrage of criticism. I know that the Government attach significant importance to improving outcomes for those who are neurodiverse. The SEND review, to be published soon, is a testament to that, as is the work being done to ensure that children with autism will have a designated key worker within the next year or so. Hundreds of millions of pounds of additional funding was made available for CAMHS in the spending review, and I have to concede that West Berkshire is one of the first 25 areas that will pilot the schools-based mental health support teams.

I said at the start of my speech that Berkshire West CAMHS received significant investment from the Government last year—£1.6 million in April 2021. In fact, when I spoke to the service a few months ago, it said that funding was no longer the problem. The money will enable it to recruit another 27 members of staff that it so badly needs, although so far it has managed to recruit only 12.

Despite a detailed local transformation plan published last September, in which some laudable ambitions were set out, including a goal of reducing waiting times for diagnoses to just a year by next month, when I spoke to Berkshire West CAMHS, it conceded that there is in fact no fixed deadline for reaching that target, so it is not really a target at all; it is nothing more than a general ambition. There is no consequence if the service fails to reduce waiting times. I regret to say that that is not good enough.

The overall impression of Berkshire West’s child and adolescent mental health service is that there is a serious lack of urgency or accountability. Dr James Cave, the well-respected medical director of the Downland Practice in my constituency, wrote to me:

“I think it is important that you understand the depths of despair GPs feel about the local CAMHS service. Remote, unresponsive, closed, uncommunicative sums them up. It feels as if they are always looking for a way NOT to have to see a child. They demand detailed referral forms from us…and then find reasons not to see a child. If they do accept a referral the wait is forever and then often the intervention is a fixed predetermined intervention that does not take”

into account

“the needs of a child.”

I am not seeking to humiliate anyone, but families in West Berkshire are being failed, and it is my role and my responsibility to fight for them.

The Health Secretary has said time and again that the Health and Care Bill currently making its way through the House will deliver better accountability. Speaking in the debate in July, he stated:

“The third theme of the Bill is greater accountability.”—[Official Report, 14 July 2021; Vol. 699, c. 430.]

He said that people have the right to expect “clear lines of accountability” for how every priority is delivered. So my plea—a cri de coeur—from the many families in West Berkshire is that the Department demands better accountability from CAMHS in West Berkshire and across the country. We want details of how that £1.6 million will be spent, and firm commitments to reduce waiting lists, with consequences if managers fail to deliver.

The issue is not confined to West Berkshire, but it is stark within it, and I therefore speak today for the families that I represent and all those families across the country who are experiencing the same struggle.

However, far too often our education system is one-size-fits-all. I am really proud to chair the all-party parliamentary group for special educational needs and disabilities. It is so important that we change the classroom and home environment for these children, so that their behaviours are understood, and they can fully experience school and get to where they need to be.

So many things have gone wrong during the pandemic. Some children with autism have flourished through online learning, but others have found themselves isolated from their friends, peers, teachers and support. Several organisations are yet to start providing the therapeutic interventions that they are meant to provide under children’s education, health and care plans, and this is causing huge disruption to the ability of those children to thrive. Three quarters of disabled children have seen progress in managing their conditions and overall development regress in the pandemic. This is urgent and critical. Those who receive a diagnosis of dyslexia should also be screened for ADHD or other neurodivergent conditions, because the crossover is huge. We are letting our young people down by not helping them to get the tools they need to understand themselves—first and foremost—and how they fit in with the world.

I hope that the Minister will think more about how we can intervene as early as possible to avoid young people becoming incredibly depressed and anxious about just who they are—because they are round pegs trying to fit into square holes. It is critical that we support young people to thrive and give back to our society and economy by being the great pioneers and entrepreneurs that we all want to see.

I also have the privilege of having someone with autism in my family—

Even when someone gets an EHCP, the battle continues. Parents in my constituency report annual reviews not taking place, or the plans not being updated for months following review, severely impacting on a child’s progress through education. A lot of things go wrong in the transitions between stages of education or into work.

Added to that is the struggle to obtain adequate mental health treatment. One constituent of mine was told that the priority waiting list for CAMHS—not the list to which my hon. Friend the Member for Newbury was referring earlier—is 11 months in Staffordshire. That is the priority list. Only this week, a constituent described how she is desperate for respite provision, having accepted a child back into her care on the basis that the local authority would support her.

The local authority has been good at keeping in touch, but its hands have been tied by what it says is a lack of resources. As well as struggling to find an educational placement for the young person, it has only just found an agency to take him on outings twice a week. After five and a half months of caring 24/7, my constituent is exhausted and in the terrible position of considering having to say that she can no longer look after the young man. She has been let down by a breach of implied trust—the local authority told her that it would support her, but it has not been able to.

As Members of Parliament, we inevitably hear the failures, rather than the success stories, but I welcome any support that can be given to improve the experience of so many. As my constituent Mr Winkle said:

“In this journey I have communicated with many regulatory bodies each claiming to have the child’s interests wishes and safety at the forefront of their agenda...but as I have experienced this is certainly not so...my assumption is that it’s a closed circle and these entities do not know how to facilitate or co-ordinate any kind of solution and just want it to ‘Go Away’.”

I am sure that is not the full truth of it, but that is the experience that people are having out there.

I welcome the imminent Green Paper and the additional funding, but too many people have been failed for far too long. I hope the Minister will be able to address that when she responds.

Children should never be put in the “too difficult” box, but I have heard many examples of children being out of school without any support or just having part-time schooling or perhaps hospital school tutoring—if a child has to go into hospital because of their underlying physical disabilities or illness, they will have education there, but not when they are at home. Parents complain about schools having a one-size-fits-all approach to dealing with children with additional needs, while there are complaints from schools that they can no longer afford teaching assistants, who are so valuable in providing children with the one-to-one attention they need.

Delay can make a huge difference to children’s wellbeing and future attainment, as we have heard. We know that half of all mental health problems are established by the age of 14. Tragically, in some cases, young lives will be lost if we do not intervene early. In 2017, suicide was the most common cause of death for both boys and girls aged between five and 19.

I would like the Minister to commit to provide mental health support in every school, early interventions so that we can spot the signs—otherwise, problems will increase in severity—and respect for a child’s individuality. I know that that costs more and needs more resources, but the problem with these pathways—the hon. Member for Newbury talked about fixed, predetermined interventions—is that it does not help to refer a child with autism for counselling based on cognitive behavioural therapy, because their minds just do not work like that. Finally, we also need better in-patient services, because sending children hundreds of miles away from home, when they need intensive support, is absolutely unconscionable.

I would like to see every local authority in the UK comprehensively reviewing its SEND provision, so that it becomes available in every area. Specialist and dedicated settings are the way forward for those who need them. We need to give our teachers better training with education, health and care plans. Those should not become a magic bullet—a passport for the lucky few—but a rightful passport for every child to get the support they need.

Lastly, CAMHS across the UK need 20,000 volts put straight through them. For families to wait two and a half years for a consultation is not only immoral but frankly inept. The irony will not have escaped anybody here that a GP cannot prescribe medication for ASD, ADHD, oppositional defiant disorder, Asperger’s or any other mental health condition, without a diagnosis from CAMHS. We have to focus on CAMHS right now.

To conclude, let us please get spending, diagnosing and treating, and let us give all our children, not least in Berkshire, the future they deserve.

My first question to the Minister is on the lack of educational psychologists in this country. My local county council is doing its very best; it is one of the F40 councils and is twelfth-lowest in the country when it comes to the high needs block. I said, “If you had a magic wand and could ask for anything from the Minister, what would it be?” and the council said, “More educational psychologists.” We currently fund only 200 training places in the country. There is only one educational psychologist for every 5,000 young people, which is nowhere near enough. Tackling that issue would go a huge way towards immediately helping to alleviate the backlog.

In the interim, there are amazing third-party groups that are helping. There is Shift, which is an informal parent group in Abingdon, set up by Sally and Andy Foulsham. They run it, provide support and help families navigate the system. There is also The Abingdon Bridge, which is the only wellbeing and mental health charity for young people in Vale of White Horse. It focuses on 18 to 25-year-olds. It is particularly worried about the 16 to 18-year olds that it finds because, if they are referred to CAMHS, the waiting lists are so long that they then drop off that cliff edge. Strangely, the charity cannot access funding from the CCG because of the way that the funding works. Could the Minister help me help The Abingdon Bridge to access more funding?

To conclude where I started, we absolutely must appreciate that these children deserve the best, and deserve more, but the current system is failing them. There is a perverse disincentive in the system, where a school must basically pay the first £6,000 of the funding. We need a national SEND strategy that solves the problem once and for all. Without that, we risk failing our children and our country in the future.

In Children’s Mental Health Week, I pay tribute to the local authorities in my constituency. This week, Westminster launched a trial of a keyring, which will reach 4,000 young people. They simply scan a QR code to take them to a special hub, which will give them the advice and support they need. That is the kind of practical help we need to give our children, but this is also about getting the funding that our schools need, to ensure that our young people have the future they deserve.