Good mental health is fundamental to thriving in life. I knew it from the other side of the tracks. My dear, late mother suffered greatly with mental health throughout her life, so I grew up and grew old trying to deal with it. It made me much more aware of what it means. I always used to say that if my mother came into school or wherever wearing a plaster cast on her arm, they would know that she had a broken arm. However, they did not know that she had a broken mind. At times it was extremely challenging. It made me a better person, more understanding and very aware of mental health issues.
More than one in 10 children aged 10 to 15 say they have no one to talk to or would not talk to anyone in school if they felt worried or sad. This is the same proportion of children who have a diagnosable mental health problem. Research shows that 50% of mental health problems are established by the age of 14 and 75% are by the age of 24. Young people in the UK today are dealing with high levels of stress due to a variety of issues.
The DfE’s state of the nation annual report that draws upon children and young people’s mental health, well-being and experiences over the previous academic year, found that evidence indicated lower well-being in December 2020 and February 2021 when schools were closed to most pupils compared to the previous months in the academic year. Reductions in average levels of well-being occurred most clearly in February 2021 when schools were closed to the majority of children before recovering towards the end of the academic year when restrictions were eased.
Of Ofsted’s eight strategic priorities, one is called “keeping children safe”. Ofsted notes that it has
“seen an increase in the complexity of children’s needs”.
No area has seen such a growth in complexity than mental health issues. In this context we have introduced three amendments. Amendment 145 asks that schools’ new attendance policies must consider
“the extent to which mental illness has contributed to truancy, and how mental health will be considered in developing the policy”.
In Amendment 170, during a school inspection Ofsted must assess
“the mental health of the student body”, which easily sits alongside its current strategic priority of “keeping children safe”. Thus schools with an inadequate mental health rating cannot be rated good or outstanding. In Amendment 171M we ask that
“The Secretary of State must report each year on … how the physical health of children in schools in England affects and is affected by their schooling”.
Some shocking and disturbing research from UCL has found that nearly five times as many children died from suicide compared to coronavirus during the first year of lockdowns. There were more than 1 million referrals made to specialist mental health services in 2021, up 15% compared to before the pandemic.
I draw noble Lords’ attention to the fact that mental health is not mentioned in this Bill. What we have debated over the past four and a half days is that this Bill tinkers with school structures while one in six children aged between six and 16 has a probable mental health issue. This is a priority area for Labour. We would guarantee mental health treatment for all who need it within a month and hire at least 8,500 new mental health professionals. But a creaking NHS cannot do this alone and the focus should be on prevention.
I have noted previously when talking about attendance matters that schools play a vital role in these areas, with the maintenance of general welfare and resilience throughout a child’s time in education rather than acting on it only in times of crisis, when it is often too late. One of my favourite mantras—anyone who has worked with me or for me in schools would say this—is “head it off at the pass”. It is what I always tried to do: stop it becoming a bigger problem. My other was always “less is more”, so I am going to finish now by saying that it is an absolute, acute crisis and one that needs recognising as essential to learning and welfare. We need to understand the drivers of the problem and we must give targeted support to tackle it.
My Lords, the noble Baroness, Lady Brinton, will be taking part remotely in this group. I invite the noble Baroness to take part.
My Lords, it is a pleasure to follow the noble Baroness, Lady Wilcox, especially today when the Anti-Bullying Alliance is asking all of us to encourage children to talk to someone if they are isolated, depressed or bullied. We know that they are not alone, but of course they feel fearfully alone.
Amendment 145 returns us to the issue of mental health in children in schools, which I raised in earlier parts of the Bill. It looks specifically at school attendance policy and ensuring that any mental health illness that has contributed to truancy is taken into account. That is helpful and fits neatly with my other amendments about following the advice of a doctor.
Amendment 170 is more general, and asks for Ofsted to assess the mental health of a student body—the overall health of all children in a school. We know that children and young people, their parents, their families, Ministers and parliamentarians are all too aware of the effect of the pandemic on their mental health. It is really important that we learn from that.
That is why I am particularly pleased to see Amendment 171M placing a duty on the Secretary of State to report each year on the physical health and mental health of children at school in England. This is particularly helpful, especially with all the concerns expressed recently. I particularly like the physical side: we all talk all the time about how important it is that children take exercise and that they eat properly. On all sides of the House, we discuss it often. But I do not think we actually assess what is happening in schools. For the Secretary of State to have to prepare an annual report on this will be extraordinarily helpful. I particularly like, in the amendment, proposed new paragraph (b)(iii) and (iv), which specifies
“the length of time spent by pupils waiting for mental health support provided through their school” and
“the adequacy of provision of mental health support in and through schools.”
That is because at the moment there is no focus. We keep saying that schools are the front line of mental health problems; indeed, we know that money has been put in by the NHS to provide counselling services, but we need to be able to see how long children are waiting and whether that money is sufficient. I have to say, wearing my health portfolio hat, that we know that mental health is still really underfunded, so we need to understand if delays continue even after some of this money has reached the front line.
The noble Baroness, Lady Wilcox, is absolutely right: the NHS cannot do this on its own. But I would go further: managing children’s mental health problems must be a joint venture between the child’s school and their access to mental health services. By cataloguing this in a report, the Secretary of State can be held accountable, alongside the Secretary of State for Health, for making sure that the Government deliver on their promises for mental health for our children.
My Lords, I will speak briefly on the issue raised by these amendments. I support the thrust of them, although I do not support all the details, particularly the one about Ofsted. I think that would not be an Ofsted role, but I agree that we need to have focus on it and that some organisation needs to give it.
My worry is that we are in the foothills of learning about what we should do with mental health in school. When I taught, which was many years ago now, it was never even discussed. It was not on our agenda, yet the children I taught in the inner city were just as likely to suffer from mental health problems as the generation that we have now. We are very much learning how to deal with this, which is worth bearing in mind.
I do not know what the answers are, but I think there is a problem and it is growing. In a way, it is becoming more evident to us because we did not analyse it in that way. Historically, we have always assumed that children did not suffer from mental health problems. It could be unhappiness at home, bad behaviour or whatever, but in schools we did not focus on mental health being a problem, except in the most extreme cases. Things are being done, but we really are in the foothills and we had such a long way to go before now.
There is the whole issue about CAMHS and its underfunding. It is a disgrace—we all know that. So much more needs to be done. I was interested in hearing from the Minister was about prevention work and the things that we can reasonably expect schools to do to head off people needing more acute services. The work I do in the Birmingham Education Partnership has had some success in this. We received a grant from the clinical commissioning group—so it was actually health money—about three or four years ago. We have rolled out a programme across the city now. I think it has been taken up by the DfE and is either closely aligned to, or has become part of, the DfE initiative, where it is getting mental health leads in schools.
All that is good, and I have seen the good work happening, but it is not universally successful. In Birmingham, where we have over 400 schools, we have put in extra money, resource and effort; we value this highly and prioritise it. After three or four years, however, we have still not rolled it out to every school, and we have only one person on this. This is a major problem. That is where my concerns are.
I will end up not disagreeing at all with what the Minister says about the initiative that has been launched for mental health leads, but it is not at the pace or speed that we need. We are starting from way behind if you look at any other area of school activity, be it phonics, numeracy, PE, sports or art. We have only just started on the journey of understanding what to do to support our young people with mental health difficulties. I should like to hear from the Minister what else is going to happen, and how they will build on the small seeds which have been slowly put into the ground and will take decades to help solve the problem.
If we are to get this right, we must have a picture that schools will not be staffed as they are at the moment. I worry that it is the teacher who has become the mental health lead. To be honest, if it is the physics teacher doing that, we need them in the physics lab teaching physics lessons. We cannot constantly take teachers away from the subjects we need them to teach to give them extra responsibilities to address important issues.
I know I am harking back a bit but, in the days of Every Child Matters and Sure Start, the aim that we made a start on when I was in the department was for a school to be staffed with people other than teachers. I remember visiting a school in the north-east, in Gateshead, where the secondary head proudly told me that just under 50% of his staff were teaching. The other 51% were not teaching: they were counsellors, mentors, assistants, lab assistants, careers advisers—all those other things. Unless you have that multitude of roles within the school, you cannot expect schools to be a key player in this; they just cannot do it. They can enable politicians to tick the box, make a speech and say, “I have done this”, but they will not be delivering effectively.
My vision would be to go back to the model of schools as bases where we can begin to support children’s mental health needs. The only way to do that adequately is to staff them with people who have the skills to do it. Of course, teachers have a role in that and we need mental health leads. I do not have a problem with that, but we cannot have nothing between the mental health lead and CAMHS. That is what we have at the moment: there is nothing in between, as far as a school is concerned. That is my worry.
It is a shame that Amendment 171Y was not spoken to as it is about testing eyesight. It is a great little amendment and it would be effective. I happened to work with some researchers once who did research in American kindergartens, the lowest schools in the system; they were experts in literacy and numeracy. They did eye tests on all five and six year-olds, and the number of children proven to need glasses at that point was unbelievable. They gave the kids a pair of glasses and kept a pair of glasses at the school—it was in a deprived area—and the attainment rate at the school rose significantly. No one had spotted that poor eyesight meant that the child did not know that they were missing out to some extent, especially children sitting at the back of classes. It is an important amendment, which would not need as much resource as mental health, but it would add to well-being and health. That would acknowledge the point that if we want to remove barriers to children’s learning, making sure they are mentally and physically well is a prerequisite for everything else.
My Lords, I want to raise some qualms about this set of amendments. For different reasons, I find myself agreeing with the way the noble Baroness, Lady Morris of Yardley, has just raised some issues.
I have spoken, on earlier amendments, about my concern about pathologising and medicalising all sorts of everyday experiences for children and adolescents. If we see the trials and tribulations of growing up— goodness knows, there are many of them—too much through the prism of mental health, we can contribute to children being anxious and worried about their own mental health. There is a kind of danger that we make children self-absorbed or unable to get over things and undermine their resilience. Important work has been done on this. One of my favourite books is The Dangerous Rise of Therapeutic Education by Professors Kathryn Ecclestone and Dennis Hayes, which was ahead of its time in worrying about some of these issues and raising them. There is a whole body of research on this work.
I started my professional career many decades ago as a mental health social worker before I became a teacher in further education. At that time working in mental health, I watched the expansion of what constituted a mental illness. Many people in the world of psychiatry and psychology are concerned about this. One thing the noble Baroness, Lady Morris, said was that it is early days with some of this. We have to be a bit careful and think about what we are doing when kids look as though they are stressed out—though obviously there are problems.
For example, we know that there has been, particularly among young girls and adolescents, an outbreak of self-harm. There is a real problem there; it is a kind of social contagion, and then we think that they need CAMHS support. On the other hand, there has also been a slight social contagion of gender dysphoria—certainly in many schools, among a lot of young women—but we are not allowed to say that that is a mental health problem because it apparently would be a form of bigotry. I suggest a certain modesty here in finding out where we are at.
We also have to be a bit honest with ourselves and say that maybe one of the greatest scandals of abandoning the young in recent times, and a real failure of safeguarding, has been that we closed down schools so much during lockdown—it was in and out, on and off. It was obvious what the consequences would be. There was collateral damage: the virus itself was not so much of a threat to young people but they suffered the consequences of two years of not knowing what they were doing—again, I recommend that people read the new UsforThem book The Children’s Inquiry, which includes a lot of evidence. That was what led to a lot of the problematic aspects of the Bill being rushed through —a panic about children not being in school and all the rest of it. This area requires great thought and a careful look at the research. We should certainly not rush in and it should certainly not be part of the Bill.
My final point is that, honestly, the idea of Ofsted inspections being asked to judge the mental health of the student body is traumatising even thinking of it. For any of us who have been in education, we know that the biggest dilemma for teachers is that they have to pass on a body of knowledge—a millennia of knowledge. You never know what to do. The curriculum arguments would be the bits that are the best of what is known and thought. Then there is the modern world: which bits do you pass on to young people? That is our obligation as educators, but you spend the whole time thinking that you have to cut out loads of stuff.
My concern is that if the purpose of schools becomes too embroiled in the therapeutic, we will end up never educating any young people. That would be bad for their physical and mental health, and certainly for their educational development. That is what schools should be for, without being insensitive to some of the mental health challenges of the day.
For the first time, I agree with the noble Baroness, Lady Fox, in many of the things that she said. This is a first.
One thing I want to add is that the Covid lockdown certainly created real problems. However, you can go further back and say that the recession created a situation whereby local authorities had massive cuts to their budgets. For example, my local authority in Liverpool lost a third of its budget, and services such as CAMHS just went. The resource was not there.
We all understand that young children’s mental health is hugely important, but we have not really thought it through. I do not mean this as any criticism at all. Governments will say, “Yes, we’ve got this scheme going, we’re doing this and we’re doing that”, but I would much prefer it if we completely understood what provision we needed to provide in all our schools and then made sure that it was absolutely Rolls-Royce. I would rather we said that, in every single primary and secondary school in England and Wales, we will ensure that somebody referred to CAMHS is seen within 10 days. Currently, we cannot do that. On Monday, we took evidence from a group of parents regarding, I am sorry to say, alternative provision. A very young, single parent talked us through how she had waited never mind days but months to get referred to CAMHS. Let us do just one small thing at a time and be successful in it.
The second thing I want to say, which my noble friend Lady Brinton mentioned, is the importance of linking up with health. We are not very good at this. I remember that health was the real problem for the education, health and care plans in the Children and Families Act. Getting health to work with education was an absolute nightmare, so good luck on that one. I do not understand why that is the case.
I turn to Amendment 171Y. Noble Lords will be sorry to hear that the noble Baroness, Lady Finlay, has had to catch a train back to Cardiff, so she asked me whether I would read out her speech—am I allowed to say that?
I am learning all the time, after 10 years.
Some 80% of all learning is visual. A child who has undiagnosed, uncorrected vision problems faces academic disadvantages, particularly in literacy and numeracy. This affects their safety, social and cultural development, and physical agility, and disadvantages them for life. The current child screening programme recommended by the National Screening Committee is targeted at four to five year-olds starting school, but a recent pre-Covid study suggested that only around 50% of local authorities are fully compliant with its specifications, and there is no commissioned post-screening follow-up. There is no provision for vision screening in other age groups, despite the numbers needing visual correction increasing in secondary school years.
The prevalence of myopia—short-sightedness—among 10 to 16 year-olds has more than doubled in the past 50 years from 7.2% to 16.4% and continues to grow. During Covid, short-sightedness may have increased between 1.4 and three times, driven by more time indoors and increased screen time. Up to 15% of pupils need spectacles or need their spectacles reviewed. Although an NHS eye examination is free for under 16 year-olds, a child might not be fully aware of, or may be reluctant to admit to, vision problems that would be picked up by a simple universal screening programme. Parents, teachers and carers might also not realise that the child’s vision is deficient. Universal screening would ensure that advice is available to all.
Basic smartphone or laptop-enabled screening could take less than one minute per eye to carry out. It builds on screening carried out in developing countries by volunteers using an “E” shape. Here, training of volunteers or support staff takes only half a day. Reports from schools are positive. It simply alerts the parent or guardian that the child should have a free NHS eye check. The details of the standard can be agreed by the Secretaries of State for Education and Health, with appropriate input from professional bodies and education advisers.
The amendment would not interfere with the NHS’s special schools eye care service, which began to roll out in April 2021 to over 70 special schools. Four in five children with learning difficulties attend special schools and are 28% more likely to have a sight problem than other children; 23% need glasses. The NHS service in special schools is praised by schools and parents. It has already identified that half of children in special schools have a sight problem, and more than 4,000 children have already benefited from it. I hope the Minister can provide an assurance that the rollout of the NHS’s special schools eye care service will restart, to reach a further 130,000 children in the next few years.
The amendment empowers the Secretary of State to set the standards to provide simple screening for all schools to alert to possible vision problems, which, if unaddressed, threaten the academic potential and social development of the child. It aims to remove health inequalities and to enable all children to access the support they need.
My Lords, taking first Amendment 145, the Government recognise that some pupils, such as those with mental ill-health, may face greater barriers to attendance than their peers. To ensure that all pupils receive the support they need to remove barriers to attendance, the department has recently published new attendance guidance entitled Working Together to Improve School Attendance. Through this Bill, we intend to make this guidance statutory.
The new guidance sets a clear expectation on all schools to have an attendance policy that is applied in such a way that it considers the individual needs of pupils and supports pupils to overcome barriers to attendance. This includes supporting pupils with mental ill-health, so that they can attend school regularly. This is in addition to obligations under the Equality Act 2010 and the UN Convention on the Rights of the Child. Ofsted will consider schools’ efforts to improve or sustain high attendance as part of its regular inspections, which includes efforts on their attendance policies.
On Amendment 170, it is right that schools should be accountable for their role in supporting their pupils’ mental health, but requiring Ofsted inspectors to assess pupils’ mental health and then to restrict inspection outcomes on that basis, as this amendment would do, would place responsibility for pupils’ mental health squarely on the shoulders of the individual school. I hope your Lordships would accept that that is not appropriate. Many factors can influence a pupil’s mental health and some of these, such as the culture of a school, are inside the school’s control, but many others are not.
As I think noble Lords have agreed on previous debates on mental health, it is not for schools to take on the role of providing specialist mental health support. It is important that we hold schools to account for the right things: delivering a high-quality curriculum that meets people’s needs; providing strong pastoral support; promoting a strong ethos and an inclusive culture; ensuring pupils are safe and feel safe; and engaging effectively with parents and local services. These elements play a key role in supporting pupils’ mental health and are an essential focus of Ofsted’s school inspections.
On Amendment 171M, the department already gathers and assesses a range of data on children and young people’s mental and physical health to improve our understanding and inform the support we provide children, young people and education settings. We do this through publishing an annual State of the Nation report. The department also undertakes and publishes pupil, parent and teacher omnibus surveys, which include a range of questions about the type and level of mental health support provided in schools.
What the debate has been trying to get at—and we have had this for several days in Committee—is thinking through and making sure the Government continue to be held to account for improving the provision of mental health services for young people, including in the support they get through schools. We have put quite a lot of thought and work into that, but there is definitely more to do.
To take the point from the noble Baroness, Lady Morris, we have a policy of putting funding in place so that every school can have a mental health lead trained by 2025. That mental health lead can take a whole-school view of the school’s role in supporting pupils’ mental health. A lot of that might be about prevention, discussion in PSHE classes, the school’s ethos and other things. They will then be equipped with the training to make sure they develop the right approach for their school, but we know that they should not provide specialist mental health support. That is why we are rolling out mental health support teams to provide both early support within schools and that link to specialist support. That is funded by the NHS.
However, those teams are no good if the services are not there for students to access. This is why we are increasing funding to children’s and young people’s mental health every year; it is going up as a proportion of spend compared to both adult mental health and the NHS overall. Noble Lords have made the point about pace, and I appreciate this because, even with the money there, it takes time to scale up those services. So it is not that we are complacent or claim to have all the answers, but I reassure noble Lords that we have thought this through from the perspective of the funding for the specialist services and the link between schools and those specialist services. We are then equipping teachers within those schools to think about what can be done within the school itself. I think we are making good progress on that.
As a final point on pace, we are ahead of our aims on those specialist mental health support teams. We were aiming for them to be in a quarter of schools by next year, but as we are already at 26%, we have increased our ambition to 35% of schools. Again, we need to go further, but I hope that this provides some reassurance to noble Lords on what we are doing and how seriously we are taking it.
On the NHS side of things—which noble Lords have touched on—there is a series of commitments about introducing new access and waiting time standards for mental health services to ensure timely access to community health care. This includes a new access and waiting time standard for children and young people, and their families or carers, presenting to community mental health services to start receiving care within four weeks from referral.
Finally, on Amendment 171Y, introduced by the noble Lord, Lord Storey, as noble Lords are aware, free eyesight tests are available at opticians, funded by the NHS, for all children under 16 and for young people under 19 who are in full-time education. Further, vision screening is usually carried out for four and five year-olds, most often in school settings, to check children’s eyes. Under the opportunity area programme, we are running the Glasses in Classes scheme in five disadvantaged areas in England. We are also trialling a feasibility study into school-led vision checking across schools on the North Yorkshire coast. While it remains the case that qualified NHS staff and opticians are best placed to undertake regular annual vision screening for most children and young people, I hope that noble Lords are reassured by the extensive work the Government are doing.
Returning to the point on mental health, I hope that I have provided a better picture of what we are doing and how we have thought about our actions in this area. With that, I hope that the noble Baroness, Lady Wilcox, can withdraw her amendment.
I thank the Minister for her reply. Picking up on the glasses point raised by my noble friend Lady Morris and in the amendment of the noble Baroness, Lady Finlay, I remember that we had a huge influx of Roma children to Newport a couple of years ago. Ensuring that they got their eyes tested was very much part of what we did for them—it opened up a whole new world and we kept a spare pair of glasses in school for them. We had about 150 children in one fell swoop. It was a great idea and I have seen it work in practice.
The new guidance to which the Minister refers will no doubt be welcomed, if there is specific awareness of mental health issues. I note her response regarding Ofsted and the comments from other noble Lords, but I still think that there are opportunities that could be developed. We indeed want to hold the Government to account for improving and developing the approach towards mental health matters; it is about playing catch-up, and this is not going to go away. On that basis, I beg leave to withdraw my amendments.
Amendment 145 withdrawn.
Clause 53 agreed.
Clauses 54 and 55 agreed.
Amendment 146 not moved.
Clause 56: Expanding the scope of regulation