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 of 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.
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 Long Term 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.