Mental Health Services

Lord Bradley Excerpts

Wednesday 25th February 2015 Lords Chamber

[Lord Bradley (Lab)]

My Lords, I, too, congratulate the noble Earl, Lord Listowel, on securing this very important and timely debate on mental health services, particularly for children in care. As we have heard, it has produced many important speeches. I believe that we are at a time when mental health has never been higher on the political and, more importantly, the public agenda. As such, we must all seize the moment. In my brief contribution, I want to remind the House of some key facts that are behind the barriers that may be stopping improvement in mental health services for children, care leavers and, in particular, adolescents.

As we know, mental health problems affect 23% of the population at any one time, and the economic and social cost of mental ill health was estimated in 2009-10 to be £105 billion. As has been pointed out, that is the entire annual National Health Service budget. Furthermore, three-quarters of people with depression receive no treatment at all. That includes children, and 10% of five to 15 year-olds have a mental health problem. This is especially true of children in the care system, who have a poorer level of physical and mental health than their peers and whose long-term outcomes remain worse. Two-thirds of looked-after children have at least one physical health complaint and nearly half have a mental health disorder.

Although the ambition for parity of esteem between mental and physical health is clearly welcome—nothing could be more important in this ambition than children in care—there are concerns that there are major problems in actually achieving it. For example, a recent survey by the Royal College of Nursing revealed that there are now 3,300 fewer posts in mental health nursing and 1,500 fewer beds than in 2010. These problems were further exposed by the Health Select Committee in October 2014, in its report on child and adolescent mental health services. It concludes:

“There are serious and deeply ingrained problems with the commissioning and provision of Children’s and adolescents’ mental health services. These run through the whole system from prevention and early intervention through to inpatient services for the most vulnerable young people”.

That is not surprising given that we know that only 6% of the mental health budget is spent on children and young people in the mental health system and, as has been pointed out, this has been exacerbated by recent cuts in CAMHS services.

Against this backdrop, what needs to be done to improve mental health services, particularly for children in care? First, we need to ensure that there is an adequate number and proper geographical distribution of in-patient beds for all age groups, but particularly for children, when they are required. This should resolve the problem of children being taken hundreds of miles away from home or ending up in adult psychiatric beds, which is totally unacceptable, as the whole House will agree. I know the task force is undertaking this work, and I would be grateful if the Minister could advise us what progress has been made on this issue.

We heard from the noble Lord, Lord Ramsbotham, about the use of police cells and the inaccessibility of proper places of safety. Linked to that, we must ensure that the liaison and diversion programme is completed by 2017. We heard about the expansion of therapy, particularly the IAPT programme, and therapy services for children, which I support, but we must look in particular at transitional arrangements and the ages at which people have access, in a timely way, to those programmes. It is crucial that we recognise the value of early intervention and the dramatic effect on people’s lives, particularly for young people and their families, if that intervention does not take place.

We need a real focus on schools, with all staff, especially teachers, having some level of training in mental health so that they can identity possible issues and passport children to specialist services. We need to look at the Mentally Healthy Society report that was published today, which recognises the need within schools to have a named CAMHS worker for proper link and access. It also recommends training health workers—we have heard a lot about training today—on mental health issues, because, again, they can be crucial in early intervention.

I recently visited a liaison project in Sunderland and met with parents of children who had a mental health problem. The scheme is excellent and the parents are wonderful, but they need tailored, timely and continuous support. Parenting programmes, which are supported by the Royal College of Psychiatrists, need to be expanded and must be funded and developed. Finally, we need a clear strategic commissioning framework to ensure that all relevant agencies—health, criminal justice and others, as well as local authorities, particularly for children in care—work effectively together so that we do far better for all children who have mental health problems.