School-based Counselling Services

– in the House of Commons at 4:58 pm on 9th November 2021.

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Photo of Rosie Winterton Rosie Winterton Deputy Speaker (First Deputy Chairman of Ways and Means) 4:58 pm, 9th November 2021

There have been some additions to the speaking list, so I will introduce a time limit for Back-Bench speeches, which is likely to be seven minutes, following the opening speech from Mr Brown.

Photo of Nick Brown Nick Brown Chair, Finance Committee (Commons), Chair, Finance Committee (Commons) 5:00 pm, 9th November 2021

I beg to move,

That this House
has considered the provision of school-based counselling services.

Let me start by saying how grateful I am to the Backbench Business Committee for affording me almost half a day for this topic. I thank my friends throughout the House for making the case to the Committee, and I particularly thank my friend Robert Halfon, who has joined me in sponsoring the neutral proposition on which the debate is based.

It is estimated that in England, one in eight young people—13% of those aged between five and 19—are living with diagnosable mental health disorders. They include depression, anxiety, and conduct disorder, which is a type of behavioural problem. While the announcement earlier this year of extra funding for young people’s mental health services is welcome, it is targeted specifically at the extra dimensions of the problem caused by covid within schools. The problem was there before. It has grown, and it needs to be addressed. The services were under pressure before the pandemic, and they remain so now.

The Children’s Society tells us that 75% of young people are not receiving the help that they need, and 34% of those who manage to be referred to NHS services are not accepted for treatment. Public Health England says that in the north-east the number of pupils with social, emotional and mental health needs is higher than the national average, and the same is true in respect of hospital admissions resulting from 10 to 24-year-olds self-harming. This is an issue for the country, but it is a particular issue for our region.

Photo of Catherine McKinnell Catherine McKinnell Chair, Petitions Committee, Chair, Petitions Committee

I apologise for interrupting an excellent and very timely speech, and congratulate my right hon. Friend on securing the debate. I do not know whether he has seen the data, but does he share my concern that there seems to have been a much steeper increase in the mental health challenges faced by girls throughout their secondary school years than has been the case among boys? By the time they leave secondary school, girls have had almost twice as many contacts with mental health services as boys. Many of those challenges could potentially have been avoided if there were proper counselling in schools, for which I am sure my right hon. Friend will be making the case. Moreover, if boys are more reluctant to come forward for that help, is that not also a problem demonstrated by the data?

Photo of Nick Brown Nick Brown Chair, Finance Committee (Commons), Chair, Finance Committee (Commons)

Whatever the cause, the problem is clear enough, and it needs to be addressed. My hon. Friend is right to make the point, and she is also right to suggest that the roots of this, particularly in our region and the city that we both represent, are to be found in deprivation and in poverty. That is a particular feature of our region, and my hon. Friend spoke about it very movingly in the earlier debate. We know that mental health issues have a disproportionate impact on the most vulnerable children, and the roots of that are in social deprivation. It is a particular problem in my own constituency. In 2014, 27% of children in east Newcastle lived in poverty; the latest figure, for 2019-20, is 38%, and it is increasing year on year.

The north-east of England is bearing the brunt of the increase in child poverty, with all 12 local authorities within the north-east region in the top 20 authorities that have seen the highest increase across England as a whole. The last Labour Government boosted the life chances and welfare of children, and I am proud to being a part of that. Policies such as Sure Start, working tax credits and well-funded family-friendly public services ensured that every child had a positive start in life. How far we have slid from that, and how misguided and mistaken we were to get ourselves into that position.

I particularly want to make the case for services for the disabled, whether they have a physical disability or mental health problems. I recently met representatives of the National Deaf Children’s Society who told me about the disproportionate impact that the coronavirus lockdowns have had on the mental health of deaf children. Measures taken to fight covid, such as the widespread wearing of face masks, particularly in the classroom, have led to communication difficulties for deaf children. As a result, 60% of deaf children have indicated that their mental health has worsened, and 58% have reported feeling isolated and lonely. Many felt that services relied too much on the telephone for booking appointments, and others did not like the fact that some appointments were now available only on the telephone.

I also want to say something about the special needs and significant mental health problems that child refugees face when they enter the United Kingdom and, eventually, the school system. I have received a substantial amount of casework regarding the situation in Afghanistan, including many requests for help to leave that country. I do my best to help my constituents, and I know that other MPs are in the same position. On the point about ring-fenced funding for mental health support in schools, I have written to the Home Secretary on behalf of my constituents and I look forward to receiving a response. It is a specific problem and it requires a specific response.

Existing provision of schools-based counselling is patchy. There is currently no legal requirement on schools in England to provide counselling services. There is, however, a specific requirement for such provision in Scotland, Wales and Northern Ireland. I understand that the Department for Education does not routinely collect school workforce data that would allow us to identify how many schools directly employed their own counsellors. Some employ their own, and some link up with other schools and share a counsellor. We know that provision is varied. Some have more casual arrangements with the voluntary sector or local authority partners. Some simply do not offer any school-based provision, and instead refer children to an external service.

There is a demand to make schools-based counselling services more consistent. More than two thirds of young people would prefer to be able to access mental health support without going through their GP. The Government’s roll-out of mental health support teams goes some way towards meeting the lower-level mental health support needs of children by offering group work and cognitive behavioural therapy for emerging issues. However, by 2023, the new teams will reach only about 30% of schools and colleges, leaving a worrying 70% with no additional early help or support other than funds that may be accessed directly via the education recovery plan.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

There are many charities, particularly children’s charities, across the United Kingdom that I can think of, such as the National Society for the Prevention of Cruelty to Children, Barnardo’s and Mind, that have a great grasp and knowledge of where the real priorities need to be. Does the right hon. Gentleman feel that when the Government reply, they should listen to the organisations that know, and then deliver a strategy that can help with these situations?

Photo of Nick Brown Nick Brown Chair, Finance Committee (Commons), Chair, Finance Committee (Commons)

I have a relatively open mind on the particular route that should be taken to meet these issues head-on, and I have no ideological objection to a role for the voluntary sector or for those who want to contribute, but—at least in England—the state must take a lead. Things cannot be left as they are. I believe that school-based counselling, regardless of which organisation provides it, could fill the gap between those mental health support teams in schools and the national health service’s child and adolescent mental health services. There are limits to voluntarism, of course, and we would need the people delivering the service in the schools to have some form of qualification and understanding of what they are doing.

The British Association for Counselling and Psychotherapy makes that point and is campaigning on these issues. Schools-based counselling is a proven intervention for children and young people experiencing psychological distress. Some 50% of mental health disorders are present by the age of 14, increasing to 75% by the age of 18, so early intervention is key, as it is with many of these issues.

Photo of Kevan Jones Kevan Jones Labour, North Durham

My right hon. Friend has just mentioned the statistics about early intervention. In the previous debate we were talking about investment in children at a young age. Does he agree that targeted investment in these young people is not just good for those individuals but makes economic common sense, in that the payback will be that we have productive and stable members of society?

Photo of Nick Brown Nick Brown Chair, Finance Committee (Commons), Chair, Finance Committee (Commons)

My right hon. Friend is absolutely right. It also relieves pressure on the national health service in the longer term, because the NHS tends to end up as the service of last resort—a role it shares with the police, equally unfairly in my view.

I commend the efforts of the Tyne & Wear Citizens group, which has been working to raise the profile of schools-based counselling and with which I have had regular meetings. The group has set out three core principles that a successful schools-based counselling programme ought to follow: first, that services should be co-operative and inclusive, including the use of digital wellbeing tools, telephone counselling and face-to-face sessions at school or external venues; secondly, that services should be collaborative and liaise with external agencies such as social services and the police where it is appropriate to do so and, thirdly, that services should be consistent, provided by those trained on a nationally recognised course, registered with a professional body and experienced in working with school-age children.

In concluding my contribution to this debate, I want to say something about the schools-based counselling programme in place in the Newcastle East NEAT Academy Trust in my constituency. I have nothing but praise for the project itself and the enthusiastic support that it is receiving from the broader schools community; my right hon. Friend will remember it well, because he used to be a councillor for the local government ward that it serves.

The project has found clear signs of improvement in educational attainment for around one in three of the pupils who received counselling. There was a significant improvement in pupils’ achieving their personal goals, with an 85% improvement in reported progress towards achieving these goals. No child reported a sharp deterioration in progress.

The counsellor—not a local government-type councillor but a schools-based counsellor—in the trial that is taking place has told me that embedding the counselling service as part of the whole-school approach is vital to removing the stigma around mental health and promoting a culture shift in the community. She has reported high levels of engagement in the programme and has stressed that demand is increasing. In order to reach more children and young people in crisis and to prevent future mental health issues from developing, I am convinced that the project has made a strong case for more school-based counsellors delivering interventions.

Were the Government to continue to take an interest in this way, it should be possible to achieve something more. I give them credit for tentatively seeing the need to intervene in this area and I hope that today’s debate, across the Floor of the House, reinforces their appetite for further action.

Several hon. Members:

rose—

Photo of Tracey Crouch Tracey Crouch Conservative, Chatham and Aylesford 5:15 pm, 9th November 2021

It is an honour to be able to speak in this debate, and I congratulate Mr Brown on securing it and the Backbench Business Committee on granting the House time to discuss such an important matter.

I want to start with an admission. When I first became an MP, I did not think that schools should be involved in matters that were beyond the core curriculum, such as mental health. My mind was changed pretty swiftly in two ways. First, my own brush with anxiety and depression in 2012 enlightened me about mental health and cast aside any unconscious prejudice I may have had about who is affected by poor mental wellbeing. The second came through the privilege that we, as Members, have of visiting schools in our constituency and seeing that education is holistic, child-centred and rarely textbook—I ask the House to forgive the pun.

Having had my lightbulb moment, I now feel a responsibility to stand up in this Chamber to advocate for better mental health services for our children. Our child and adolescent mental health services are, I am afraid, overwhelmed, and we could, and perhaps should, have another three-hour debate about that. However, while that remains the case, the system of support for our children needs to be widened, and that is where our schools come in.

Reading the briefings for this debate, I was struck by the statistics of deteriorating mental wellbeing among our children, especially following covid, but the stat that made me feel sick was in the brief provided by YoungMinds, which noted:

“In 2017, suicide was the most common cause of death for both boys and girls aged between 5 and 19”.

That made me want to cry. There are so many heartbreaking stories of children whose lives have been robbed by a disease of which they had no control, but suicide should be preventable, if we have the right awareness, training and essential support services in place. No one, but especially no child, should lose their life to suicide.

Prior to this debate, I sought some thoughts from a handful of schools in my constituency, both primary and secondary, just as a snapshot reflection of need and provision. Anything I say from here onwards is not a criticism of the services that they, as schools, provide—quite the opposite. They are doing their absolute best, despite all the challenges that they face, which I hope to outline in what is left of my speech. It is clear that schools can play a vital role in supporting pupils’ mental health, given that they provide routine and structure to those in their daily care. However, as the need increases, it is clear that the existing provision, which in itself varies, is inadequate in meeting the need from not just a quantitative perspective, but a quality one.

Access to school counsellors may well be an integral part of ensuring that young people have access to support, but only if a school can afford to purchase the school counsellor. Most of my local secondary schools are in some form of academy trust and therefore they are able to pool resources and provide a school counselling service. One trust told me that, despite having a counsellor who works at one secondary each morning and one primary in the afternoon, and another secondary that buys in external support for three days a week, it is nowhere near enough. Another trust told me that it is lucky to have built up a specialist team of experienced professionals to plug the gap when other agencies are not on board. They have a qualified counsellor and a full-time safeguarding lead, but still their young people are crying out for help and, with the greatest respect to those working their socks off in schools, what they absolutely do not need is to be told there is a two-year wait to see CAMHS when a pupil is self-harming or has suicidal thoughts.

It is useful to be able to provide that support where the resources can be pooled to do it, but for a small school with a published admission number of 180, like one of the primary schools I reached out to, the funding is simply not available. If anyone thinks that there is not an acute need in primary schools for wellbeing support services, they are fools. I have heard as many stories of self-harm, suicidal thoughts and depression in our younger age groups as I have in secondary. But if they cannot afford a counsellor or a family liaison officer, they are left to rely on a mental health lead, which is basically a teacher still doing their job and all the things required on a curriculum, but having completed an online learning course. That course qualifies them to deal with mental health conditions as much as my FA level 1 coaching badge qualifies me to manage England.

I applaud the Government focus on this issue in guidance and, of course, the increase in funding for mental health services, but the sad truth is that more is needed. First, we need ringfenced funding. One head said to me that

“if you put additional funding into our budgets it would get lost so whilst I hate this process, look at a ring fenced amount for the next 5 years to allow us to specifically fund mental health provision in schools”.

Secondly, as suggested by one of my local schools, the training of mental health first aid should be mandatory in schools. They legally have to provide physical first aiders; why is it not the same with mental health? The training needs to be funded and not just the preserve of schools that can pay £300 per person and release staff for two days of training.

Thirdly, the Government need to fund the provision of curriculum resources to adequately teach mental health and wellbeing skills. As a strong advocate of the benefit of mindfulness in schools, I believe that the welcome but patchy initiatives that help to support wellbeing while building resilience should become standard, funded practice. It does not have to be mindfulness—one of my schools has a pat-a-dog, which has had a remarkable impact on student wellbeing—but aligning mental health and wellbeing to the curriculum, as we do with physical education, would be enormously positive.

We need to reflect on the role of designated mental health lead. I am afraid my local schools think that although it was designed with good intentions, it will end up like the role of designated safeguarding lead, which is done by a teacher, usually someone on the senior leadership team who, by the nature of their position, already has significant responsibility.

Finally, it is clear that schools are really good places to host hubs for wellbeing, so why not capitalize on that view and ensure that each cluster of schools has access to a mental health worker, a social worker, a school nurse and even a police community support officer, to deliver resource right into the heart of the community, for the most vulnerable within it?

Photo of Munira Wilson Munira Wilson Liberal Democrat Spokesperson (Education)

The hon. Lady is making an excellent speech and I agree with pretty much everything she is saying. On hubs, does she agree that some children and young people will not feel comfortable and will not want to access services through their school, for a variety of reasons? Community-based mental health support hubs that are a one-stop-shop for a variety of services are an essential complement to school-based counselling services.

Photo of Tracey Crouch Tracey Crouch Conservative, Chatham and Aylesford

I am grateful for the hon. Lady’s intervention. We need to reduce the stigma around mental health and give people the confidence to access support services wherever they are, whether that is in a school or a community hub.

It is clear that we stand on the edge of a young people’s mental health crisis, and more so because of covid, but it could also be that because of covid we have the chance to make fundamental change rather than minor tweaks here or there. I have a great deal of respect for the Minister and know that he will hear what colleagues say this afternoon. I hope he will go back to the Department, gather together all the relevant stakeholders to urgently review provision in the light of the increasing need, and then propose radical reform to support better in-house provision, because it takes less than a few minutes of listening to teachers in our constituencies to understand how urgently that is needed.

Photo of Sharon Hodgson Sharon Hodgson Labour, Washington and Sunderland West 5:23 pm, 9th November 2021

I am happy to speak in this debate on school-based counselling services and thank my right hon. Friend Mr Brown for securing this important debate.

A silent epidemic is sweeping through our schools and through some of our young people. It is a wide-reaching and indiscriminate epidemic, yet we are so often unwilling to discuss it. I am, of course, talking about the mental health crisis in young people. A recent NHS report published in 2021 found that the number of young people with probable mental health disorders had been rising steadily since 2017. Currently, an estimated one in six young people between the ages of six and 19 have a probable mental health disorder. The pandemic was hard for us all, but it could be said that it was felt hardest by our young people, who were cut off from school, part-time jobs and their friends. Worse still, the pandemic and chronic underfunding of our NHS caused one of the largest backlogs of mental health patients that this country has ever seen. The situation is dire and changes are long overdue.

As children return to school, we must use this opportunity to build a more welcoming and available system for young people with mental health problems. While mental health problems can afflict anyone from all walks of life, for those children whose homes have unstable economic or familial dynamics, and when those disorders are also compounded by fear and stigma, schools are often the only outlet, the only safe place. Schools must be part of the solution.

I am sure that all of us here know someone who has suffered from mental health issues. Tragically, some may also end up taking their own lives as a result. It is in times such as these that we are often forced to ask ourselves: what if we had known sooner; what if they had got the support they needed. That is the essence of what I am putting forward today? What if we tackle mental health complications early? No child should be left to begin their life with baggage—a weight to bear for the rest of their lives. Schools provide us with unparalleled access into the minds of still developing young people and it is here that we can really make a difference.

The current system to tackle young mental health concerns is outdated. A 2014 report by the Health Committee found that the Child and Adolescent Mental Health Services has a complex funding arrangement and a tier-based model that fails to truly integrate the range of organisations tasked with safeguarding young people. We must show that we have listened to those families who have struggled to access mental health support during the pandemic, when pressures on children and families were at an all-time high.

While I welcome the Government’s plan to expand mental health provisions in schools, progress is painfully slow. I also fear that their current solution of increasing mental health support teams creates a “missing middle” of children who would not qualify for CAMHS, but whose needs are too complex for MHSTs. Yet again, the Government have put forward a plan that is unambitious and riddled with holes. We need a system that is more straightforward and co-operative and that supports all needs.

Employing counsellors in every school could be a viable solution to this, and it is an extremely popular measure among the public, especially those with children under the age of 18. Only around 61% of schools and colleges in England offer counselling services, more often than not run by under-qualified counsellors. That is not good enough. Concerns about the number of trained counsellors in schools and whether they are mandatory should be addressed by the Government.

Citizens UK has estimated that hiring the required 13,394 fully trained, school-based British Association for Counselling and Psychotherapy accredited counsellors would cost only £554 million a year. That compares with the £1.4 billion per year currently spent on CAMHS. School counsellors in every school would centralise services, reaching the “missing middle” as well as help the 65% of pupils not currently supported under the MHST model.

I am by no means suggesting that we should spend less on mental health services, but the current unsubstantiated spending does nothing to improve services. We need focused care that identifies the problem, communicates with students in the most appropriate way and co-operates with all local institutions.

For far too long, mental health services have been shunted to the back of the queue and not taken seriously. I was shocked to discover that, when questioned in July, the former Health Minister, Ms Dorries, revealed that counselling services for schools were not yet mandatory and she did not indicate any plan to make mental health services mandatory. Instead, she indicated that schools should be given the “freedom to decide”. The mental health of our children is not a subject for party dogma over freedom. Would any responsible parent send their child to school without someone who is, at the very least, first aid trained with a first aid kit to hand. If their child then fell over in the playground or had an allergic reaction, they would hope that someone would be there to help them, so why should mental health be any different?

What I, my right hon. Friend the Member for Newcastle upon Tyne East, and I think all of us in the Chamber are advocating is this: a safe environment for young people where mental health is no longer the unknown or unaccounted for. If we are ever to achieve genuine parity of esteem, that is the very least we should be doing.

Photo of Robert Halfon Robert Halfon Chair, Education Committee, Chair, Education Committee 5:30 pm, 9th November 2021

It was an honour to present before the Backbench Business Committee with my friend, Mr Brown.

The repercussions of the pandemic will have a significant impact on children and young people. As the mental health charity, Mind, has pointed out, covid-19 will leave a “deep and lasting scar” on the mental health of millions. The statistics are grim; some have already been cited. In March, my Committee heard from the Royal College of Psychiatrists that there had been a “massive” rise in children self-harming, with a 7% rise among girls aged 11 to 16 since 2017. In 2019-20, the number of children being referred for mental health treatment soared by 60%. We all see these awful statistics in our constituencies. A mother in Harlow came to me and told me that her otherwise healthy child had started compulsively washing her hands until they were raw and bleeding since lockdown and not being at school.

Are our children getting the help that they need? The Children’s Commissioner suggested that the number of children accessing the treatment that they need has increased by just 4%. I believe that there are ways in which we can turn the tide. Let us rocket-boost the Government’s proposals to put mental health professionals in every school, quicker than the current plans. The What Works Centre for Wellbeing has identified that good mental health and wellbeing at age 14 to 15 has a significant impact on educational attainment at age 18. The Department for Education shows that pupils with better emotional wellbeing at age seven were more than one term ahead of pupils with poorer emotional wellbeing. I have seen the impact of organisations such as Place2Be in schools in Harlow, such as Stewards Academy, which benefits from its services.

This is not just about the provision of mental health; it is also about prevention and resilience. Last week, I visited a remarkable school—Newham Collegiate Sixth Form Centre—where I met students and the headteacher, who described the resilience and preventive work that the school does. It employs a coach to work with students to develop techniques to conquer their anxieties. School assemblies are used to teach the tools needed to manage highly pressured environments, using examples presented by sporting personalities. In private study periods, the desks are set up to resemble an exam hall to help pupils to become familiar with the setting. That is the kind of arsenal that should be replicated in schools around the country.

The second element of prevention must be considering extending the school day for extracurricular activities. I welcome the Government’s £5 billion for educational catch-up, but this should also be about extracurricular activities, because we know that young people who participate in after-school clubs are 20% less likely to suffer from a mental health disorder. The Education Policy Institute found that a longer school day increases educational attainment by two to three months, and the Department for Digital, Culture, Media and Sport found that an extended school day can boost numeracy skills by 29%.

Why on earth will the Department for Education not at least pilot proper experiments of extended school days in some disadvantaged areas of the country, using civil society to provide those extracurricular activities, so that we can really see the difference they make; and then make that case to the Treasury? Headteachers such as the head at Newham would love to be able to offer their students extracurricular activities, just as the private schools do, but they simply do not have the funding to do so.

The Local Government Association estimates that the annual cost of mental health problems in England is about £119 billion, but rolling out counselling services to all state-funded secondary schools could cost £100 million per annum. That would provide for access to a school counsellor for at least two days a week for more than 90% of schools. It makes economic sense to invest in prevention, given that most mental health problems emerge before the age of 25.

Finally, we know that social media is a wrecking ball for young people’s mental health and wellbeing; it is damaging all of us, but particularly young people. Research from the Education Policy Institute and the Prince’s Trust found the damage that social media is doing to teenagers’ mental health, and 79% of Barnardo’s practitioners reported that children between the ages of 10 and 15 have accessed unsuitable or harmful content. One in three girls said that they were unhappy with their personal appearance by the age of 14.

The links are clear. Social media providers should not be allowed to duck their responsibilities, and I urge the children’s Minister to work with the Treasury to introduce a mental health levy for social media giants so that they can take responsibility for what is happening to our young children. Ofcom published a report earlier this year that stated that the revenue of social media companies is £4.8 billion. Introducing a 2% levy could create a funding pot of around £100 million, which could be distributed to schools to provide mental health support and digital skills training for our young people to build the resilience and online safety skills that they need. If the social media companies knew that they had to pay the levy, they might at last behave more responsibly towards our young people.

Social media firms and tech giants must do more given that much of the problem is caused by the very apps and platforms that they have built. We must rapidly deliver the commitments in the mental health Green Paper to ensure that there is a mental health professional based in every school—sooner rather than later. Priority should be given to initiatives that support prevention and teach resilience, as I highlighted with the example of Newham Collegiate Sixth Form Centre. Only by doing so can we deal with this epidemic and ensure that our children and young people emerge from the pandemic resilient and able to climb the education ladder of opportunity.

Photo of Kevan Jones Kevan Jones Labour, North Durham 5:36 pm, 9th November 2021

I congratulate my right hon. Friend Mr Brown on securing this debate, and I thank the Backbench Business Committee. Talking about mental health is something that we are doing more of in this place, and that is good.

In August 2019, the Children’s Society produced “The Good Childhood Report”, which found that an increasing number of young people—around a quarter of a million—are now feeling low and unhappy about their lives. Robert Halfon has just mentioned the pandemic. I recommend that people read the recent report by King’s College London and Oxford University on the pandemic and young people’s mental health, because we have not yet seen the long-term effects.

In opening, my right hon. Friend the Member for Newcastle upon Tyne East mentioned the statistic that 50% of mental health problems develop before the age of 14, and 75% before the age of 24. We have to change attitudes in this country. Is mental health a health issue? I have to say that for me, it is not; it is an economic issue as well. If we are not going to invest money in early interventions in schools, we will frankly not get the economic rewards. Those interventions would not only improve individuals’ lives, but save us money later on.

My hon. Friend Mrs Hodgson mentioned CAMHS. I pay tribute to all who work in CAMHS, but it will never work as it is set up at the moment. We can pour as much money as we like into it, but it will just not work. We have to try to stop the pipeline of young people going into CAMHS, because some people will need assessment by CAMHS but a lot of people do not. It is totally demoralising for young people and their families to be stuck on waiting lists, so we need processes to ensure that they can get early intervention.

I fully support school-based counselling as a way forward, but this is a broader issue. It is not just about schools; it is about the entire way we set up mental health services in this country. We need an open access policy, where people can access mental health services in the community and young people can access them in schools. If we do not do that, we will always have this system where we pour so much money into the medical side of it without addressing the real problem: dealing with those who are in crisis and need support earlier. Early intervention can prevent people from calling on services in later life, and save money. It is not just about saving money, though; it is about ensuring that those people have fulfilling lives.

Are schools islands? No, they are not. They are part of local communities, and it is vitally important that whatever we put into schools—I would certainly make it mandatory for schools to have school-based counselling —has to have links into local communities. I consider myself very fortunate in County Durham. We have a fantastic network of community-based, open-access, voluntary sector organisations that get on and deal with helping people in the community. If U Care Share is a suicide prevention charity that goes into schools and works in the community around young people and mental health. We have just had the new, fantastic Think Positive PACT House project open in Stanley in my constituency. It is a completely open-access hub. People can just walk into it and get the support they need. The people there not only give people support but, if they need to, refer them to more intensive services. We have a fantastic organisation called Rollercoaster based at the Riverside in Chester-le-Street, which supports parents of young people suffering with mental illness. We should not forget that it is not just the young person who is affected; the issue often affects an entire family. Rollercoaster is a fantastic organisation working on that.

In the system I would like to see, it is very important that we have school-based counselling, but we have to have that network of community open-access facilities that allow people, if they want to, to access mental health services. That is not just about people who are in crisis; it could just be people who want some advice. We should do that. People say, “If you give it to the voluntary sector, that is saving money”—no, it is not. Money properly invested in the voluntary sector at the local level pays dividends. It will not only lead to better outcomes, but be better value for money.

I will finish on stigma, which I have done a lot of work on with many Members of the House. We are making progress, but we have to change people’s attitudes. It is that simple thing that if someone had a broken leg or a physical disability, they would go to a doctor or ask for help, but the problem is that many people do not do that when they have a mental health condition. We have to get the system to the point where people can just walk in, ask for help and get it. I have great respect for GPs, and make no criticism of the work they do, but they should not be the only way of accessing those services. If we had that open-access policy, community-based services and schools working with their local communities, we would not only have better outcomes for individuals, but save money. A lot of the cash that goes into mental health services should be redirected into community services and schools where people are accessing it.

To finish, the more we talk about this subject, the more normalised we make it. If I may, I give one message to young people today if they are suffering—we accept the huge pressures on them today. It is not a sign of weakness to ask for help. It is there, please ask for it.

Photo of Jo Gideon Jo Gideon Conservative, Stoke-on-Trent Central 5:43 pm, 9th November 2021

I congratulate Mr Brown on securing this important debate. I rise to speak both as chair of the all-party parliamentary group on youth affairs and as the Member of Parliament for Stoke-on-Trent Central, which has significant challenges due to multiple deprivation factors in our city and the high levels of young people in care—more than 1,000—which mean that our schools and colleges have a vital counselling and safeguarding role. That underpins our ambitions to give our young people the best opportunities to achieve and fulfil their potential.

However, support for care leavers and those who live independently is inconsistent and a high-risk area. These young people are vulnerable, as well as being high-risk for mental health issues. Young people’s mental health issues impact educational outcomes and the ability to form friendships. Problems can last into adulthood, affecting life chances and physical health.

In Stoke-on-Trent, CAMHS is overstretched and cannot meet the demands across the city. Students do not see the same person for any follow-up appointments or long-term counselling treatment. In addition, a 17-year-old student is unlikely to be seen until they reach 18 due to the waiting list. Services are now focused on the reactive as opposed to the preventive at a time of wide recognition that investment must be focused on preventive actions to avoid the physical and mental—and financial—cost of waiting until a young person presents with a major trauma.

I welcome the recommendations in the national food strategy about the importance of access for every child to nutritious food and healthy eating, to address the causes of malnutrition in schools and to tackle eating disorders, which recently have risen significantly. Those issues are also probably picked up more by counsellors than by other services.

This year, City of Stoke-on-Trent Sixth Form College’s safeguarding, counselling and wellbeing team received a national award for its emotional wellbeing project. I am sure the House will join me in congratulating Jo Finn, Kirsty Cooper and Claire Gaygan on the superb work that they do, which was made possible by the opportunity area funding. The college looks after about 1,800 students, many of whom are from disadvantaged backgrounds. The funding enabled the team to devise a model to meet the needs of the young people of Stoke-on-Trent, rather than the other way round. The impact of that is measurable in clinical data, as well as other key performance indicators, including attendance, progression and retention. Young people have engaged with the service as it fits around their timetables, no travel is involved, they see the purpose and they are referred quickly internally to a mental health practitioner, an emotional wellbeing worker, or one of the many groups that they can attend.

Across the city, schools also take on the hugely important role of safeguarding. They act as a triage service that notifies other statutory services when they become aware of issues, as well as providing a safe space where children can open up to a trusted adult. I commend the excellent work undertaken in all our schools and colleges. I have the utmost respect for all the teachers and support staff who work so hard to provide not only quality education but pastoral care to our children and young people. I have heard many accounts of the daily challenges faced in providing such support as an unfunded or temporarily funded extra. I speak today in support of core funding for mental health counselling and safeguarding provision to ensure that those with added personal challenges and health issues have the best possible chances throughout our education system.

In Stoke-on-Trent, loss of early intervention across the city means more focus on higher-tier services that look at extreme cases involving, for example, domestic abuse, substance misuse or human trafficking. Schools and colleges are therefore having to deal with intermediate services. Locally, Stoke-on-Trent has lost essential services such as the school nurse service, which provided preventive support and guidance, and sometimes immediate referrals to A&E, particularly for mental health issues and eating disorders; “Hidden Harm”, a drug service supporting young people with parents with drug-related and mental health issues; and the STAR—sex teenagers and relationships—service that provided early intervention and support around healthy relationships. As a result, schools and colleges are having to pick that up.

The threshold for family services is extremely high, which means that schools and colleges are also picking up that early intervention work. They have the skills and experience to do that, but they have no allocated budget or time. It is an additional responsibility.

Photo of Munira Wilson Munira Wilson Liberal Democrat Spokesperson (Education)

The hon. Lady is making some important points. When I tour schools in my constituency, mental health is by far the No. 1 priority that every headteacher gives me. I have been struck by the impact on staff, many of whom do not have the skills and experience to deal with the level of mental health problems that they face. I went into a secondary school a few days after a young person had taken their own life. Just recently, I saw a seven-year-old expressing violent behaviour and the teacher was shaken up and had to take time out of the classroom. That is why we need mental health support teams rolled out quickly. The Government’s catch-up funding must provide not just academic support but holistic support, including for mental health, because teachers and headteachers are really struggling.

Photo of Jo Gideon Jo Gideon Conservative, Stoke-on-Trent Central

I thank the hon. Lady, and I agree with all she says.

The threshold for family services is extremely high, which means that schools and colleges are picking up early intervention work. The sixth-form college works specifically with 16 to 18-year-olds, which is a really challenging place to be. Legally, this age group is still classed as children, but accessing external support is increasingly challenging. There is a huge gap between children’s and adults’ services, and the threshold for adult services is even higher than for children’s services. At 18 someone will come under adult services, but it is almost impossible to have an adult services support worker for an 18-year-old.

The issue of funding counselling services spans both the Health and the Education Departments. Disappointingly the college approached the clinical commissioning group to share costs and provide additional support for both colleges in the city, which would have cost about £40,000, but the CCG declined. As we move to integrated care partnerships, I hope that it will take an holistic view of preventive mental health support, and that means working closely with education and schools.

I recognise that the cost of staffing counselling service provision across all the schools in England is significant, but I truly believe that it is a key element of levelling up. If areas such as Stoke-on-Trent are to level up our educational achievement, the things that hold us and our children and young people back must be addressed by having extra counselling services. We cannot raise standards without recognising the real barriers that most vulnerable young people face and putting in place core funding for essential school and college-based counselling services. I believe that that will address these issues, particularly in the most disadvantaged areas—there is a need for these services in every area, but those areas need disproportionately more, and any help that the Government provide is most welcome. We need to recognise that some areas need more help than others, and I hope that the Minister is listening.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Digital, Culture, Media and Sport) 5:51 pm, 9th November 2021

It is a real pleasure to speak in today’s debate, and I thank my right hon. Friend Mr Brown and Robert Halfon for securing it.

Early intervention cuts harm, reduces risk now and in the long term and, crucially, prevents ill health in the first place. Children and young people are exposed to so many risks and so much trauma in their lives. Bullying occurs, adverse childhood experiences are real and there is the issue of social media. I would also say to the Minister and his Department that the pressure of the school system and exams is bearing down on children.

If we do not produce well-rounded children at the end of their schooling, what have we done to our young people? That is why it is so important that today’s debate looks holistically not just at children’s mental health issues but at their causes, and that it addresses those too. That is particularly important given that we heard that one in nine children had a diagnosable mental health condition pre-pandemic, rising to one in six as a result of covid—covid has of course borne down so heavily on so many of our constituents.

A quarter of 17-year-olds have self-harmed, and 7% have attempted suicide. The numbers are rising fast. This is an epidemic, and we need the Government to shift resources now to get a grip on what is happening. It is unforgivable that the Vale of York CCG budget for child mental health is so limited and that just 0.8% of its overall budget is spent on child mental health—just £55 per child. Children wait 39 weeks for their first contact with the service, and longer for treatment.

Surveys of schools in York show that we are crying out for counsellors. Some schools have told me that they have been able to find a few hours for wellbeing by replacing teacher time or by benefiting from student counsellors or the school wellbeing service. However, by their own admission, provision was too little, too late or non-existent. Schools therefore need support. When they do engage, of course, they have all sorts of challenges around information sharing. While they understand the need for confidentiality, they need to address those issues too. School mental health should not be just another thing for teachers to do. That is unsafe. What if they miss a diagnosis or an intervention? That is where we need to have trained professionals at the helm, creating healthy environments for children to be nurtured in.

Of course, training teachers is important. We can address the culture and climate of a school, but ultimately this must be a job for health professionals. However, without a workforce plan, supporting young people is not going to happen. I recall when the Government focused on driving up the number of health visitors—sadly that is now regressing fast. I was head of health at Unite at the time. It was a priority for No.10. There was action every day. Mountains were moved and people were trained. However, there is no similar focus on the mental health and wellbeing of our precious and often fragile young people and I call on the Minister to look at that today. What happened around training those health visitors? Can that be translated into putting school counsellors in place, addressing a massive shortage in the workforce? That was the case with health visitors then and it is the case with counsellors now.

We need to ensure that a proper structure is in place. This is not just about young people; it is also about parents. Parents want support and to know how best to nurture their children through a crisis, and through developing and increasing mental health challenges. If a child broke their leg, they would know exactly where to go, where to get support and—guess what—on day one they would get the treatment they need. But it is months and months for an injured mind and that is certainly not parity of esteem. So why not make schools the hub for all child mental health, from nursery to primary to secondary to college and to university?

We also need community services. I urge the Minister to talk about youth services, and the need to ensure that we properly invest in those services as a hub in the community that children can access. If we know about place and about the professionals we need in that place, we can then have a programme to get to the point we need to get to. That is what is missing. Where do people go? We hear about family hubs, virtuous as they may be, but then we have CAMHS services and GPs. It is a minefield and a mess, so we must simplify the system and bring it into one place to help families to know exactly where they are heading.

I am not trying to pathologise mental health—quite the opposite. If we have the right professionals in place, they can easily triage individuals into the right place and services. For some people, that will involve an escalation to see an educational psychologist, a psychiatrist, or other professionals. Perhaps it will lead to social prescribing. I urge the Minister to look at the success of the social prescribing programme. It is being rolled out for adults, but what about engaging children and young people in various things happening in their community? I commend organisations such as The Island in my constituency, which provides space and time for vulnerable young people to build confidence and self-esteem, and to unlock their potential through building positive mentoring relationships and unique programmes. The testimonies from there are phenomenal.

In conclusion, let us agree a few principles. The first is place and that is the educational setting. Then it is the workforce. Then let us get a workforce plan in place. Let us consider the recruitment and training we need, and let us have uncapped funding so that we get on top of this crisis and address the needs that follow. If the Education Minister does one thing in his time in post, building and enhancing the wellbeing, confidence and wholeness of a young person would be a far greater legacy than perhaps any of his predecessors have ever achieved.

Photo of Miriam Cates Miriam Cates Conservative, Penistone and Stocksbridge 5:58 pm, 9th November 2021

It is a pleasure to follow Rachael Maskell, and I congratulate Catherine McKinnell and my right hon. Friend Robert Halfon on securing such an important debate.

Some time ago, before I was an MP, I was a secondary school science teacher. Like most busy secondary school teachers, I taught more than 300 pupils every week. As a teacher, I was very much focused on delivering the syllabus, ensuring that no one set fire to the classroom, and getting through all the teaching material on schedule. For a classroom teacher, it is important that students are ready to learn, and we often think about that in terms of, “Have they got the right pens and the right pencils? Have they brought their textbooks and homework?” However, it is, of course, also important that students are ready to learn emotionally and mentally.

It is not uncommon for teachers to have students turn up to the classroom who are just not in a fit state to learn. They might need to go to pastoral support or take some time out. Sometimes, the issues—a falling out between friends, an unexpectedly bad test result, or perhaps not getting into a sports team—resolve themselves on their own. But sometimes—often, in fact—the issues are deeper and harder to fix. I am thinking of things such as low self-esteem, a chaotic home life, abuse and, increasingly commonly, sexual exploitation over the internet.

Members on both sides of the House have made excellent speeches about how children are increasingly affected by mental health challenges that they desperately need help with and are not going to recover from on their own. Of course, some will have parents and extended family who are able to help, but many will not. It is not just important for their educational prospects that they have access to counselling in school; it is also important for their life chances in general that we address these problems early to stop them becoming chronic and affecting their whole lives. I do not want to repeat the many excellent remarks about the challenges our children are facing and how it is so important that all children have access to professional support.

Some schools are doing an amazing job already. Horizon Community College in Barnsley in my constituency has a wellbeing centre on site that is staffed by counsellors and people from the multi-agency support team, who support not only the children in the school but the whole community. That is a fantastic example, and we should share such good practice. But the truth is that many smaller schools do not have the resources to put in place something as innovative as that, so I fully support the campaign by my right hon. Friend the Member for Harlow to have a mental health professional available in every school.

Of course we need counsellors in schools, but it is very important that they are professional, that they follow guidance and that they can be trusted. In response to a survey by the Department for Education in 2017, only 47% of schools that employed counsellors said that their counsellors were registered with professional bodies, and one in seven said that their counsellors had no qualifications at all. We need to be very careful when we talk about counsellors in schools. They have a very influential role and they deal with vulnerable children, who often have mental health issues, as we know. They must fulfill that role responsibly and professionally, and they must follow guidance. I very much welcome the idea of community sector and third sector involvement, but we have to be very careful about the potential safeguarding issues if we do not follow the guidance and do not ensure professionalism.

I want to raise what I think is a very dangerous potential safeguarding issue that we are seeing in this area right now. Schools are inviting outside organisations in to provide counselling-type services and using their materials. Groups such as Stonewall and Mermaids are teaching what I think are dangerous and contested, extreme ideologies that do not have a basis in science to our children, and it is contrary to DFE guidance. We have groups such as the Allsorts Youth Project, which is teaching children that there are more than two sexes, and the Diversity Role Models group, which comes into school and provides workshops but tells children that their sex was assigned to them at birth. I have seen a video today by the Free to Be group telling teachers that they might drive children to suicide if they do not accept this ideology. And we have Stonewall wrongly interpreting the Equality Act 2010 in a way that erodes the sex-based rights particularly of girls, in a way that I think is very dangerous.

I know of children who have been counselled by adults in school that they would be happier if they changed their gender, and frighteningly, they are being told not to tell their parents and to keep this a secret. I know of schools where children are disciplined for complaining about children of the opposite sex being allowed to use their PE changing rooms. I think this pushing of an extreme ideology that does not have a basis in science and is highly contested is having terrible consequences, and teachers and pupils are afraid to speak out.

In 2009, 72 children were referred to the Tavistock’s gender identity service. In 2019, 2,364 children, of which two thirds were girls, were sent to the service. That is a 5,000% increase in the number of girls sent to the clinic in just 10 years. Many of them go on to be prescribed puberty blockers, and research suggests that 98% of those children are then given cross-sex hormones. These are children who will become infertile, sterile and have permanent loss of sexual function. How can 12, 13 or 14-year-olds consent to that? Many of these children have complex mental health issues. Many are autistic and many have difficult family backgrounds. Some are same-sex attracted, but are being told that they should change their gender. I am afraid that that is a consequence of a harm being done to our children as a direct result of this agenda being pushed in schools contrary to DFE guidance, which states:

“You should not reinforce harmful stereotypes, for instance by suggesting that children might be a different gender”.

The guidance goes on to talk about what material can and cannot be used.

I appreciate that the Minister has agreed to meet me to discuss this issue. Absolutely, we need counsellors to be available in school and we need more focus on wellbeing and emotional health. However, we must have a robust safeguarding process to ensure that the adults who go into schools and the materials they use are registered, approved and in line with DFE guidance, and that they are doing the best for our children, encouraging their wellbeing and not pushing their own agenda. I look forward to hearing from the Minister how he intends to ensure the guidance is followed and I appreciate his offer to meet me.