Child and Adolescent Mental Health Services

Andrew Percy Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Andrew Percy (Brigg and Goole) (Con)]

It is a pleasure to take part in this debate as a member of the Committee, and I associate myself with the kind words of our excellent chairperson, my hon. Friend the Member for Totnes (Dr Wollaston), about everyone who gave evidence, and about all the Clerks and House staff who supported the inquiry. It was one of the most important and far-reaching inquiries we have undertaken in the past few years, and I was proud to have been a part of it, because the issue is so important.

I wish to make a few general comments about this whole area and then to talk specifically about the role schools can play in mental health services for children and young people. I noted with interest the comments made by the hon. Member for Stoke-on-Trent South (Robert Flello). The comments today have generally been quite consensual, although something I will say a little later about funding may be less consensual. He pointed out that 10 years ago we were having many of these same conversations, but things have really moved on in the past 10 years, not least in this area; we heard in our inquiry about the increase in demand. Although many of the pressures young people faced 10 years ago are similar, a whole host of other pressures on young people now did not exist then, particularly those of a cyber nature, be it those arising from Facebook, Twitter or online bullying. When I started teaching in 2002 people did not have a great deal of understanding or expectation of any of those things, but they have now become so widespread that we have had a massive increase in demand in this area.

In addition, the way in which mental health services and care are delivered has changed beyond recognition during that period, and some would argue that it has not always been for the better. As we know, between 1998 and 2010 the number of mental health beds reduced from 35,000 to 25,000, and we have seen a continuing shift away from in-patient treatment units. What came out of this inquiry, and what I have seen in my constituency in mental health service provision for both young people and adults, is that although that more traditional unit-based, hospital-based, bed-based system of treatment has changed, what has replaced it has not necessarily always filled users with confidence or has even been consistent across the country. As our report makes clear, there is a lot more we need to do.

As I have said, I wish to focus on what we heard from young people. It was great that our inquiry had a session with young service users, including some from Hull, near my area, who came down to tell us about how they have engaged with local voluntary, local authority and, of course, school services. In our inquiry, we heard that the support schools offer young people is very patchy across the country, changing even within cities or within counties. Some young people we heard from, and some of the other evidence we took, made it clear that some of the best support they had received had come from dedicated teachers who understood mental health issues, really wanted to engage with those young people on them and help them access services. Having a teacher who was engaged and who understood what to look for in mental health really helped young people. Some pupils had different experiences. They felt that teachers either lacked the skills or were too uninterested to deal with the problem. Very often that can be because teachers are scared of mental health issues. In some cases, therefore, pupils experiencing mental health problems did not receive the support that they needed.

I started teaching in 2002. When I think back to some of the young people we had to deal with, I can see that many of them probably had mental health issues. At the time though, those pupils were dismissed as being badly behaved or as having background problems. As a practitioner, I was sometimes guilty of not understanding the signs that were being presented to me. However, teachers cannot be blamed for that; they work in a pressured environment. The pressures around school standards seem to get more intense every year and with every Government initiative.

What we did hear in our evidence was that 61% to 85% of schools are providing access to school-based counselling. Although that is a wide variation, it is a positive thing. We heard that some schools engage really proactively with the local authority and the NHS in this area. Unfortunately, though, we also heard of others that do not engage so well. Some schools seem to think that mental health issues are for health services and social services, but not for schools. When we talk about integration in all areas of health care, this area is one in which we need it the most and, potentially, it could have the biggest impact. My hon. Friend the Member for Totnes talked about early intervention. When we fail in that regard, the consequences are picked up by other services. That means that we have increased referrals and more behavioural difficulties in our schools, which leads to more exclusions. Those exclusions have consequences not just for the management of the school but for that young person’s life chances.

What can we do in schools to make a real difference? Increased collaboration among the services is vital. Although we talk about integration and greater collaboration, we need someone at some point to take responsibility for that and to be held accountable when that collaboration does not work. As we heard in our evidence sessions, some schools are keen to take the lead in that regard, and others less so. Clearly, this is an area where we need greater clarity.

The curriculum was raised by a number of young people, particularly around personal, social, health and economic education. They said, “We learn everything in PSHE. We learn about sexual activity, financial matters, career advice and career choices, but what we do not learn about is mental health and well-being.” Ofsted found that 40% of PSHE provision required improvements nationally and that one third of young people say that they want to know more about how to deal with stress and how to access help for eating disorders. Some 38% said that they wanted education around bereavement, which surprised me.

We have seen some good things happen with the curriculum. We heard in our inquiry that the ICT curriculum now contains a section on cyber-bullying. Clearly, some improvements have been highlighted but an awful lot more still needs to be done. The focus should be on young people as much as it is on teacher training. In our evidence sessions, we heard from the Secretary of State about how a great deal of effort has gone into providing teachers with the tools to deal with mental health issues and to improve training, and that is really important.

When I did my postgraduate certificate in education, I do not remember receiving a great deal of education about mental health and young people’s emotional well-being. Clearly, that needs to change, but the focus should be not only on equipping teachers better, but on ensuring through the curriculum that young people are able to understand mental health issues. The stigma needs to be removed through both teacher training and the curriculum, and young people who have had experience of mental health issues should be involved in developing that curriculum.

I wanted to say a little more about youth services, but I do not have a great deal of time. We have heard a lot about council spending reductions and the impact that that can have. The truth is that whoever was in power, we would be in this position, with council budgets having been reduced. In my area, I am very pleased that North Lincolnshire council has made a concerted effort to reverse the cuts to youth services instituted by the previous administration of a different party, which cut the services by £194,000. Even in these tough times the council has been able to put in an extra £100,000 of funding and over the next three years will add to that a further £300,000.

Local authorities can do that if they have the necessary vision. In the case of North Lincolnshire, the driver for that is a very good portfolio holder in the cabinet who understands that we have to get it right early. That means that we need proper investment in positive activities for young people, because that allows savings elsewhere down the line. Despite all the difficulties that we have faced in local government funding, where there is leadership and vision, people who understand the value of these services can find the money to invest in them. With that, I will end as I am conscious of time and I know that one of my colleagues wishes to speak.

--- Later in debate ---

[Grahame M. Morris]

That is true. Some of the organisations that submitted evidence to the Health Committee and subsequently provided briefings made that point.

Another issue of concern is the complex commissioning landscape for CAMHS, which can result in poorly co-ordinated services and a lack of clarity about roles and responsibilities, leading to gaps in provision and poor transitions from child to adolescent and from adolescent to adult. The service is certainly underfunded. We often talk in this place about parity of esteem. As other Members have reported, CAMHS nationally is receiving about £1.8 billion of the £14 billion that is spent on mental health. Local authority-provided services, which are often having to bridge the gap, are facing huge financial challenges. My local authority, which I share with my hon. Friend the Member for North Durham (Mr Jones), has had to cope with cuts of £250 million over the lifetime of this Parliament. That is forcing councils to make extremely difficult decisions about which services are funded.

I fully understand the point made by the hon. Member for Brigg and Goole, but I also fully understand the difficult decisions faced particularly by authorities in the north that seem to be suffering disproportionate cuts. Councils are embracing their new public health responsibilities—

[Andrew Percy]

I hope the hon. Gentleman understands that both my local authorities are in the north of England; I would not want him to get his geography wrong.

[Grahame M. Morris]

I am certainly aware that some authorities are facing higher cuts than others. My area is one of relatively high deprivation, but we seem to be in a far worse position than some in the south that are more affluent and do not have the same kinds of pressures.

In rural areas, in particular, people face problems with travelling long distances, a lack of accessibility to specialist services, and long waits. One issue is the 12-week target for referral to CAMHS in cases where children and adolescents are referred out of their local areas. Transition between services varies from one area to another. In some areas it happens at 16, in some at 18, and in some at a point in between. These issues all need to be addressed.

Fundamentally, this issue comes down to funding. I welcome the establishment of the taskforce and the provision of £30 million over the next five years to improve services for young people with mental health problems. However, we must recognise that councils play a vital role in working with health services to target support and co-ordinate services, and they should play a key role in directing the funding.