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.
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.