[Relevant documents: First Joint Report of the Education and Health Committees of Session 2016-17, Children and young people’s mental health—the role of education, HC 849, and First Joint Special Report of the Education and Health Committees of Session 2017-19, Children and young people’s mental health—the role of education: Government Response to the First Joint Report of the Education and Health Committees of Session 2016–17, HC 451]
I beg to move,
That this House
has considered e-petition 176555 relating to mental health education in schools.
It is a pleasure to serve under your chairmanship, Mr Brady, and to lead this debate on behalf of the Petitions Committee, given the importance of this issue for society as a whole and because of the frequency with which young people raise it with me whenever I visit local schools and youth organisations in Newcastle upon Tyne North. The e-petition, entitled “Make mental health education compulsory in primary and secondary schools”, has been signed by more than 103,000 people. It reads:
“Mental health education is still not part of the UK curriculum despite consistently high rates of child and adolescent mental health issues. By educating young people about mental health in schools, we can increase awareness and hope to encourage open and honest discussion among young people.”
I am pleased that many hon. Members are present today. That reflects the importance and timeliness of the debate. Many other hon. Members would like to be here but are unable to attend, and I am happy to put their concerns on the record. My hon. Friend Vernon Coaker asked me to convey his constituents’ concerns, even though he is unable to be here himself.
I congratulate the e-petition’s creators—Tom King, a student mental health nurse, and Adam Shaw, the chairman of the Shaw Mind Foundation—on securing more than 100,000 signatures in the three months before the e-petition was closed just before the unexpected general election. Adam Shaw launched the e-petition as part of his charity’s wider HeaducationUK campaign. He explained why he established it:
“Currently mental health is only taught as an optional component of PSHE—but this is not good enough. It needs to be compulsory. Understanding mental health is an absolute life skill, and should be just as fundamental within the school curriculum as reading and writing. There needs to be a compulsory collaboration and integration between mental health education and physical education, so that children and young people can understand that maintaining good mental health is equally vital to their wellbeing.”
The HeaducationUK website states:
“The UK national curriculum puts a lot of emphasis on teaching our children about how our bodies work, physical illnesses, and how exercise and nutrition can keep us healthy. These are taught in mandatory subjects such as PE (physical education) and biology…Currently, mental health education is taught inconsistently in the UK, and only in secondary schools—despite 1 in 5 children experiencing a mental health difficulty before the age of 11.”
Will my hon. Friend pay tribute to the mindfulness pioneers in the UK who developed the .b curriculum for secondary schools and Paws b for seven to 11-year-olds, which was developed at Bangor University? Bangor is already working on a curriculum for three to seven-year-olds. Most importantly, will she commend the work of Oxford University’s mindfulness centre and the Mindfulness and Resilience in Adolescence—MYRIAD—project, which hope to prove scientifically the benefits of mindfulness for young people aged 11 to 18?
I am more than happy to join my hon. Friend in congratulating those organisations. He has campaigned hard on that issue in this place for many years.
“Mental health education is delivered via the non-compulsory subject PSHE (Personal, Social, Health and Economic), or sometimes during school assembly or drama lessons. As PSHE is a non-compulsory subject, this means that not all schools teach it, and that in turn means that mental health education isn’t always taught.”
I completely support the thrust of the hon. Lady’s argument. Does she agree that, because of the lack of training for teachers in this particularly important subject, what is being applied now is really just emotional first-aid? If people are to do more, they have to have the ability to teach more. How does she see that working out?
The right hon. Gentleman makes a very important point. Teachers are not mental health professionals: they are teachers by profession. It is therefore vital that we improve not only our educational input but the training and support for teachers so they can deliver this support at an appropriate level and are able to signpost and refer issues if professional input is required. I will return to that key issue later.
Following the point made by Sir Nicholas Soames, does my hon. Friend, like me, welcome the fact that one teacher in every secondary school is now going forward for mental health first-aid training? In itself, that will not deal with our young people’s mental health needs, so we need a full-scale plan to train teachers and equip every young person with the skills and expertise they need to deal with their mental health and that of others.
Does my hon. Friend agree that, in light of the fact that mental health challenges start when people are young, it is crucial that schools have mental health practitioners who can support young people? Teachers are not health professionals, and therefore do not have the necessary skills. They have numerous other pressures to focus on, so is it not crucial that we have mental health practitioners in schools?
Yes—I will come on to some of the big challenges in this area. It is one thing for us to agree on the principles and on the fact that we want a much better focus on mental health in the education system, but it is another matter to ensure we make the tools and resources available to make that a reality for every child in this country. I will expand on that later.
The Northherts Emotionalhealth in Schools Service trains teachers, parents and students, with peer mentoring, so all parts of the school team work together on mental health. It has been really quite successful, and has held conferences. Should the Government not look at examples such as that—it is funded by Hertfordshire County Council—for the future?
Indeed. I thank the right hon. and learned Gentleman for putting that on the record.
I pay tribute to UsActive, a Newcastle-based charity, whose representatives I met recently. It uses physical activity to promote better mental health for children and young people in my local area, and highlights the interrelated nature of physical and mental health in young people’s lives. I absolutely agree with the concerns that the petition raises. We must highlight the link between our physical and mental health if we are to get the best outcomes for our children holistically and educationally.
I agree that the earlier that children and young people are educated about these issues, the better. We must properly support them throughout their childhood, help them to develop resilience so they can deal with any issues they face, prepare them for adult life, help them to develop coping mechanisms for the many challenges that life will bring, and ensure that they become well-rounded individuals capable of empathy and understanding for others, whether friends, family members or work colleagues, who will inevitably be affected by mental health issues. They should recognise that such issues are as much a part of everyday life as physical health concerns.
I am delighted that I have a local link to the creator of the e-petition through my constituent Reverend Mark Edwards, who works closely with the Shaw Mind Foundation to raise awareness about mental health. Mark recently published a book via Trigger Press about his mental health journey entitled “Life After Care: From Lost Cause to MBE”. It details how he went from spending the majority of his childhood in foster care and being sectioned under the Mental Health Act 1983 to being a team vicar at St Matthew’s church in Dinnington in my constituency, a volunteer first responder with the North East Ambulance Service, police chaplain to the Northumbria police and a former volunteer lifeboat crew member—all of which led to his being awarded an MBE. Mark has shared his experience because, in his own words:
“So many people’s stories end in tragedy either because they suffer in silence or because they feel there is no support for them and that they are the only one suffering mental health issues.”
Crucially, he wanted to share his story to illustrate that “there is always hope”. Mark’s story is a powerful one, and would be if it were included in any mental health education delivered in schools.
The hon. Lady is making a powerful and important point about supporting children in care and meeting their mental health needs. She served with me on the Select Committee on Education when we did an important report more than a year ago about the mental health needs of young people in care. Does she agree that that is an important part of what we are debating?
Absolutely. The hon. Lady is right that the Select Committees on Health and on Education undertook a joint inquiry and report into these very issues because, crucially, health and education are intertwined when we look at mental health and physical wellbeing. The outcome of that inquiry was that I was very keen to lead in this debate, because I share her view that it is crucial to improve outcomes for children in care as well as for all our children and young people.
The statistics are startling. HeaducationUK highlights some of them: 850,000 UK children and young people aged five to 16 have mental health problems, which equates to around three in every classroom; more than 75% of mental illnesses in adult life begin before the age of 18; the number of young people attending accident and emergency with a psychiatric condition has risen by 106% since 2009; reports of self-harming among girls aged 13 to 16 rose by 68% between 2011 and 2014; and suicide is the biggest killer of young people aged under 35, with an average of 126 suicides a week and more than 200 children of school age dying by suicide each year.
Is my hon. Friend aware that 32.3% of 15 to 25-year-olds have one or more psychiatric conditions? The wider point about all those terrible statistics is that even people who are not adversely affected by mental ill health can be taught in school through modern positive psychology and mindfulness to lead flourishing lives. The whole wellbeing curve of mental health could be shifted if we took that root-and-branch approach to putting mental education into our schools.
My hon. Friend makes a powerful point. It is about not just shifting the life experience of an individual, but the knock-on effect of shifting the life experience of everyone around the individual and the whole community. We know that the lack of support and mental health education affects not only individual young people, perhaps for the rest of their life, but those around them. The potential returns from investing in our young people in that way are significant.
Is it not crucial that we also understand the triggers, the causation, of mental health conditions in young people and where the stress factors fall, for example in the pressures of the exam system? Those issues should be addressed.
I agree with my hon. Friend. I will talk about that because it is one of the issues that young people raise with me time and time again: the amount of stress and pressure that they feel under from a worryingly young age.
The figure my hon. Friend gave of three children in every classroom being affected comes from a study done more than 10 years ago. Does she, like me, look forward to the Government’s review of young people’s mental health in this country because, anecdotally and from what figures we have, more children are coming forward? The acuity of the conditions that they are affected by and of their feelings and whatnot are, in essence, elevated from previous levels.
I absolutely agree, and that is something I have seen even since I was elected in 2010. When I meet groups of young people, they used to be worried about their local parks—their availability or local vandalism—but now the No. 1 issue that young people raise is stress and anxiety. I will go on to talk about the range of factors involved, such as social media and its impact on young people, which is obviously positive but also has some clear negatives, with warning factors. The level of academic pressure that young people are under from a very young age is a big concern and one that I would like the Government to listen to seriously and address.
I support the main thrust of the debate, but education is not the whole issue, although my hon. Friend is making some good points. The scandal that we are facing is about parity of esteem for support in schools—I totally support work on that—as well as the broken child and adolescent mental health services system. I have constituents who, even when they are not facing crisis, wait for months or in some cases years to get a diagnosis. This is about not only education in schools but, when young people get into crisis, the scandal of the CAMHS system which, I am sorry to say, is just broken.
My hon. Friend speaks from great knowledge, experience and passionate campaigning. I agree very much with what he has said. We would not tolerate a child with a broken leg being left untreated for months on end, yet that is the case for far too many of our children and young people who present with mental health issues that clearly need professional attention. Such is the concern about the situation in my local area that the newly established community-led campaigning organisation Tyne and Wear Citizens has decided to hold an inquiry into the issue in the new year, very much based on feedback from groups of young people who have raised it as their key concern. I look forward to taking part in that inquiry in the months to come.
I agree very much with the general thrust of what has just been asked and said, but does the hon. Lady also agree that making counselling available in the school, increasing awareness among parents of issues such as self-harm and anxiety, and having peer mentors—to take an holistic approach—can nip in the bud some conditions that could otherwise get worse?
I absolutely agree, and we are not at odds in that viewpoint. What I hope comes out of the debate—what I hope the Minister listens to and takes on board—is the holistic approach. It is about taking a whole-person approach in the education system, while ensuring that our health system matches it equally. We talk about parity, but my hon. Friend Mr Jones is absolutely right that that is not a reality for those needing mental health support. We need proper training and resources in schools from as young an age as possible to give that support and educational input and to ensure that specifically trained health professionals can provide support and treatment where necessary for young people.
My hon. Friend is being very generous with her time. As has been mentioned, a survey by HeaducationUK found that 75% of school leaders said they lacked the resources to meet the mental health needs of their pupils, citing the lack of training as one of the main contributing factors. I of course agree with Sir Oliver Heald that counsellors and an holistic approach would be beneficial and would help to nip the problem in the bud, but I would like to put on the record the massive funding pressure on schools. I am sure that teachers and heads will be looking at this debate saying, “Of course we would like to put that on, but we are currently having to cut core subjects from our curriculum, let alone looking at additional extras that it would be wonderful to have in schools.”
I absolutely agree, and my hon. Friend makes the case clearly, as I intend to in this debate. It is not about talking the talk but about walking the walk, to ensure that we have the resources necessary, not only for the training that our teachers need to feel confident about providing educational input where appropriate, but for trained professionals to be in place where required.
Schools are under inordinate pressure. I had a very difficult meeting with a local headteacher who struggled to hold back tears as she explained that she would have to lay off the school councillor for this financial school year—the choice was that or cancelling all the school excursions for the entire year. That is a very difficult decision for any headteacher to make, but there are school leaders up and down the country making those difficult decisions that ultimately will ensure that our children do not have the support that they need, and that children and their families are not looked after when they are in trouble, which will have long-term impacts on the education outcomes not only of that child but all the other children in that school.
I thank my hon. Friend for kindly giving way—I will not make any further interventions although I am very passionate and want to do so, but unfortunately I cannot stay for the entire debate. To add to the point about the passion that exists across the country, I had the opportunity to join the Liverpool Association of Secondary Head Teachers on a termly basis. Those headteachers are all passionate about their students’ mental health, but in Liverpool we have just seen a cut to our young person’s advisory service, which is the key mental health service for our young people, of 74%. That is a staggering amount—three quarters of a million pounds. Our main service for primary school children, the seedlings service, has also been taken away. There is a big disconnect between what schools want to do for their students and what they are able to do, which is why this debate is so important.
I am delighted that hon. Members on all sides of this debate are making my case for me. I just hope that the Minister is genuinely listening and taking that on board, so that change and something positive can come from putting on record the cross-party agreement on the need to do something for our young people on this issue.
The figure that I mentioned of 32.2% of 15 to 25 year-olds will include trainee teachers. After they finish their training, 40% of teachers do not continue in education after the first year, largely because of stress, so does my hon. Friend agree that perhaps one way to square the circle would be to train those 18 to 21-year-old potential teachers in ways of getting their own equilibrium, which might be a gift that they can pass on to tens of thousands of children over the course of their career?
My hon. Friend makes a key point. It is not just children and young people who face mental health difficulties as a result of the stressed environment in our education system, but the teachers, too. One has a huge impact on the other. Taking a whole-school approach to the issue could transform the lives of everybody in that school environment, all the families who surround it and are connected with it, and the local community.
Last week, my right hon. Friend Robert Halfon and I, along with other members of the Select Committee on Education, met teachers to discuss that very point about the mental health implications for them of being overburdened and overstressed by the many demands made on them. They made the exact point that the hon. Lady just made: that the mental health difficulties that they encounter inhibit them from helping their pupils. Does she agree that it is very important that the Green Paper includes provision for assisting teachers in dealing with their own mental health?
The hon. Lady put that very well.
Comments from Adam Shaw, the creator of the e-petition, are highly pertinent. He says:
“I would personally love to ask” the Prime Minister
“and Government ministers what the benefits are for not having compulsory mental health education. If you really study this question and ask yourself it seriously, the more ridiculous the concept of not having it becomes.”
As I mentioned, in the last Parliament, the Education Committee, of which I was a member, and the Health Committee published a joint report, “Children and young people’s mental health—the role of education”, which concluded that
“Schools and colleges have a front line role in promoting and protecting children and young people's mental health and well-being.”
We also welcomed the Government’s commitment in March to make personal, social, health and economic education and relationships and sex education a compulsory part of the curriculum from 2019. The Department for Education’s policy guidance accompanying the announcement confirmed that statutory PSHE is expected to cover
“healthy minds, including emotional wellbeing, resilience, mental health”, and statutory RSE is likely to include
“how relationships may affect health and wellbeing, including mental health”.
However, in the context of this debate and the request of the e-petition, will the Minister say from what age he expects that to be covered in schools, and how much time he expects will be dedicated to it? It is important to highlight that we talking about a cross-party, joint Select Committee report, which expresses its support for
“a whole school approach that embeds the promotion of well-being throughout the culture of the school and curriculum as well as in staff training and continuing professional development.”
As such, we concluded:
“The promotion of well-being cannot be confined to the provision of PSHE classes.”
I am very sorry to intrude on the hon. Lady’s good nature by intervening again. I share everything that she says and I will support it to the nth degree, but I am worried about a question that needs to be answered. Given the diversity of teacher training, how will we get the kind of consistency required to deliver the excellent improvements that she suggests?
The right hon. Gentleman raises a pertinent question and one that I would be keen for the Minister to answer when he responds. This is not just about the young people who we want to benefit from a whole-school, holistic approach to mental health education; it is about the ability of our teachers, support staff and the wider school to deliver that. It is partly a training issue but partly, and significantly, also a resource issue. I am pleased that the right hon. Gentleman raised that question and I would like to hear the Minister’s response.
The whole-school and universal approach to mental health is supported by the British Psychological Society and the Association of Educational Psychologists. The charity YoungMinds, which also campaigned on this issue, made the following recommendations to the Government in its recent report, “Wise Up: Prioritising Wellbeing in Schools”. It recommended that existing legislation should be updated
“to enshrine wellbeing as a fundamental priority of schools” and that mental health and wellbeing should be established
“as a central part of school improvement, by strengthening the focus on wellbeing provision within the Ofsted framework”.
It also recommended that a wellbeing measurement framework should be developed, trialled and established by 2020, that an
“understanding of wellbeing, mental health and resilience” is embedded in all teacher training, and that schools are provided with
“designated funding to resource wellbeing provision.”
That leads me to a number of key issues that I believe must be addressed alongside the provision of compulsory mental health education if we are serious about genuinely supporting children and young people on this issue.
On funding, does my hon. Friend not agree that it is economically expedient to put this training in place? I know from talking to a head of a primary school in York that she was spending all her time trying to support the mental health challenges of the children in her school, as opposed to being the head of the school, as it is so time-consuming. Therefore, putting the expenditure, funding and investment—if I can call it that—into ensuring that we have a proper mental health programme will actually save resources.
My hon. Friend is absolutely right. It feels uncomfortable to talk about this in monetary terms, but ultimately an invest-to-save policy approach would make huge differences, because if teachers and young people are better supported in their mental health and wellbeing, that will relieve pressures in that school and further down the system, and into adulthood and beyond.
The Government should take seriously the recommendations that I outlined from YoungMinds, which all address putting targets in place and the funding necessary to meet them. I want all children across the country to have the best possible education, filled with rigour and challenge—one that will provide them with the right knowledge and skills to set them up for their adult lives, where they will face many challenges, including in the workplace. However, I know from my time on the Education Committee and from regular conversations with school students, parents and teachers across my constituency just how much pressure young people feel under as a result of ever-increasing demands for schools to deliver the right academic results. Indeed, a constituent recently contacted me about her son, who was prevented from studying certain subjects at A-level despite having achieved good B grades at GCSE. She commented:
“My son is resilient but this has knocked his confidence as he is effectively being told he is not good enough at the start of a really important two years of school.”
There are increasing concerns about the introduction of the English baccalaureate and its significant narrowing of the curriculum at many secondary schools, which reduces the opportunity for many pupils to excel, such is the pressure on schools to deliver results in a small number of Government-defined core subjects.
There is really disturbing pressure on primary age pupils as a result of significant recent changes to the curriculum, school performance measures and SATs. A recent Guardian survey found that some 82% of primary school leaders had seen an increase in mental health issues among primary age pupils around the time of exams, with effects including loss of eyelashes through stress, sobbing during tests, sleeplessness, anxiety, fear of academic failure, low self-esteem, panic attacks and depression. That is in primary schools. I find that a really disturbing picture. Although I am pleased that the Government have listened to some of the concerns across the sector and agreed to scrap key stage 1 tests by 2023, the impact of high-stakes assessments clearly remains for key stage 2 pupils.
It seems to me that there is little point in the Government mandating compulsory mental health education in our schools while they actively undermine pupils’ mental health in the way that I have outlined and that I have seen in the young people I have spoken to and heard from. Indeed, the joint report of the Education and Health Committees concluded:
“Achieving a balance between promoting academic attainment and well-being should not be regarded as a zero-sum activity. Greater well-being can equip pupils to achieve academically. If the pressure to promote academic excellence is detrimentally affecting pupils, it becomes self-defeating. Government and schools must be conscious of the stress and anxiety that they are placing on pupils and ensure that sufficient time is allowed for activities which develop life-long skills for well-being.”
I look forward to hearing how the Minister intends to ensure that this situation is rectified, as it is clearly in the Government’s gift to do so. Of course, a plethora of other issues contribute to the poor mental health of far too many children and young people. The Select Committees’ joint report touched on some of those, which include social media pressures, cyber-bullying, internet safety, sleep deprivation and body confidence.
I seriously urge the Government to recognise just how detrimental families’ economic situations can be for children and young people’s mental health. As part of its breathing space campaign, the Children’s Society powerfully highlighted that
“children in low-income families with multiple debts are more likely to suffer from mental health problems than equivalent families with fewer debts.”
It is estimated that in my constituency alone, some 3,348 children live in families with problem debt. Again, it is in the Government’s gift to do something about that.
Of course, one of the key ways to ensure that our schools deliver something is measurement of it by Ofsted. Reporting to the Education and Health Committees’ inquiry, the Association for Child and Adolescent Mental Health described Ofsted as the
“largest driving force in school practice”; the Institute for Public Policy Research stated that the
“Ofsted framework has a very strong ability to influence school behaviour”; and the Education Policy Institute commented that the
“benefit of having Ofsted look at wellbeing is that it is a signal to schools that it is part of their job, and it is not just about accountability measures and the academic side”.
However, IPPR research found that just one third of Ofsted reports made explicit reference to pupils’ mental health and wellbeing, even after personal development and wellbeing criteria were included in the Ofsted inspection framework. That is why the Select Committees’ joint report recommended:
“More must be done to ensure that mental health and well-being are given appropriate prominence in inspections and in contributing to the overall grade given to the school or college. The recently appointed Chief Inspector should, as a matter of priority, consider ways in which the inspection regime gives sufficient prominence to well-being.”
I congratulate my hon. Friend, who is making a compelling case and a thoroughly excellent speech; she has stolen nearly all the points I wanted to raise. She makes an important point about Ofsted and why it is wholly inappropriate to roll mental health education into PSHE. Ofsted mentioned PSHE provision in just 14% of its secondary school reports and only 8% of its primary school reports under its most recent inspection framework. That shows how poor PSHE provision is in schools and why it is vital that mental health education provision is completely separate.
I thank my hon. Friend for both her kind comments and her intervention. We will go on repeating the same arguments and the same compelling case for change until the Government make the changes that we know are needed. I look forward to hearing the Minister’s responses to the specific concerns that I outlined in relation to the Select Committees’ joint report and to the concerns raised by my hon. Friend, from whom I hope we will hear more later.
It would be hugely remiss of me to lead a debate on this subject without touching on the increasing pressures on our education system. Although I firmly believe in the importance of mental health education in our schools, I am always reluctant to propose placing yet another requirement on teachers, who are hugely overworked and under-resourced, particularly given the ongoing financial crisis that many of our schools face.
Despite the Government’s recent announcement about additional funding, the reality is that 88% of our schools still face a real-terms budget cut by 2020. In my constituency, that means Walbottle Campus losing more than £460,000 in real terms between 2015-16 and 2019-20—the equivalent of 10 teachers or £321 per pupil. For Gosforth Academy, it equates to a total real-terms loss of almost £430,000 in the same period. Those are staggering sums, and I know how agonising that is for headteachers who are trying to balance the books. I mentioned earlier that at least one of my local headteachers had to cut the school counsellor to make the necessary savings.
There is little point in seeking to introduce compulsory mental health education at the same time as budget cuts are resulting in existing mental health support for students and families being axed—a situation that is reflected around the country, as the evidence given to the Education and Health Committees showed. There is also little point in introducing compulsory mental health education or a whole-school approach to mental health if it is not done properly, which is why the Select Committees’ joint report highlighted that doing so
“will have implications for staffing and training and the balance of provision and delivery of subjects across the curriculum to allow more time to focus on well-being and building resilience.”
Our report also emphasised:
“Teachers are not mental health professionals, but they are in many cases well placed to identify mental ill health and refer students to further assessment and support. Training school and college staff to recognise the warning signs of mental health ill health in their students is crucial. We encourage the Government to build on the inclusion of mental health training in initial teacher training and ensure current teachers also receive training as part of an entitlement to continuing professional development.”
I know that there is much support for that from hon. Members who have already contributed to this debate.
I am grateful to my hon. Friend; she is being generous with her time. Is there not a risk that teachers may feel pressure that they may miss something if they have to refer people to the system, and therefore that they will be really concerned about over-referring or under-referring? That is why it is so important for mental health professionals to be available to support teachers and, more importantly, children.
My hon. Friend raises an important point. I wanted to come on to CAMHS, which my hon. Friend Mr Jones raised eloquently and powerfully. I support the introduction of mental health education in our schools, for that whole-school approach to be implemented, but I reiterate my concerns that teachers and schools must be adequately resourced and trained for that. School budget cuts, which are resulting in vital services being axed, must stop, and the Government must seriously look again at those issues that are causing young people’s mental health to be so adversely affected. I also feel strongly that in promoting greater mental health awareness and encouraging children and young people to speak out and seek that help, we must ensure that treatment and support is available for them when they need it. We all know that simply is not the case for far, far too many young people affected by mental health conditions at present.
“whilst most specialist services provide good quality care, too many young people find it difficult to access services and so do not receive the care that they need when they need it. One young person told CQC that they waited 18 months to receive help. Using estimates from the London School of Economics, Public Health England reported that only 25% of children and young people with a diagnosable mental health condition accessed support. The Royal College of Psychiatrists has noted difficulties in finding specialist inpatient beds close to a young person’s home.
CQC has rated 39%—26 services—of specialist community child and adolescent mental health services…as requires improvement and 2%—1 service—as inadequate against CQC’s ‘responsive’ key question, which looks at whether people access care and treatment in a timely way.”
It went on to comment:
“The problem of gaining access to specialist help is contributed to and compounded by the fact that those who work with children and young people—in schools, GP practices and A&E…do not always have the skills or capacity to identify or support the mental health needs of children and young people. When concerns are identified, children and young people, and their families, often struggle to navigate the complicated and fractured system of services created by a lack of joined-up working. Many organisations are involved in planning, funding, commissioning, providing and overseeing support and care for young people with mental health problems. Poor collaboration and communication between these agencies can lead to fragmented care, create inefficiencies in the system, and impede efforts to improve the quality of care.”
That paints a deeply concerning picture, particularly in the light of the statistics I cited at the beginning of the debate. Indeed, the Children’s Commissioner, Anne Longfield, has stated that the CQC’s report makes for “sad reading.” She went on to comment:
“Like the CQC, I acknowledge there are efforts being made to change things and that the staff working in children’s mental health are doing a good job in difficult circumstances. That was never my concern. It is those not getting the care they need…that worries me most…fewer than a quarter of children needing mental health support received it last year. There are severe shortages throughout the system, with the majority of local NHS areas failing to meet NHS standards on improving services.
Yet the numbers we cite on delays, expenditures and percentages can only tell you so much. The reason my office has focused so hard on…mental health this year is that we also hear—day in, day out—from children themselves, their carers, teachers and health system professionals about just how desperate the need is out there.”
I reiterate my concerns about the risks of introducing compulsory mental health education and a whole-school approach to this issue if we do not ensure at the same time a dramatic improvement in the support and treatment available to children and young people when they encounter a mental health condition. We must not have situations in which children wait 18 months to receive support, so that we are not simply ensuring that that those children and young people will continue to be affected by those mental health issues throughout their lives, with all the long-term social, economic and personal costs associated with that.
I reiterate my absolute support for the issues the e-petition raises and the need to ensure that all children and young people receive good quality, age-appropriate mental health education throughout their schooling. I acknowledge that some progress has been made in this area: for example, the Education and Health Select Committees heard about the 2015-16 £3 million pilot between the Department for Education and NHS England to provide joint training to schools and CAMHS staff and to test how having single points of contact in both schools and CAMHS can improve referrals to specialist services. I also know from the Government’s response to the e-petition that they are developing a new Green Paper on children and young people’s mental health to be published later this year, with
“new proposals for both improving services and increasing focus on preventative activity.”
May I take this opportunity to press the Minister to ensure that the various concerns I and hon. Members have raised today—I am sure they will continue to be raised as the debate continues—are tackled as part of the Green Paper, if we are genuinely to address the wider issues for children and young people: the pressures they face as a result of issues in their school and home life; the severe financial pressures schools are now facing and the implications of that in their ability to provide mental health support; and of course the monumental pressure on CAMHS services, which has resulted in a system that is at breaking point? I also suggest to him that, instead of more pilots, promises or warm words about mental health, we take those urgent, necessary steps. We need Government action if we are to prevent the terrible statistics I have outlined throughout this speech, which are just getting worse.
Indeed, only yesterday it was reported that 12 mental health organisations, including the UK Council for Psychotherapy, the Mental Health Foundation and YoungMinds, have written to the Chancellor ahead of his Budget this month, saying:
“We cannot go on with such unambitious targets, or simply accept a situation where promises of extra funding don’t actually materialise at the front line. If the Government is actually to deliver parity of esteem, the Chancellor needs to invest in and ring-fence the mental health budget to ensure any money promised genuinely reaches those it is intended to help. The crisis is here, the crisis is now.”
I agree, and compulsory mental health education, if introduced, would be an important part of the jigsaw in tackling those issues, but only if it has the support it needs both financially and in Government action to make it a reality.
I am grateful for the opportunity to serve under your chairmanship, Mr Brady. I pay tribute to Catherine McKinnell for the thoughtful and non-partisan way in which she approached this issue. She has done work with the petitioners, many of whom are here today, and I pay tribute to them for raising awareness of this. I also thank my predecessor as Chair of the Education Committee, and the current Chair of the Health Committee, who produced the report that the hon. Lady described. This debate is important, because we await the Government’s Green Paper on children and young people’s mental health. As I understand it, it will hopefully come out very soon.
It is essential to address the mental health of children and young people for their life chances and wellbeing, and for them to be able to climb the educational ladder of opportunity. The hon. Lady and others have quoted statistics showing that half of mental illness in adult life starts at the age of 15. In her report on mental healthcare in England, the Children’s Commissioner she says that according to the
“Millennium Cohort Study…of over 10,000 children born in the year 2000…At age 7, about 7% of both boys and girls have a diagnosable mental health condition…At age 11, about 12% of both boys and girls have a diagnosable mental health condition…At age 14, about 12% of boys and 18% of girls have a diagnosable mental health condition.”
My constituency experience is that the problem is getting greater and greater.
I have recently had a Westminster Hall debate about the same problem as it affects the parents of children with autism, and I agree with the hon. Lady. I did not want to repeat in my speech some of the things that other hon. Members had already mentioned, but she is right.
It is important to educate children and young people about mental health. I mentioned that in the previous Parliament the Education and Health Committees looked into the issue, and reported on it just before the general election. Both Committees recognised that schools and colleges have a front-line role in promoting and protecting children’s and young people’s mental health and wellbeing, and they recognised the need for education and mental health services to work closely together. One of the Committees’ key recommendations was to promote the whole-school approach, which embeds the promotion of wellbeing throughout the culture of the school and the curriculum, rather than confining it to PHSE lessons. They recommended that Ofsted should take the approach to mental health and wellbeing into account when inspecting and reporting on a school. The Institute for Public Policy Research report said:
“The Ofsted framework has a very strong ability to influence school behaviour”.
The Association for Child and Adolescent Mental Health described it as the
“largest driving force in school practice”.
Dr Peter Hindley also said that, although he felt that too often the relevant aspect of the framework had not been implemented, nevertheless there was strong support for the idea that Ofsted should look at how mental health is dealt with in schools.
The need for strong partnerships between the education sector and mental health services is reflected in the report, and concerns were raised, as the hon. Member for Newcastle upon Tyne North and other Members mentioned, about the variation in the quality of links between schools and colleges and CAMHS. The Committee visited Regent High School in Camden where the Tavistock and Portman NHS Foundation Trust has been commissioned to run CAMHS. That partnership between education, health and the local authority was a great example of inter-agency co-operation.
When the excellent previous Minister for Children, Edward Timpson, appeared before the Health Committee, he said that the pilot would be extended to cover 1,200 more schools and that funding had been allocated for that next stage. In light of the kind of project that has been set up in Camden, will the Minister tell us the present position in relation to pilots, and what more is going to be done? The report by the Children’s Commissioner says that it is important it is to have such medical support inside the school:
“Schools should be an access point for early support for children with emerging problems such as short courses of therapy. Where possible, this should be provided within the school. The Green Paper should be clear that council and NHS budgets should help to fund these services.
Where children have more serious needs, schools should be a referral point into specialised services.”
Where there are issues that can exacerbate poor emotional wellbeing or mental health issues, we need to address the root of the problem. According to the Office for National Statistics, children who reported being bullied frequently were four times more likely to report symptoms of mental ill health. A third of children who said that they were unhappy with their appearance also reported symptoms of mental ill health, compared with one in 12 of children who were happy with their appearance. Children who spent more than three hours on social media on a school night were more than twice as likely to report symptoms of mental ill health as children who spent less time on such sites.
We need to ensure that we help children and young people to make sensible choices about social media. Our predecessor Committees recommended that schools should include education about social media in PSHE lessons, providing children with the skills and ability to make wise and better-informed choices about their use of social media. I ask the Minister and the Department for Education to conduct a serious study of the impact of social media—a separate issue from cyber-bullying, although that is very much part of it—on children’s mental health. Then we will be able to see proper data, and the impact of what is happening.
The Minister relentlessly pursues high standards, and there is a lot of sympathy for that, but the pursuit of high academic standards should not come at the expense of children’s mental health. Witnesses who gave evidence to previous Committees suggested that other subjects, such as art and creative activities, have been squeezed out, but that those things help in developing lifelong skills for improving wellbeing. Last week, as my fellow Select Committee Member, my hon. Friend Lucy Allan pointed out, the Education Committee held a round table with teachers, who spoke movingly about the pressure on children, and the mental health problems that they faced in the classroom. One participant told us of the importance of time for physical exercise and social skills, and for wellbeing and mindfulness. Achieving a balance between promoting academic attainment and wellbeing should not be regarded as a zero-sum activity. Increased mental health treatment and wellbeing can equip pupils to achieve academically.
That is something that I know from my constituency experience. Last year, their Royal Highnesses the Duke and Duchess of Cambridge visited the Stewards Academy as part of the Heads Together campaign, which does a lot of work on mental health; it works with the mental health charity Place2Be, as well as fundraising for mental health services. The school was highly commended. Since it has placed an emphasis on looking after the mental health and wellbeing of its students its GCSE and other exam results have improved.
I welcome the Government’s intention to publish a Green Paper. The Committee and I look forward to examining it, and to seeing whether the recommendations of the previous Committees have been taken on board. Statistics from the prevalence survey have been quoted. My concern is that the previous prevalence survey was done in 2004. I understand that there is to be one next year, but the Minister and the Secretary of State are rightly mindful of the importance of data in making decisions, and it is incumbent on the Government to analyse the data on the mental health problems of children in schools and to examine whether such problems are increasing as, anecdotally, many of us have found is happening in our areas. There is a need to consider whether funding restraint has led to an increase in the number of children suffering from mental health difficulties. I should be grateful if the Minister told us when the next survey will be published.
I mentioned that it is a false dichotomy to have to choose between academic standards and students’ wellbeing. The Health Committee report noted that
“the Association of Directors of Public Health told us that ‘Children with higher levels of emotional, behavioural, social and school wellbeing have higher levels of academic achievement on average’”.
That is an important statement. I mentioned that it would be good to study the impact of funding pressures. I recognise that the Government have recently made welcome announcements about the national funding formula. However, the report of the Children’s Commissioner mentions a cost-benefit analysis in relation to resources for schools to deal with children’s mental health difficulties:
“The Department of Health estimate that a targeted therapeutic intervention delivered in a school costs about £229 but derives an average lifetime benefit of £7,252. This is cost-benefit ratio of 32:1.”
I think that that is a powerful statistic supporting the argument that if we put in resources we can make a difference and avoid huge cost pressures on the Exchequer later. Not only is it the right thing to do but it helps with funding.
Finally—I know other hon. Members want to speak—the aim of the Education Committee is to promote the educational ladder of opportunity and to look at the skills problems we face. The first rung of the educational ladder of opportunity is addressing social injustice, and there is a real problem of social injustice here. The Government have done good work, but problems for children and mental health seem to be endemic in our school system for a variety of reasons that were ably set out by the hon. Member for Newcastle upon Tyne North. I urge the Minister and the Department for Education to treat the matter of social injustice with as much importance as they do raising standards and improving quality in our education system—something that the Minister is an important proponent of and has done so much to achieve.
Thank you for calling me to speak in this important debate, Mr Brady. It is a pleasure to follow my right hon. Friend Robert Halfon, and I pay tribute to Catherine McKinnell for her inspiring opening to the debate.
We all agree that education is about preparing our young people for the future. Key to both success and survival in life is being able to build resilience and learning how to take care of our own wellbeing and mental health. Without doubt, that is the most vital tool in the armoury of any young person, as they will inevitably take on many challenges as they go through life. Schools have a critical role to play in promoting an understanding of self-care as it relates to exercise, diet, sleep, mindfulness and building strong social networks for support, as well as the negative role of alcohol and drugs in mental health and how to avoid the pernicious influence of social media and its effect on wellbeing. However, family, friends and healthcare workers also have a significant role to play.
I am pleased that today young people are far more likely to talk openly about mental health issues, whether in school, at home or with friends. There are real signs that the silence and stigma are being shattered, but there is much more work to do, and schools can play a vital part in that. I welcome the Prime Minister’s commitment to mental health training—I think it was referred to mental health first aid training. I was not entirely sure what that meant, but mental health awareness training is a goal we should seek to achieve. I would like every school to seek to promote mental health awareness and to give students pointers on where to go, and all teachers to have an understanding of how to spot signs of mental ill health.
I welcome the forthcoming Green Paper on children’s mental health, and I ask the Minister to consider an earlier Education Committee report, prior to the joint report between the Health and Education Committees that we have talked about. The earlier report was in the 2015-16 Session, when the Education Committee looked into the mental health of children in care. One of the points that emerged in that report was about navigating the system and getting access to support when a child might experience multiple placements in any one year. One of the blockages to accessing support was that without a stable placement, the child was not eligible to qualify for child and adolescent mental health services. I urge the Minister to commit to reading that report, because we took evidence from a large number of influential and knowledgeable people, and their recommendations and some of the proposals in the report were somehow put to one side at the end of the last Session. Please, please can the Minister read the report and confirm that the upcoming Green Paper will specifically include provision for children in care and the need for school-based counselling for looked-after children?
To re-emphasise that point, during the inquiry into the mental health care of children in care, one child told us:
“The state took us away from our parents, the Government are now our parents. Parents will do anything for you”— parents will help their children to navigate the system—
“but the state doesn’t provide that.”
We have a special duty to those children in care, who do not have parents to fight the system for them and help them to get access.
About a year ago, we had a debate on that report in this Chamber. I urge the Minister to look back at what was said, because the excellent and much missed former Member for Crewe and Nantwich, then the Minister for Children and Families, had a great deal to say. He committed to a number of measures that I feel may also have slipped to the back of the shelf. I would love to see that work not going to waste but brought forward during the drafting of the Green Paper, so that the Committee’s work, the Minister’s commitment and the evidence of all the experts are not wasted. The then Children’s Minister said that there would be an expert working group to consider access to mental health care for children in care via school systems. That may have fallen by the wayside, or the expert working group may be well under way, and I would be grateful to know which it is. If the Minister cannot answer that today, I would be most grateful if he did so in due course.
I hesitate to sound any discordant note in this collaborative and helpful debate, where we all want to achieve the same thing, namely improving the mental health of children in school, but I have concerns, and will sound a note of caution, about the compulsory element for all schools. I recognise that there is patchy provision across the country, but to my mind it is the CAMHS provision that is so patchy. I am wary of imposing on teachers yet another burden that becomes a tick-box exercise, so they can say, “We’ve done this—end of. We’ve dealt with mental health care of children. We gave that half-hour lesson in the personal, social and health and economic education class and that’s finished. We don’t have to deal with it anymore.” Schools may want to signpost students, discuss wellbeing through informal drop-ins or school counselling sessions, or they may want to make it a formal part of PSHE, but that may not always deliver the results we all seek for our young people.
I also question whether a school should be responsible for identifying our young people’s mental health needs. As we have heard from many speakers today, teachers are not mental health professionals. They cannot replace the services of CAMHS and we should not ask them to do so. What role should we encourage families to take in helping young people to understand self-care and the pointers to where mental health support is required? We should all encourage young people to take care of their own mental health and wellbeing and, as they grow older, to accept some responsibility and accept that they can make a difference to their own mental health and seek out assistance and support where required.
I entirely agree with the line that my hon. Friend is taking, but as I said to Catherine McKinnell, who so brilliantly introduced the debate, there are not enough teachers qualified to do that, and to get them all up to speed and consistently trained will be a very long-term project. What we need to aim for is a tiered service that works, where the teacher is able to help with more than just emotional first aid, but is then guaranteed to be able to pass the child through to the next stage, which will then deal with them. It is the next stage that simply fails in my constituency. It fails. That is the stage where, if a child can cope with their own mental difficulties—God knows that is hard enough—there is someone they can go and talk to, who can refer them on to someone who will do something about it.
My right hon. Friend makes a vital point. I would like to see mental health awareness built into the fundamental training of all teachers. To be a good teacher, someone has to have an understanding of the mental health issues and challenges that young people in their care will face.
Far more important than training one teacher to be a first aid counsellor is to give all teachers that awareness, so that they can identify the signs and be able to point people in the right direction and encourage young people to seek help. They could also then advise them on how to navigate the system and access that help, because one of the most difficult things in providing support to young people—to anybody with a mental health condition, in fact—is their accessing the support that they need. Somebody may go along to their GP and say they think they are having a mental health crisis, but how many people can actually navigate the appointments system and persuade their GP that that is the issue that they face? That is where young people need the most help possible, because navigating the available mental health system, which is of a high quality in some areas, is a complex process.
To give an example in support of my earlier point about a formal mechanism for educating young people about mental health within a PSHE framework, a young constituent told me in a recent surgery that she had learned all about child exploitation in school in a PSHE class. As she sat there listening and taking notes, she knew that she was a victim of child sexual exploitation at that time, yet she still felt unable—despite the fact it was being discussed within a classroom environment—to get the help she needed. She went through the motions of attending the class and nodding away, but she felt completely disconnected from what was going on; it did not bear any relation to her personal experience.
I therefore do not think that compulsory mental health education is enough; we should look for an entire shift in attitude. It is about creating an environment that gives the confidence to ask for help and to know where to go, and that says it is okay to ask for help. Perhaps that is the sticking point at the moment: young people can sit in a class, but do they know how to access the help they need, or even have the confidence to overcome some of the shame and stigma that still exists in going up to the teacher and saying, “Okay, I have a problem—what do I do?”? That young person felt unable to do that, in the context of the child sexual exploitation problem that she faced.
I was a secondary school teacher and I delivered some PSHE classes. I remember that they were often not very satisfactory, because there were no exams, so young people did not take it particularly seriously. Also, they were often lumped into the last lesson of a particular school day. Would it not be a lot better if each school had a dedicated mental health lead? That would obviously be a teacher-led position, and each school could then deliver a strategy for dealing with mental health.
That is an excellent idea, although I would still like to see some form of training built into the basic PGCE training that all teachers receive. However, a dedicated individual with a strategy for the school, which the governors would be aware of and everybody would buy into through a whole-school approach, would be extremely helpful.
As I am sure anybody who has ever heard me talk about anything knows, I am instinctively wary of the state telling those at the coalface how to best deliver for the young people in their care. Education should never be about delivering as many qualifications as possible but always about preparing young people for life and the challenges that they will face. Building resilience is a key part of that.
The hon. Lady is making a compelling speech, and I understand her reservations about the state telling teachers how to do their jobs. However, a key issue, which I hope the Government will respond to, is the role of Ofsted and its power and influence over what schools can and cannot manage to do within their limited resources and the time in the school day. Will she take that into consideration?
The hon. Lady makes an important point about Ofsted’s role in all of this. Many teachers, who I am sure she speaks to, live in fear of Ofsted. I do not know if she has ever been a school governor, but Ofsted visits are quite a scary process, as is the whole concept of having one more box to tick—“Have I satisfied the safeguarding requirement? Have I satisfied the mental health requirement?” Instead of, “Have I met the needs of the children?”, it is, “Have I met the needs of Ofsted?” While I understand that that focuses the attention of the school, the governors and the teachers as a body, sometimes it becomes, “As long as I keep Ofsted happy, perhaps what I’m delivering to the young people in my care is a secondary priority.” I would be very concerned if that were the case.
I understand the hon. Lady’s point, and it is certainly one to consider, but the flipside to her argument is that schools are therefore so focused on delivering what Ofsted requires of them, in terms of ticking the boxes, that the holistic wellbeing of the young people and children in their care is perhaps not prioritised as much as it could and should be.
The hon. Lady is absolutely right. What we must press for, and what we must ask the Minister to respond to, is that this becomes a priority for all schools. They should help their children to identify the signs of mental ill health and equip them with the skills to deal with those, as well as helping them to access the support that they need. All teachers must be trained to understand the signs and the steps they can take, but we should be wary of forcing more burdens on to already overburdened schools and teachers, as we heard on the Education Committee last week.
The Green Paper is to be welcomed, and I urge the Minister to consider the recommendations of the Education Committee’s report on the mental health of children in care. They are so often forgotten, and their mental health needs are often way above those of children in a family environment that helps them to overcome some of the challenges they experience, so it merits specific provision in the Green Paper. I will continue to press for that, so that those children are not forgotten. I thank the hon. Member for Newcastle upon Tyne North and everybody else who has come together today to make an important contribution on what is a huge issue for the future of our young people and their success in building a future in which they are able to cope with what life will throw at them.
It is a great pleasure to serve under your chairmanship, Mr Brady. I congratulate Catherine McKinnell on her formidable introduction. It was completely dispassionate yet very powerful about this terribly serious issue. I also congratulate my hon. Friends who have spoken. I will, unusually, speak very briefly, just to make a couple of points.
My hon. Friend Lucy Allan made an important point about the ability of children and young people to confront this issue for themselves, and also to have the immense guts required to tell someone that they really do have a problem. It takes a brave person to do that, who will quite often be in a very ugly place, which, if anyone knew what they were dealing with, would have been identified sometime beforehand. This is where the Government have an immensely important part to play in the very difficult area of children’s centres and children’s hubs and all the works that go towards trying to help people through these very difficult periods.
However, those children all end up back at school somehow, and it is the teachers who have to pick up the pieces if the parents cannot; often, the parents will not be able to, or will be so worried that they will not know how. As so often, the teachers have to rescue the day. It is not easy to do that in such a specialist area for someone who has not been properly trained to do so.
This issue is a fundamental part of growing up. Looking back on it, I know how lucky I was to have a happy, golden childhood. Parents come to see me in my surgery who are desperately worried about their children and anxious about what they will get at school. When we talk to the schools, the teachers say that they know they cannot do the job properly, and headteachers know they do not have the resources to do it.
My right hon. Friend the Minister and I live in West Sussex. He is a senior West Sussex Member, and he knows the difficulty that our local county council has with finance for this kind of thing. I was in a school the other day where I asked about mental health teaching and was told that an excellent lady had done it, but she had moved on in a general sort-out and had not been properly replaced. We are back into what my hon. Friend Robert Halfon were talking about.
I think this is a national crisis. I wish, if I may, to stray a little beyond what I normally do in public and to congratulate the Duke of Cambridge and Prince Harry on what they have done to bring national attention to this issue in a very powerful, acceptable and touching way. We can see the connection they have with these young people and the way the young people look to them for help, which is what they are providing. I commend them and the Duchess of Cambridge very strongly for what they are doing. It is very important work, and I hope they will go on doing it.
I do not want to overdo it. There are a number of areas in our national life where we constantly face great difficulties, but this is a real national crisis, and the scale of it is only just beginning to be realised. I know the Minister will take very seriously what the hon. Member for Newcastle upon Tyne North said, but the whole question of training teachers is cardinal. I repeat that if there is not consistent teaching across a diversity of providers, there is no way these children will be able to access the kind of services we want to see. Headteachers and teachers do not have the time; they have so many things to deal with, and they need to be confident they have the skills and ability to see these children right in referring them to other services.
Mr Brady, thank you very much for calling me to speak. I apologise for speaking so briefly, as I know it will disappoint you, but there are others here who know much more about this than I do.
I do not intend to speak at great length. I would just like to reiterate the vital nature of this issue.
I support what my right hon. Friend Sir Nicholas Soames said a moment ago: this has got to the point where it is of great national importance. Some years ago, I was my party’s mental health spokesman, and at that time we were learning about children’s mental health. We now have a real understanding of how early mental health problems can arise—something that was not fully understood back then —and how important it is to intervene as speedily as we can to tackle these issues, which can become much worse over time if that does not happen.
Hertfordshire County Council has supported the Northherts Emotionalhealth in Schools Service, led by a co-ordinator who is a very experienced school mental health counsellor. She is offering teacher training and support, and numerous teachers have now been taught about how counselling works and mental health issues that arise. Teachers have found that knowledge very useful for not only the students but themselves, because they also face pressures. The service offers training to parents, and forums are held on subjects such as self-harm and promoting resilience against anxiety, for which there is now quite a waiting list. It offers peer mentor training on positive mental health called “How to help a friend” and provides schools with registered counsellors, who are helping. There is close liaison with NHS services, so everybody knows what is going on. As my right hon. Friend the Member for Mid Sussex said, it is necessary to understand the problem but then also perhaps to pass it on, in cases of serious mental conditions.
That approach seems to be working quite well. The service has had support from the Anna Freud Centre and recently held a conference with early years and primary school staff. There was a really good response from everybody involved, including the Anna Freud Centre and Steve Mallen, who heads up the MindEd Trust. His son Ed took his life two years ago. Steve set up that charity and is very supportive of this approach. He believes it is helping parents, students and teachers. Comments that came out of the conference included,
“The workshops were particularly useful and I can see how they can be implemented in my school and be beneficial to the children and their families” and,
“All of it was useful. A good balance between knowledge and practical stuff.”
This petition is about education in schools, but the Minister might like to look at the sort of service we have in north Hertfordshire, with his Green Paper in mind. Finally, it is worth mentioning that young people, of course, are marvellous with digital and social media. I understand that some apps are available that can help with anxiety and reinforce messages. He might want to look at that too.
It is a great pleasure to serve under your chairmanship, Mr Brady. I congratulate Catherine McKinnell on putting the case so cogently for the importance of education about mental health in schools.
In preparation for the debate, I reflected on the distance we have come and the sense that we still have a long way to go on what I would call mental health literacy. I remember being at school in the late 1970s and early 1980s and having, as a 13 or 14-year-old, a sense of anxiety and some sense of uncertainty about the future. I could not label the condition I was suffering from at that time, but subsequently I learned that it was called depression. I think I had a depressive episode of quite a severe nature when I was about 13 or 14 at school. At that time, it was not a condition that was being labelled, so I did not have a way of talking about it that made sense. In the school environment of the 1970s and 1980s, teaching staff did not have the capability and my peers did not have the awareness of what mental health really meant.
The truth is, as other Members have said, that we have come a huge distance over the last 30 years. It would be churlish to characterise what we face today as a unique set of contemporary circumstances. The debate about mental health and our understanding of young people’s mental health has come a huge distance, as has the way in which it is represented in our media and the way we have talked about it in Parliament over the last few years. As you may know, Mr Brady, I was chair of the all-party parliamentary group on mental health in the last Parliament, when we had a series of very important debates about mental health that galvanised and were a lightning rod for further discussion in the public realm about young people’s mental health.
The representation of mental health in drama and soap operas has undergone quite a revolution. There was a time when young people’s mental health was often talked about only in terms of negative, stigmatised associations with suicide and so on. The public’s and schools’ awareness of mental health has undergone some degree of transformation.
The broad consensus in the Chamber on this subject is really welcome. Like the hon. Gentleman, I very much welcome the fact that the stigma about mental health is starting to go away and people can talk more openly about their issue, but helping young people requires resources. Norman Lamb, who was the initiator of an initiative called Future in Mind, secured funding, during the coalition Government, of £1.25 billion, to be spent over the next five years. That should amount to £250 million each year, but only £143 million was released in the first year of the programme, 2015-16. Should not we all in this Chamber urge the Minister to continue that commitment and the budget that was secured under the coalition Government?
Let me just remind the hon. Lady that her colleague should be referred to in the Chamber as the right hon. Member for North Norfolk, rather than by name.
I thank the hon. Lady for her intervention. The simple answer to her question is yes.
[Phil Wilson in the Chair]
The Government are, as I understand it, fully committed to that additional investment over the five years of this Parliament. The truth is that a lot of progress has been made under the current Government in terms of further investment in child and adolescent mental health services. Obviously, there is more to do, and Future in Mind, to which the hon. Lady refers, was a very good initiative, led by Norman Lamb when he was the Minister with responsibility for mental health. I am not arguing that somehow that money will magically transform the CAMHS system, but the truth is that some progress has been made in understanding the extent and prevalence of children and young people’s mental health problems. The Department of Health is beginning to gather, for the first time, meaningful data about what is happening in the system. That was never in place before; child and adolescent mental health was a data-free zone until very recently.
Also, in terms of the extra money, we have only started to understand and have the data on where the money is actually being spent. The NHS dashboard that has been created for mental health is, for the first time, acting as a tool to put pressure on local commissioners to spend the money that they have been allocated. Clearly, there has been a discussion about this. The money is not ring-fenced currently, but with the dashboard created by the Department of Health, we can see what local clinical commissioning groups are spending on child and adolescent mental health. That should be used as a tool to continue to put pressure on commissioners to make the right sorts of choices.
I mentioned what the vision and set of principles should be for this area. In the school environment, we should be trying to move towards what I call mental health literacy, which means giving young people the facility to talk about the mind and their mental health in a way that is intelligible for them and their peers. That is what we should seek to achieve in this context. We have had a very rich debate talking about this issue. I do not think that it is just a question of what is in the curriculum. Young people and children as they are growing up will listen to teachers in a particular way. They might not really want to listen to the message that the teacher is giving, because the teacher may represent a position of authority that they feel uncomfortable with. I am not saying that it is not important that teachers are trained and aware and that there is provision in the school environment, but that is not the whole picture.
We need to consider two further aspects. Peer pressure or peer conversation is almost as important as what is in the curriculum. I am talking about a structure in the school environment that allows young people to talk with one another about mental health, equipping them with the knowledge, skills and literacy to be able to have that conversation. I remember that back when I was at school, I felt very isolated—a sense of isolation—that somehow what I was thinking about was not legitimate; it was something dark and horrible and I was the only person who could possibly be having that issue at the age of 13 or 14. It is extremely liberating for young people when they realise that a vast range of their peers have the same sorts of questions about the future. It is relatively normal for adolescents to have periods when they are very uncertain about the future and how they fit in with their peers. They may have particular issues, but that ability for the school community, for children and young people together, to be able to talk about that is vital. It is a kind of therapeutic valve in the school environment, which I think is critical. In fact, much of the evidence base that I have seen shows that peer-to-peer communication on mental health in schools is extremely effective as a mechanism for helping young people, so that is the vision of what we should seek to achieve.
Also crucial, as other hon. Members have mentioned, is the involvement of families in the conversation. Families should not be excluded from the conversation, but brought into it as part of the process that we are describing, because obviously the family is the crucible in which a young person is brought up. For many young people, that is, as my right hon. Friend Sir Nicholas Soames said, a golden experience, but for many other young people it is characterised by dysfunction and relationships breaking down; it is often characterised by confusion.
I agree with that point and ask my hon. Friend to consider the excellent work being done by our hon. Friend Fiona Bruce on family hubs and centres, which I think is remarkable. If people are in the very unhappy position described, the trouble is that there is no one single signpost for them other than, as I said, the poor teachers, so the family hubs or centres are immensely important and must be encouraged and developed.
I definitely agree with my right hon. Friend on that. As I said, the family is the crucible. The issue is often very complex, and the relationship between the family and the school is a critical part of what we are discussing because, again, families can be a place where therapy is very effective, and can be a very effective way of helping the child and making them resilient, so I very much agree with my right hon. Friend’s point.
Could I add just one qualification? Children with mental health difficulties may be experiencing significant family breakdown and may not be able to have the family involved, and therefore the school is literally the one place that can really help the child. That goes back to what my right hon. Friend Sir Nicholas Soames and others said about teacher training and a young person being able to go to someone in the school who can actually look after that student.
I thank my right hon. Friend for that intervention. I totally agree: clearly, it will not be possible to involve the family in all cases. I have seen examples in my constituency, particularly in the primary school environment, in which headteachers and teachers have taken really interesting and creative decisions to replicate the family environment for children who have not been brought up in a stable family environment and have not entered primary school in a properly socialised way. They have replicated the family environment and tried to create those kinds of structures because they have been absent, so I completely agree with my right hon. Friend on that.
Other hon. Members have talked about CAMHS and I want to make a few comments about early intervention. If you look at the spectrum of what we are talking about, it could be argued that by the time children get to school any mental distress and difficulties they suffer from will have been baked in for many years. There has been a debate about early intervention and mental health for years; it is what I would call a policy no-brainer. Everybody agrees we should intervene earlier. Everybody agrees that in principle that is a good thing. Yet we are still debating about whether we are doing it sufficiently well and how it should be done. The truth is that we should shift resources to where the evidence points us.
The evidence points to the joint Green Paper on children’s health and education, and adolescent mental health, which other hon. Members have mentioned. The evidence suggests that interventions at an early age, sometimes pre-primary school, are the most effective interventions that we can make on a therapeutic level. From the evidence, it looks like working with children from birth to the age of two, working with families, and working with parents is the most effective intervention we can possibly make. I urge the Minister to be bold in terms of what we will do in that Green Paper. If we can do only one or two things from that Green Paper, we should focus on the really important one, which is shifting resources to genuinely effective early intervention based on evidence. Everything else we have talked about, such as mental health first aid and so on, has a role to play in this debate, but it will not solve the problem we are trying to confront. We will solve this problem by focusing a lot more resources in a laser-like way on early intervention—even before school. That is the critical part of this debate. The one bold move for the Government would be to focus their attention on that. Then we might be able to make significant progress.
Other hon. Members have mentioned CAMHS. If we were designing a child and adolescent mental health service today, we would not design it in the way it currently operates. We have had several reviews of CAMHS over the last decade. Other hon. Members have mentioned Future in Mind, the CQC has just done its review and there have been other reviews. We know that CAMHS is currently not fit for purpose. That is not to say that people working in CAMHS are not doing an excellent job in delivering the services they do, but we need a more integrated service. We need to move away from the tiering approach, which means we concentrate on tier four—that is children with the most severe mental illness. If we can get rid of this metaphor of tiering and focus on access to the appropriate level of care required by a child or young person in a place appropriate to them and deal with it across the spectrum, and integrate it with initiatives that are being taken in schools and the initiatives I have been talking about in relation to early intervention, we can make significant progress.
We have come a long way. People use the word “crisis,” which I am always very wary of using. It is not as if this crisis started today. The debate about children and young people’s mental health has been going on since about 1962 when Enoch Powell, then the Public Health Minister, made the decision that we would no longer put people in asylums but would move towards a community model. That was in 1961 or 1962. We are only now beginning to have a real debate about how we really tackle some of the underlying issues that we face in society in terms of the mental health of children and young people. We are much better at talking about it, but the debate actually is only just beginning and the Government have an opportunity to take some really bold steps, which would have a lasting legacy.
I apologise, Mr Wilson, for dipping out for an hour. I had to meet Carwyn Jones, First Minister of Wales, at a Welsh group meeting, but I was here for the first 30 minutes and I did intervene on many occasions on my hon. Friend Catherine McKinnell.
The World Health Organisation says that by 2030 the biggest health burden on the whole of the planet will not be heart disease or cancer; it will be depression. The term “burden” is not a pejorative but a descriptive term for the burden on the individual, their family, society and the economy. This tsunami of mental ill health is coming our way, and I believe that we are ill-prepared for it—ill-prepared for how we treat our adults and especially our children and young people.
In the 19th century, Frederick Douglass said:
“It is easier to build strong children than to repair broken men”— he definitely should have said, “and women.” That is the situation today. If we can build strong children and give them that resilience, it benefits the individual child and their family, and the knock-on effects of building in that resilience from an early age will benefit our economy and health service down the decades.
I am speaking today about mindfulness. I am co-chair of the all-party parliamentary group on mindfulness— I draw hon. Members’ attention to my declaration of interest. I gave the statistic in an intervention earlier that 32.3% of 15 to 25-year-olds experience one or more psychiatric conditions. That is while they are studying for their GCSEs, A-levels, degrees or post-graduate degrees. They are studying and living sub-optimally, and their suffering is magnified because we have not put the strategies in place to help those young people to cope with the modern stresses of society. Our Ministers and health service say that oral hygiene is very important, and we must brush our teeth three times a day; that nutritional health is very important, and we must have our five fruit and veg a day; and that physical activity is very important to keep our bodies healthy. But how much time is allocated to looking after our own minds, our own brains and how we actually view the world?
There are many stresses out there affecting young people. There are the stresses of advertising. Young people have Maccy D’s telling them to “Go large,” and the fashion industry saying “No, no—size zero.” The average child will see 120,000 adverts a year and the messages are well researched and well honed, especially in a digital age, when every time a young person goes on a computer an algorithm calculates what is going on inside their head and sends micro-messages to them. The point of adverting is to make people unhappy with what they have, so that they will purchase something else.
The impact of social media has already been mentioned by many speakers. When I went to school in the 1960s, if I had a fall-out, it was with five or six people. Now it could be 5,000 or 6,000 people. Being tested at school— at the ages of five, seven, 11, 14, 15, 16, 17, 18 and 21—produces massive stresses on young people. We are not equipping them with the capability to deal with those stresses; in fact we are adding to those stresses. There are many other factors that are bringing stress to our children and young people today.
We as politicians should be doing something about that, and I am pleased that this is an area we can agree on. I pay tribute to the former Prime Minister David Cameron for measuring wellbeing and saying—he was quoting Robert Kennedy—that GDP and wealth are not enough; we must look at the wider benefits to society and what makes us click as a society and as individuals within that society. I pay tribute to the Prime Minister for declaring in January that mental health, and children’s mental health, will be right at the top of her priorities. Our own shadow Chancellor, my right hon. Friend John McDonnell, quoted Robert Kennedy at the Labour conference in saying that the wellbeing of society is important. This is an area where we can, and should, come together.
I want to stress the impact that I believe mindfulness can have. Mindfulness has been freely available on the national health service since 2004. Some people might think that it is a bit woolly, but the copper-bottomed science has been proven to the National Institute for Health and Care Excellence by Professor Mark Williams, John Teasdale and Zindel Segal from Canada. Mindfulness has been available, but the take-up is minimal. The science has been proven for this intervention, which puts the individual in control and is cheaper in the long term than antidepressants or talking therapies, yet the take-up has been minimal. Again, I pay tribute to the Government, because they have promised to train an extra 200 or 300 mindfulness-based teachers over the next two years, and that is progress. We have been teaching mindfulness to MPs, peers, their staff and civil servants in Westminster.
The hon. Gentleman is making a very interesting point about the benefits of mindfulness. I have had the great pleasure of participating in the MPs’ mindfulness training, and have to say that it is quite a challenge to get MPs to turn off their phones and concentrate. Does he agree that we need to encourage more people to understand the benefits of mindfulness and to participate in it?
Absolutely. Ghandi said, “Be the change you want to see.” We are change-makers in this room, and we need to make our personal, political and parliamentary decisions from a position of personal equanimity and balance. If we do that, we will be doing tribute to ourselves and our society. Some 150 MPs and Lords have had the training, and we instituted a parliamentary inquiry on mindfulness in health, education, criminal justice and the workplace. We have put forward recommendations.
I appreciate the benefits of a healthy mind, a strong child and preparing children and young people for the challenges in life, but does the hon. Gentleman see that even though someone might have been brought up in a happy, healthy family, mental health issues can hit them at any point? There is not prevention for mental health in the same way as for other things, because we never know what will happen or come round the corner. We need to monitor mental health throughout the years, again and again and again.
I absolutely agree with the hon. Lady. That is what is happening in mindfulness research. Bangor University is looking at mindfulness for the baby in the womb. The biggest cause of low birth weight babies is maternal stress—either directly or through legal and illegal drugs, tobacco or alcohol—and it is working on a curriculum for babies in the womb. Bangor University is looking at a mindfulness curriculum for three to seven-year-olds; it already has one for seven to 11-year-olds. The .b course has been devised for 11 to 18-year-olds by top mindfulness experts who actually teach in the Palace of Westminster. There is another £7 million study into the effects of mindfulness on 11 to 18-year-olds at Oxford University called the MYRIAD project. Hopefully, the interim report will be published around 2020. If that scientific evidence is proven, as decision makers and policy makers we should look carefully at it. If we can get on top and provide that resilience to children and young people from the age of three, we should be implementing that.
I want to draw hon. Members’ attention to what we are doing in mindfulness to help us in our initiative to ensure that the proven science of mindfulness is taken up in the national health service, the education service and the criminal justice service. Some 85% of prisoners have one or more mental health issues, and some people are incarcerated from a very young age. Again, we owe it to them to look after them and to give them the best provision available.
I mentioned this in an earlier intervention, but the bell curve of wellbeing includes people who are well below that curve, the majority who are somewhere above that position of mental ill health, and a few who are flourishing. If we can shift the whole of that wellbeing curve along, the biggest beneficiaries will be those with the poorest mental health, but it will also help everybody on the curve. Mindfulness can be used not just to give people back their equanimity, but for human flourishing. This question has been posed for thousands of years, but something seems to have gone wrong in society over the past 30 years. We have had a tsunami of mental ill health washing over the whole of the world, and especially the western world. We give more credence to the pursuit of money and wealth than to individual, family, societal and community wellbeing. It is time that we took stock and asked ourselves what is important in life. The most important thing for me is to think from a position of balance. There are curricula and courses that can be taught to young people, and we are failing if we do not put those provisions in place.
Again, as I said in an earlier intervention, there is a way that we can help those students who go to university at 18 to become teachers in three or four years’ time, or who go at 18 to be medics or doctors and come out at 25 to be GPs. Many of those young people are in stress themselves—“Physician, heal thyself”. If those young students can be given the skills to get their own personal balance, when they go through their career as a GP, nurse, midwife, teacher or lecturer, they will remember the benefits that they have had—the equanimity and the ability to concentrate, to focus, to improve their grades and to improve their way of living—and they will be able to touch thousands of minds over the course of their medical or educational career. It is a huge problem that is out there, and some of the answers could be quite simple.
It is an absolute pleasure to serve under your chairmanship, Mr Wilson. I especially want to thank Catherine McKinnell, who excellently set the scene about where we are and where we all hope to progress to. That is the issue: we have come some way, but we are still on a journey in terms of mental health services across people’s lifespan.
I thank the Petitions Committee and the members of the public for supporting a debate on mental health education in schools. It shows that it is extremely important to all: our community, our constituents, children, adults and parents. It is important to MPs, as we can see today. There has been such a great consensus—it is one of the debates that I have attended where there has been such a great consensus—and that is so important to see.
I must declare an interest in mental wellbeing as a psychologist, although I worked largely with adults. I am also a member of the British Psychological Society. I was saying earlier today at a conference on trauma counselling that I think now is a pivotal moment for mental health. We all know, and are in agreement, that something has to be done across the lifespan, and this is our opportune moment to take that forward.
The petition calls for mental health education to be made a mandatory part of primary and secondary school education. That is important. Across the UK and the devolved Governments, we cannot go on with this postcode lottery. It is happening everywhere—no one service is perfect—and we all have so much progress to make. We have all been trying to make sure that services are in place. I see from my own career how far things have come, but we cannot continue with the postcode lottery. It is not fair on people. It is not fair on parents or children. We must address young people’s mental health.
Only 70% of secondary schools and 52% of primary schools currently provide counselling. Research suggests that one in 10 children aged from five to 16 suffers from a diagnosable mental health disorder. It is so important that that is picked up at an early stage. As has been stated so eloquently in this debate, including through Members’ personal experiences, if we can identify and support such children at a key early stage, prevention and early intervention will be by the far most effective interventions. That is why it is so crucial for resourcing to be targeted at that level.
Seventy-five per cent. of children and young people experiencing a mental health problem are not accessing treatment. This is the tip of the iceberg, so much more resourcing is desperately needed. In ensuring that people can come forward and speak, and that they have awareness about mental health issues and can seek treatment, we must ensure that they can access resources for support and treatment at every stage. Ninety per cent. of teachers have reported increased rates of anxiety and depression among pupils over the last five years. Clearly, we need this debate and a consensus and, importantly, we need action.
Mental health first aid training for all teachers is a welcome step forward. It has been mooted that teachers are already overburdened and that adding to their stretched teaching lives might make things very difficult for them. However, I would suggest that they are overburdened because these issues are already prevalent. Children are experiencing them, so we must ensure that they are identified and that adequate care pathways are available. If teachers can have awareness training to pick up early symptoms, that early detection will be key for prognosis.
The Green Paper on children and young people’s mental health is expected later this year, and I am extremely keen to hear what the Minister can tell us about that today. I hope he will indicate the type of progress that might be made, because we are all keen, listening ears here today and right across the United Kingdom. We must share best practice and look at the pilots working in each area of the UK, and we must ensure that those are rolled out when evidence-based practice is making a real difference for children and young people.
The collaboration between education and health services must be improved. The care pathway is needed. As I have said, identifying the issue and enabling young people to speak about it is the first stage. However, many of them will then need to access adequate help at different levels of the care pathway. It is important that we focus on mental health at a school level, because if children can verbalise their issues and teachers can recognise them, we will start to make the progress required.
This is not so much about mental illness, but about teaching wellbeing and coping skills and skills for life. The earlier we can do that, the better—even at pre-school, which has been spoken about, that is key—because the earlier that modulating emotions, concentration and mindfulness can be taught, the greater success children will have going into their adulthood. They will have a greater ability to cope with the stressors that will come into their lives later and they will go on to experience fewer difficulties that require treatment. Addressing this issue is not only economically vital, but about skilling up our future generation to cope with mental wellbeing and to cope holistically with life.
There is a need to push for a statutory footing with clear guidance. I agree with James Morris that interventions need to be peer-to-peer based and child-friendly. Children use a variety of digital technologies that are well beyond my capability, but that is how they operate in today’s society. They listen to one other—in adolescence, they listen to one another much more than they do to parents and teachers—so we must use our knowledge to ensure that peers educate peers and that we tap into digital technology for a positive response. All too often, social media can have a negative impact on mental health, fostering a culture of bullying. Some children believe that they do not have as many friends online or that they do not measure up, but we can tap into the resources that children use and turn that around, ensuring that their mental wellbeing is a key part of those apps and social media.
Focusing on diagnostic testing and access to it is also key, particularly for autism, and I have tried to champion it throughout my time in this House, because it is badly needed. Parents continually come to us all saying that they are unable to access adequate services. We need a map of clinicians with the relevant training around the UK, so we can look at where the gaps are in autism diagnosis training. We then need to fill those gaps and make sure that, no matter where someone stays, if they require a diagnosis, it happens, so that parents can access the services required for their child.
The British Psychological Society is calling for access to applied psychologists to ensure the full assessment of complex cases. We have heard about the types of complex cases that should perhaps be prioritised, including looked-after and accommodated children who might have already experienced trauma and might be most at risk.
In conclusion, I will speak briefly about a couple of my constituents. The first wrote to me as a very concerned parent, desperate for support for her 10-year-old child who struggled for years with her mental health but who has been unable to access child and adolescent mental health services. I will take that case forward, but just how many more parents are struggling with those issues across the United Kingdom? We must all work together across all the nations to ensure that we fill those gaps.
Helen Mitchell is an excellent lady who has triumphed over adversity and runs the Trust Jack Foundation, a trust created in memory of her son who suffered mental illness and took his own life. She supports services for young children suffering mental illness, including art therapy, support groups and befriending. We must remember that it is not just skills but the community and health—all of us must work together to ensure that mental wellbeing is something we take forward positively for all.
It is a pleasure to serve under your chairmanship, Mr Wilson. I acknowledge the good work done by the Shaw Mind Foundation in securing the debate. For Adam Shaw, the foundation’s chairman and founder, after struggling for 30 years with his own mental health, which led him to the brink of suicide, this is a personal issue. It is vital that we listen to the voices of those such as Adam who have experienced mental ill health in their childhood. They are telling us that understanding our own mental health is a life skill, which should be part of our childhood education as much as reading and writing. The response from the public to Adam’s petition shows that that view is shared by many people in the UK. This debate has left us in no doubt that action needs to be taken now to safeguard our children’s mental health.
My hon. Friend Catherine McKinnell made an exceptional speech. It was a real tour de force, highlighting national and local policy and bringing in individual cases from her constituency. The 103,000 people who signed the petition so that it could be debated in Parliament today can be extraordinarily proud of her contribution.
Other contributors to this debate include the Chair of the Select Committee on Education, Robert Halfon. I could not agree more that mental health requires a whole-school approach rather than just being pushed into PSHE lessons. As a former PSHE co-ordinator for a primary school in the borough of Trafford, which I represent, I know that mental health cannot be taught in the time given to that subject. More must be done.
Lucy Allan, who is also a member of the Select Committee, spoke extraordinarily powerfully about the stigma that needs to be shattered; this debate is part of doing so. I join Sir Nicholas Soames in congratulating the Duke of Cambridge and Prince Harry, who have raised the issue. He also spoke powerfully about the need for teacher training to incorporate mental health education in colleges and universities up and down the land.
James Morris gave an extraordinarily powerful personal testimony about his own mental health during his childhood. MPs being brave in that way in public life are beginning to shatter the stigma. Sir Oliver Heald also spoke eloquently about the good practice that he has seen between NHS councils and schools in his constituency. We need exemplars of good practice across the land.
My hon. Friend Chris Ruane, citing the World Health Organisation, said that mental health would be the defining issue of the 21st century and that there is a tsunami coming. He is a passionate advocate for mindfulness day in, day out in this place. We have had an extraordinarily good debate. As a former teacher, I know that schools are struggling to deal with an upsurge in mental health needs among pupils.
Dr Cameron, in an excellent speech, brought her clinical prowess and expertise to this Chamber. As she pointed out, statistics show that one in 10 children have mental health issues. That is three children in every classroom of 30. One in five adolescents experience a mental health problem in any given year. A recent survey by the union NASUWT involving more than 2,000 teachers and school leaders further underlined the scale of the problem: 98% said that they had come into contact with pupils whom they believed were experiencing mental health problems, and 46% said that they had never received any training on children’s mental health or on recognising the signs of possible mental health problems in children.
We know that half of people with mental health problems as adults present symptoms by age 14, and 75% do so by age 18. Shockingly, suicide is the most common cause of death for boys between the ages of five and 19. Data from a recently published Government study showed that one in four girls are clinically depressed by the time they turn 14, and hospital admissions for self-harm are up by two-thirds; the number of girls hospitalised for cutting themselves has quadrupled over the past decade.
I also want to point to research on the LGBT community. Stonewall found that more than four in five young people who identify as trans have self-harmed; that is an incredible statistic. Three in five lesbian, gay and bi young people who are not trans have self-harmed. Shockingly, more than two in five trans young people have attempted to take their own life. For that community, mental illness rates are huge.
The number of young people aged under 18 attending accident and emergency for a psychiatric condition more than doubled between 2010 and 2015, yet just 8% of the mental health budget is spent on children, although children represent 20% of the population. Referrals to CAMHS, as has been mentioned, increased by 64% between 2012-13 and 2014-15, but more than a quarter of children and young people referred were not allocated a service. Perhaps most damningly, Public Health England estimates that only 25% of children and young people who need treatment for a mental health problem can access it.
Following the groundswell of evidence of mental ill health in our children and young people and the system’s abject failure to deal with it, the Prime Minister announced in January, to a fanfare, a package of measures aimed at transforming mental health support in schools, workplaces and communities. As my hon. Friend Barbara Keeley pointed out following the Prime Minister’s announcement, that will not deal properly with the burning injustice faced by children and young people with mental ill health.
I am afraid that this Government talk a good game on mental health, but in reality, they have continued to underfund services. The Government’s proposals do nothing to improve waiting times for treatment for children and young people, and they put pressure on schools to take on extra work on mental health, at a time when they are having to cut budgets. The Minister and I have been no strangers to discussing budget cuts in this Chamber over the past six months.
The evaluation of the mental health services and schools link pilots published in February underlined the lack of available resources to deliver the Government’s offer universally across all schools. Headteachers are telling us that real-terms cuts of £2.8 billion to school budgets threaten existing in-school care. On top of that, funding for child and adolescent mental health services fell by almost £50 million between 2009-10 and 2012-13. The Government also cut £600 million from mental health budgets between 2010 and 2015, and the number of mental health nurses in our country has decreased by 6,000 since 2010. Our Government continually expect our teachers, schools and health services to do more for less.
I do not want to spoil the harmonious general cross-party agreement on this point, but the hon. Gentleman’s litany of despair occurs against the background of a substantial investment in mental health in this country. The problem—I see it in my constituency, and I am sure that everyone in this room sees the same thing—is the time from what, in the Army, they call flash to bang. Once the money is voted and put into the service, it takes a very long time to bring through properly qualified people to deal with the problems.
The right hon. Gentleman spoke eloquently about the need for better mental health provision for teachers throughout our country, but I point out to him, as part of the litany of despair, that a third of teachers who have trained since 2011, on this Government’s watch, have already left the profession. We must deal with these issues if we are to have a future cadre of teachers who are adequately trained in mental health education.
On the upside, there are things that we can do. We could invest in CAMHS early interventions by increasing the proportion of mental health budgets spent on support for children and young people. In order to protect service, we could also ring-fence mental health budgets and ensure that funding reaches the frontlines. We know that school counselling is an effective early intervention; Labour have committed to ensuring that access to counselling services is available for all pupils in secondary schools.
Early intervention is much cheaper to deliver, as has been pointed out. The Department of Health estimates that a targeted therapeutic intervention delivered in school costs about £229, but derives an average lifetime benefit of £72,525. That is a cost-benefit ratio of 32:1. Of children and young people who had school counselling in Wales in 2014, 85% did not need any onward referral to children and adolescent mental health services.
The sad fact is that the Government’s plans for school budgets will result in further cuts to school counselling and wellbeing services. Labour has said that it will fund and ensure that every secondary school in England and Wales offers counselling. This Government’s sticking-plaster approach to our children’s mental health has not been, is not and will not be good enough. I urge the Minister to look closely at the recommendations of the first joint report of the Education and Health Committees, “Children and young people’s mental health—the role of education”.
Teachers are not mental health professionals, but they are the frontline professionals in daily contact with our children and young people, and are often the first to spot the signs of mental ill health. They are also overworked, underpaid and under-resourced, so adding an additional responsibility to their workload without the necessary training and investment will only deepen our teacher recruitment and retention crisis. Our schools need an honest approach from the Government that acknowledges the £2.8billion real-terms cuts in school budgets since 2015.
We must act now and give our children the knowledge and confidence to take charge of their own mental health. If we do not, we will never be able to relieve the huge strain on our NHS, CAMHS, social services and teachers. The Prime Minister must make good her pledge and act on children and young people’s mental health. If the Government believe in parity of mental and physical health, they will ensure not only that age- appropriate mental health education is available for children in our schools from primary school upwards, but that our schools are properly funded with the resources to deliver that.
It is a pleasure to serve under your chairmanship, Mr Wilson. I congratulate Catherine McKinnell on introducing the debate and on her excellent informative and powerful speech. I congratulate HeaducationUK and the Shaw Mind Foundation for securing more than 100,000 signatures—the first time a mental health charity has achieved that level of support on the petition website. I also congratulate other hon. Members and my right hon. and hon. Friends on their informed and powerful contributions to what has been a consensual and broadly united debate about some important and far-reaching issues.
The mental health of our children is a key priority for the Government. We want all children to have the opportunity to fulfil their potential and to develop into confident and happy members of society. In our manifesto, the Prime Minister set out a commitment to publish a Green Paper on children and young people’s mental health by the end of the year. The Department of Health and the Department for Education have been working together on the Green Paper to achieve a step change in the way we support the improvement of children and young people’s mental health.
I assure my hon. Friend James Morris, who I congratulate on a moving speech, that the Green Paper will be bold. It will look at the roles of health and education in supporting the mental health of children and young people, how we can prevent mental illness from occurring and how we ensure that children and young people receive the right treatment in the right place at the right time. I confirm to hon. Members that evidence and recommendations from the joint report of the Education and Health Committees have informed the proposals in the Green Paper. I thank all members of those Committees for their work in producing that report.
A child’s attainment at school is linked to their mental health and wellbeing. We are determined to improve both by ensuring that children with mental health issues are given all the support required to allow them to focus on their education. Schools can play a key role in how they teach about the importance of mental health and in the prevention and identification of concerns. The hon. Member for Newcastle upon Tyne North raised the issue of exam stress. Good teaching is one of the most important factors in helping pupils to achieve. Academic success is important and good headteachers know that positive wellbeing is necessary to support that achievement. Schools should encourage pupils to work hard, but not at the expense of their wellbeing. We have removed incentives for things that add to stress, such as the culture of multiple exam resits. We are helping schools to spot mental health problems through programmes such as mental health first aid training, and through resources such as the MindEd website, funded jointly by the Department of Health and the Department for Education, which has resources and information on mental health for adults working with children and young people.
We recognise that, as been said a number of times in the debate, teachers are not mental health professionals. When more serious problems occur, schools and colleges should expect the pupil to have additional support from elsewhere, including professionals working in specialist children and young people’s mental health services, voluntary organisations and local GP practices. To help with that, the Department ran pilots to look at how joint working between health and education could be improved by having single points of contact in schools and in mental health services. The evaluation found that the pilots led to increased satisfaction with working relationships, improved knowledge and awareness of mental health issues among school leads, and improved timeliness and appropriateness of referrals.
My right hon. Friend Robert Halfon asked about the future of the pilots. We are extending them to up to 1,200 more schools and colleges in 20 additional clinical commissioning group areas. Our survey, “Supporting mental health in schools and colleges”, found that 73% of schools and colleges provide specific lessons to help to promote positive mental health and that 64% of schools and colleges report that the promotion of young people’s mental health and wellbeing is integrated in the school day.
It is the same point that Ed Timpson made at that Committee, but it is important for this debate that we are extending those pilots to 1,200 more schools and colleges in 20 additional clinical commissioning group areas.
As well as the role of the wider teaching staff, many schools have staff with more specific roles in relation to mental health. Around half of schools and colleges have a dedicated lead for mental health; more than two thirds of schools have a designated member of staff responsible for linking with specialist mental health services; and 87% of institutions reported that they had a plan or policy in place for supporting pupils with identified mental health needs.
Evidence shows that a whole-school approach, established with a commitment from senior leadership and supported by external expertise, is essential to a school’s success in tackling mental health. A whole-school approach involves the work of all staff and students, with clear links to school policies, for example on behaviour, and a culture and atmosphere that promote good mental health. Tom Bennett’s review of behaviour in schools found that a consistently applied whole-school policy, with clear systems of rewards and sanctions, was key to securing good behaviour. He argued for the importance of a whole-school culture that is effectively communicated to all staff and pupils and stated that the best behaviour policies balance a culture of discipline with strong pastoral support. The combination of clear boundaries and known sanctions for poor behaviour with a caring atmosphere is fundamental to promoting good behaviour and wellbeing for all pupils.
My right hon. Friend the Member for Harlow suggested a study of the impact of social media on children’s mental health. We are working closely with the Department for Digital, Culture, Media and Sport on the internet safety strategy, which includes working on online safety with experts, social media companies, tech firms, charities, mental health practitioners and young people. I am sure that that work will highlight gaps in the evidence, as he suggested.
My right hon. Friend also asked when we would next publish a survey on children’s mental health. The Department of Health has commissioned a new survey that will examine the prevalence of mental health and wellbeing problems among children and young people nationally. The new prevalence survey will enable us to make comparisons with the prevalence recorded in the 2004 survey and will be published in 2018.
A number of hon. Members asked about Ofsted’s role in helping to deliver these objectives in our schools. Under the current inspection framework, inspectors reach a graded judgment on pupils’ personal development, behaviour and welfare and consider their spiritual, moral, social and cultural development. We will work with Ofsted on any implications that arise from mandatory relationships education and relationships and sex education.
My hon. Friend Lucy Allan raised the important issue of mental health and children in care. The forthcoming Green Paper will consider how to improve support for vulnerable children and young people, including children in care. This includes ways of improving access to support, better joint working among services and improved training for professionals. An expert working group has been established to look at ways of improving support and care for children and young people in care; it will report shortly and we will fully consider all its recommendations. We will pilot new approaches that draw on the group’s findings to improve the quality of mental health assessments for looked-after children.
Will the report also consider transition from child services to adult services? Transition is a crucial time: young people who may previously have received services often fall through the gaps and do not get the continuation of care that they need.
The hon. Lady raises an important point that will be considered in the Green Paper that we will publish shortly.
My right hon. and learned Friend Sir Oliver Heald raised peer-to-peer counselling. One of the pilots that we have just launched relates to peer-to-peer support for children and young people with mental health. We are working with the Anna Freud Centre on it, and have just invited interested schools and colleges to apply. The programme is being independently evaluated so that we can share its findings with other schools and colleges when the pilot ends in 2019.
We want to provide all young people with a curriculum that ensures that they are prepared for adult life in modern Britain. Most schools already use their curriculum and school day to support pupil wellbeing, for example through the personal, social and health and economic education curriculum and a range of extracurricular activities. Good schools establish an ethos, curriculum and behaviour policy that teaches children about the importance of healthy, respectful and caring relationships. The Government want to ensure that all children receive a high-quality education in that respect. The Children and Social Work Act 2017 requires the Secretary of State for Education to impose a statutory duty on all primary schools to teach relationships education and on all secondary schools to teach relationships and sex education. The Act also gives the Government the power, which we will consider carefully, to make PSHE a compulsory subject in all schools.
A thorough engagement process will be undertaken to determine what schools should teach with respect to these subjects. We will say more about that process shortly; we announced today that Ian Bauckham, an experienced headteacher, will lead that work. We are also carefully considering what support schools may need to adapt to changes and improve provision. I can confirm that relationships education will focus on teaching pupils about different types of relationships and the difference between healthy and unhealthy relationships, both online and offline, which will help pupils to understand their own and others’ relationships and their impact on mental health and wellbeing. That knowledge will support pupils to make good decisions and keep themselves safe and happy.
When considering how to teach these issues in schools, we need to look at what the evidence says. To help with this, the Department is undertaking a programme of randomised controlled trials to assess the effectiveness of school-based interventions to support children and young people’s mental health and wellbeing. We are also exploring, through pilots, how pupils can support each other with their mental wellbeing. The aim of these trials is to determine whether approaches such as mindfulness are effective and to make information available to any school that might be considering offering such interventions. Of course, it is equally important that we identify approaches that are not effective.
My right hon. Friend Sir Nicholas Soames asked about teacher training. Our randomised controlled trials include two international mental health programmes—Youth Aware of Mental Health, and the mental health and high school curriculum guide—and programmes that link physical and mental health through exercise, activities and routines. Those evidence-based approaches will ensure that schools can provide the right support to children and young people.
The Prime Minister has committed to a range of other activities with regard to children and young people’s mental health. The “Supporting Mental Health in Schools and Colleges” survey showed that 90% of institutions offered at least some training to staff in supporting pupils’ mental health and wellbeing, and that in most cases that training was compulsory. To support school staff further, the Department of Health is funding a mental health first-aid training offer for every primary and secondary school in England. That training, which 1,000 schools should receive by the end of the year, will help teachers to identify and support pupils with mental health issues as early as possible.
The Government have also committed to tackling the effect that bullying can have on mental health. The Department for Education and the Government Equalities Office are providing £4.6 million of funding over two years to support 10 projects to help schools prevent and tackle bullying. These include projects that target the bullying of particular groups, such as those who have special educational needs and disabilities and those who are victims of hate-related bullying; a project to report bullying online; and projects specifically to prevent and respond to homophobic, biphobic and transphobic bullying in schools.
We are committed to supporting the positive mental health of teachers, in particular by alleviating the workload pressures that teachers tell us have an impact on their mental health and wellbeing. We have worked extensively with unions, teachers, headteachers and Ofsted to challenge practices, such as triple or dialogic marking, that create unnecessary workload. As a consequence of this work, we established three independent review groups to address the priorities emerging from our 2014 workload challenge: ineffective marking, use of planning and resources, and data management. Work is progressing to meet all the commitments set out in the action plan published alongside the 2016 teacher workload survey, and we remain open to other ways in which the mental health of wellbeing of teachers can be supported.
As I said, my right hon. Friend the Member for Mid Sussex raised the issue of teacher training. We have strengthened initial teacher training, ensuring that teacher standards include the requirement for trainees to understand mental health and wellbeing. The Department’s 2017 provision survey found that 90% of schools and colleges offered staff training on mental health.
I hope hon. Members are reassured that improving and protecting the mental health of young people remains a key priority for the Government. In 2015 we allocated £1.4 billion over five years for children and young people’s mental health.
I am sorry to intervene on the Minister so late in his winding-up speech, but may I ask him to give the House an assurance that the very complex roll-out of all these new schemes will be properly co-ordinated, so that delivery throughout the system is even? It is often difficult to see that happening when new schemes are introduced, so I will be grateful if the Minister ensures it does this time.
My right hon. Friend raises a very important issue, details of which will be set out in the Green Paper that will be published shortly. The purpose of the various pilots is to ensure that we have an evidence base, so that interventions that we make in the future are effective and deliver what we all want, which is a generation of young people who are secure in their mental health and able to identify and deal with mental health issues as they arise.
I was talking about mental health spending, which has been increased to record levels by this Government, with 2016-17 seeing a record £11.4 billion being spent, with a further £1 billion planned by 2020-21. That clearly highlights the importance that the Government place on mental health and wellbeing in this country.
Crucially, we can see that mental health is already a key priority for schools themselves. The commitment that we have made to making relationships education and RSE compulsory in all schools, and to considering the case for doing the same for PSHE, will further ensure that pupil wellbeing is supported in our schools. That sits alongside the wide range of other activity to support schools that I have set out today, and I hope that reassures right hon. and hon. Members of the Government’s absolute commitment to this vital agenda for children and young people.
I thank those who initiated this petition, because this has been an important, timely and high-level debate on this subject. Right hon. and hon. Members have made powerful contributions today, and I pay particular tribute to James Morris for his very powerful testimony, not only about his own experience but about how that applies to a very practical approach to how we can do better for our young people and for our society in addressing this issue.
I appreciate the length of the Minister’s reply and the response that he gave to the variety of issues that were raised. There is a huge amount of cross-party consensus that we need to do things better and we need to see change. I will look out for the Green Paper and the proposals in it, and I know that the excellent organisations that initiated this debate—HeaducationUK and others—and the right hon. and hon. Members in Westminster Hall today will also look out for the Green Paper, to ensure that we get this matter right, that we address the issues, that we improve our education offer, that we remove the stigma around talking about mental health, and that we adopt a cross-sectoral approach, so that our health service is there to provide the professional support that must be available and that will match our provision within the education sector.
Personally, I would like to see a really bold message coming from the Government in the Green Paper that this issue has parity of esteem, and that we do not only talk about supporting better mental health within our education system but that the Government will take the steps to ensure that it is a priority and is delivered. All right hon. and hon. Members here today will hold the Government to account on that issue.
Question put and agreed to.
That this House
has considered e-petition 176555 relating to mental health education in schools.