My Lords, I congratulate my noble friend on bringing this important debate to your Lordships’ House. It is of course appropriate that we are having it during Mental Health Week, as my noble friend Lord Haskel said at the beginning of his remarks. Indeed, he is quite right: we have been on a mental health journey in this country over the past 10 to 20 years. My noble friend described most eloquently the issues facing students and others with mental health problems. I should like to address the scale of the challenge we face.
I start with a shaming aspect of this challenge. Some 22 children have died suspected self-inflicted deaths while admitted to mental health hospitals and in-patient units in the past five years. My noble friend Lord Giddens spoke more widely about the tragic issue of suicide and related behaviour. Figures released by the Department of Health and Social Care show that four patients aged under 18 have died already in 2019, matching the highest number of fatalities in any previous year.
A Sky News investigation reveals that poor care in privately run child and adolescent mental health services units is putting vulnerable young people at risk. Patients, parents and whistleblowers have shared their experiences of privately run facilities paid directly by the NHS to care for some of the most challenging mental health patients, including those with serious eating disorders and those engaged in persistent self-harm and suicidal behaviour. One former patient told a story of the brutal physical restraint she had experienced, and of how she had been able to inflict life-threatening self-harm while in a privately-run unit. She said, “I would rather have been dead than alive in that place”. Former staff at another facility run by the same company until it was closed last month, described the culture of self-harm as “out of control”, and alleged that employees were directed to downplay serious incidents. Sky News revealed that a former member of staff at a third unit, also now closed, is subject to a police investigation.
These children are often placed in units many miles from home and family because of a shortage of appropriate services in their area. In 2017-18, NHS England paid private providers £156.5 million for specialist mental health services, which is 44% of its specialist budget. Inspection reports compiled since 2016 for 60 CAMHS units show that 88% of the NHS units were rated good or outstanding, while just 58% of those run by the largest private recipients of NHS funding were rated good. No privately run unit was rated outstanding, five were rated inadequate, and, since 2017, five have been closed.
First, how acceptable does the Minister think this is? Does she think that the NHS is getting value for money from these units? What is the incentive to make these young people well, given that the duty of the private units is to their shareholders, which must mean keeping full occupancy? There is a potential conflict of interest here. Those of us who have recently been engaged on the Mental Capacity (Amendment) Bill will be familiar with this issue. I would like to know from the Minister what the safeguards are.
A recent FoI request by the Labour Party found that 1,039 children and adolescents in England were admitted to non-local beds in 2017-18 for NHS mental health treatment, in many cases more than 100 miles from home. Is it acceptable that patients from Canterbury in Kent were sent 285 miles for in-patient mental health care, those from Cornwall and the Isles of Scilly 258 miles, and those from Bristol 243 miles? What effect does the Minister think this has on the youngster and their family? If that family are on a low income, it might prove impossible to visit on a regular basis, or for them to know what treatment their youngster is receiving.
Let us look further at the scale of this challenge. As my noble friend Lady Royall said, three in four children with a diagnosable mental health condition do not get access to the support they need. Three in four: that is graphically illustrated by the narrative from my noble friend Lady Massey. CAMHS turn away 26%—more than a quarter—of children referred to them for treatment by concerned parents, GPs, teachers and others. The average waiting time is more than 26 weeks. In a YoungMinds survey, 76% of parents said that their children’s mental health had deteriorated while waiting for CAMHS treatment.
Therefore, is it surprising that the number of A&E attendances by people aged 18 or under with a recorded diagnosis of a psychiatric condition has almost tripled since 2010? This translates, for example, to a severely depressed or anxious young person being at home for several months, unable to go to school because they feel so ill, with all the strain that puts on them and their family, to say nothing of the education they might be missing. They may become even more severely ill, which could have been avoided had treatment been readily available.
As many noble Lords have said, this means a huge cost to our NHS. Can the Minister provide assurance that the Government’s forthcoming Green Paper on prevention will include measures to improve the promotion of positive mental health for children and young people? Given that one in six young people aged 16 to 24 have symptoms of a common mental health disorder such as depression or anxiety, how does the Minister’s department aim to address the specific needs of that age group?
My noble friend Lord Bradley and the noble Baroness, Lady Tyler, have approached the workforce issues more than adequately. It is concerning that the number of doctors working in child and adolescent psychiatry has fallen every month since the beginning of 2018. There are serious societal problems that need addressing because of our children’s growing mental health issues. My noble friend Lady Morris gave us a great message of hope, but children who have had the most difficult and complex starts in life, experiencing abuse, neglect, bereavement, discrimination or poverty, are more likely to have mental health problems as they grow up. A study by SafeLives showed that 52% of children who witness domestic abuse experience behavioural problems in later life.
At a time of austerity, rising personal debt and precarious work, we are all encouraged to be individuals and not rely on anybody. Society perceives us to have failed in life and look weak if we do. There is a narrative that many people choose to be on zero-hours contracts. Then there is the gig economy. All these things put stresses on families, which puts stresses on our children. It is not only a well-funded NHS that we need. It is no accident that countries with stable welfare systems and school systems that do not focus on endless testing have good records on workers’ rights. That surely, is where we must aim to be.
I thank my noble friend Lady McIntosh for her brave and honest speech. I too watched Nadiya Hussain yesterday, and was very moved by her story. I also thank my noble friend Lord Bragg for reminding us of the change we have seen and the reducing of stigmatisation, and my noble friend Lord Layard for asking very pointed questions about money, which is where I wish to end my remarks.
One of the key targets in the Five Year Forward View for Mental Health is to go from 25% of CYP to 35%. That still leaves 65% not receiving access, which is not good. I am so pleased that my noble friend Lord Bradley shared his huge experience with the House. He got to the nub of it. Research by YoungMinds demonstrated that only 14% of STP plans at local level showed evidence of engagement with children and young people. Can the Minister provide assurances that integrated care systems will be required to consult young people about the services that affect them, as part of the implementation of the NHS long-term plan?