Young People’s Mental Health

Seema Malhotra Excerpts

Thursday 27th October 2016 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) and the hon. Member for South Cambridgeshire (Heidi Allen) on securing this debate. I warmly congratulate, too, the clearly very talented Youth Select Committee on producing such an excellent report, which cogently highlights the need for additional and better mental health services for young people. It is a job very well done indeed.

For too long, those suffering from mental ill health have received far less care and attention than those suffering from physical ailments. Even though mental ill health accounts for 28% of the total burden of disease, it gets just 13% of the NHS budget. One in four adults is diagnosed with a mental illness at some point in their lives, but only about a quarter of those who need mental health services have access to them. Serious medical conditions are going untreated because of the disparity of esteem between physical and mental health that everybody—the Government, health professionals, patients, the voluntary sector—speaks of wishing to end. There is such a long way to go.

The consequences of our neglect of mental health services are devastating. Over a third of people with mild mental health problems and almost two thirds of those with more severe mental health problems are, in fact, unemployed—yet research shows that the vast majority of them wish to work.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

I thank my hon. Friend for giving way and congratulate the Select Committee on this report. She makes an important point about the number of people with mental health issues who are unemployed. I have been struck by the message from schools; one in my constituency told me that it was referring 40% of its pupils for mental health support. Does she agree that early intervention, as highlighted in the report, is vital? Does she recognise the work of Members of the Youth Parliament, including Tafumi Omisore in Hounslow, who raised these important issues with us?

[Lyn Brown]

Absolutely. I totally agree with my hon. Friend, and as I go through my speech I am hoping to provide an example to show how intervention is particularly important for a very young child because of the impact on the rest of the family. Early intervention can do a lot to mitigate other events and difficulties occurring in the family that might include other family members, too.

Unfortunately, tragically and outrageously, young people’s mental health services often receive less attention than adult mental health services, so that young people’s mental health services have been called the “Cinderella of Cinderella services”. In November 2014, the Health Committee found that there were

“serious and deeply ingrained problems with the commissioning and provision of services for young people’s mental health.”

Many providers reported increased waiting times and increased referral thresholds for specialist services, where patients would have to show severer symptoms to receive treatment than they would have done in the past. GPs reported feeling ill-equipped and lacking in confidence when dealing with young people’s mental health issues. The Select Committee found that early intervention programmes were

“suffering from insecure or short term funding, or being cut altogether.”

There really is no excuse for this failing. Around half of people with lifetime mental health problems experience symptoms by the age of 14, and about 75% of them before the age of 18. Catching these problems early could well lessen the severity of adult problems, possibly saving the NHS money in the long term. More importantly, I would suggest, it would reduce unnecessary suffering and enable people to live better lives.

I want to be fair to the Government, who have recognised that there is a problem. In 2014 they set up a children and young people’s mental health and wellbeing taskforce, which made a number of recommendations in its 2015 “Future in mind” report. The taskforce identified a number of problems with young people’s mental health services. The right hon. Member for North Norfolk (Norman Lamb), who was then the responsible Minister, said that there needed to be a fundamental shift in culture, with a much greater focus on prevention and early intervention.

The taskforce rightly recognised that one of the challenges facing young people’s mental health services was—unsurprisingly—funding. I was pleased when the Government responded by announcing the provision of an additional £1.4 billion of transitional funding for youth mental health services, but that additional money needs to be considered in the context of the less encouraging overall picture of mental health services funding. NHS England’s planning guidance states that all clinical commissioning groups must increase their spending on mental health services by at least as much as their overall budget increases. However, there have been warnings from organisations including mental health trusts that mental health funding is not properly ring-fenced, and that NHS England’s target is being missed.

Let me again follow in the footsteps of my hon. Friend the Member for Dulwich and West Norwood. We know from the responses to a series of freedom of information requests from my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) that more than 50% of CCGs intend to spend a smaller proportion of their budgets on mental health in 2016-17. That clearly demonstrates that what the Government tried to do has failed, and that that target is being missed as well.

[Lyn Brown]

We need early identification and we need early intervention, but we also need the funds to ensure that there are services to which people can be referred. That is the rub of this whole debate. There does not seem to be the necessary funding at any point in the journey of young people who need help, whether in the form of awareness, intervention or services.

I have been looking into the good work done in my borough, the London borough of Newham. Even in these difficult times, it is increasing its mental health spending in both absolute and relative terms, and its children’s mental health services received an “outstanding” rating from the Care Quality Commission. I wanted to find out how we could improve young people’s mental health provision, and to learn about the challenges that an “outstanding” local provider continued to face in its fight for better services. Professionals in Newham recognise that a good young people’s mental health service does not just help those who have already developed severe and serious conditions, but provides early intervention and preventive programmes so that problems can be dealt with at source.

[Seema Malhotra]

Is it not important for young people’s mental health services to consider the needs of parents as well? I was struck by a recent case in which the parents did not understand where the issues had come from and could not identify what they were, and felt unable to understand how best to help their child.

[Lyn Brown]

My hon. Friend is right. The family is often key to the provision of the support that a young person needs, but a family may itself need intervention to gain the support that it needs to lead a mentally healthy life.

The national lottery funded a programme in Newham called HeadStart, which helps 10 to 16-year-olds, particularly in schools. It trains teachers in secondary schools to develop programmes that help to build resilience among their pupils. It also provides children directly with mentoring schemes so that they can learn from each other about how to manage mental health issues—it is peer-to-peer learning—and works directly with parents to show them how they can work through mental health issues with their children. Unfortunately, the scheme relies on lottery money rather than core funding, which means that its future as a core service cannot be guaranteed. It is often difficult to obtain the necessary proof that would persuade funders—including the Government—that core funding should continue, because the timescale is often not big enough to be persuasive.

Newham would love to run more services directly in the community, and more integrated services, because it knows that they make a real difference to people’s lives. M, aged two, and her baby brother T, just seven weeks old, were referred by a perinatal psychiatrist, who was helping their mother to deal with chronic mental ill health. M was still frequently breastfed, and showed a very insecure attachment to her mum. Her anxious, and therefore sometimes controlling, behaviour was making it difficult for her mum to wean her and to attend to the needs of the new baby, who was being bottle-fed. M’s speech was also delayed.

Following assessment, the family were offered parent-infant psychotherapy, which enabled them to reflect on the needs of both children, and gradually to help M to become more independent of her mum. At the same time, T was able to have more appropriate attention from his mum as the baby of the family. I am pleased to say that, following that intervention, M is more confident and her speech is developing. She sleeps in her own room, and has settled well into nursery. That is an example of our physical and mental health services working in tandem to improve real lives.

J was a 17-year-old who had been arrested and charged with possession of a weapon and affray. He had a history of violence and non-engagement with services. During the course of his referral to a youth offending team, the team became concerned about his mental health, and referred him directly to a child and adolescent mental health services specialist for an urgent examination. During that assessment, J was having suicidal thoughts, was highly anxious, and showed quite severe symptoms of obsessive-compulsive disorder as well as softer symptoms of attention deficit hyperactivity disorder.

The youth offending team nurse arranged for J to have urgent psychiatric treatment. He was put on medication for his anxiety, with an accompanying course of cognitive behavioural therapy for his obsessive-compulsive disorder. He will also be assessed for ADHD in the longer term once his more acute symptoms abate. I am pleased to report that J has not offended since he has engaged with the mental health services offered through the youth offenders team. That shows that integrated services are better for individuals, and better for the whole community.

Those are just a few of the stories that I have been told, but I believe that there are enormous challenges to the provision of community-based and fully integrated services. I am told that Newham would love to run services directly from general practices, but they cannot currently do so because they do not have the necessary resources. With the current staffing levels it would not be efficient, because staff would spend as much time travelling to and from general practices as they would spend helping patients.

Health professionals acknowledge that early intervention work often increases rather than reduces workload in the short term. Professionals in Newham worry that they simply will not be able to deliver the clinical hours that are necessary to help more patients. Over 50% of patients in Newham already have to wait for more than five weeks to see a specialist, and that figure can only increase when further cases are uncovered without corresponding additional resources.

Some well integrated and community-based mental health services are delivered in Newham and, I am sure, throughout the country, but if we want to preserve and expand those programmes, we must be aware that they need stable and long-term funding. A good place to start would be ensuring that money designed for mental health services actually finds its way to the front line.