Education and Health Select Committees hold join session on mental health Green Paper
On Tuesday Parliament’s Health and Education Committees heard from expert witnesses on the proposals contained in the Government’s “Transforming children and young people’s mental health provision” green paper as part of a joint inquiry on mental health provision for children and young people.
The expert witnesses, who were questioned by MPs across two sessions, were:
- Anne Longfield OBE, Children’s Commissioner for England
- Dr Pooky Knightsmith, Vice Chair of the Children and Young People’s Mental Health Coalition and Director of the Children and Young People programme at the Charlie Waller Memorial Trust
- Rowan Munson, former member 2015 Youth Select Committee
- Paul Whiteman, General Secretary, National Association of Head Teachers
- Stuart Rimmer, Principal and CEO, East Coast College
- Dr Tamsin Ford, Professor of Child and Adolescent Psychiatry, University of Exeter
- Dr Bernadka Dubicka, Chair of the Child and Adolescent Psychiatry Faculty, Royal College of Psychiatrists, Honorary Reader at the University of Manchester, and Inpatient Consultant Child and Adolescent Psychiatrist
Some of the comments given by the witnesses on Tuesday are set out thematically below.
Overall views on the Green Paper
Children’s Commissioner for England Anne Longfield welcomed the Green Paper, especially the focus on early intervention and the ambition on CAMHS waiting lists.
However, she argued that in broad terms it would not transform things as it lacks any framework of expectations and accountability. In her view we should be looking at the scale of change in the adult mental health world and trying to emulate that in the way we deal with children’s mental health. She called for the introduction of benchmarking for children’s mental health.
She said she was unclear about how the new funding that is going to be introduced and called for the National Audit Office to do a survey of funding. She pointed out that spending on children’s mental health is only 6% of what is spent on adults, calling the scale of the change needed “incredible”.
Dr Pooky Knightsmith, Vice Chair of the Children and Young People’s Mental Health Coalition and Director of the Children and Young People programme at the Charlie Waller Memorial Trust, welcomed the Green Paper as a positive step forward. However, she worried that there is not enough money available and that it wouldn’t find its way to the right places.
Dr Knightsmith went on to say prevention should become more of a key part of the approach. One of the things that isn’t in the Green Paper is 0-5 prevention. We should also be thinking of the role of school staff and parents, in terms of their mental health and their ability to act as positive role models.
She was concerned that the huge amount of good work that has already happened was sitting apart from the Green Paper proposals. She said the Green Paper is not ambitious enough.
Dr Bernadka Dubicka, Chair of the Child and Adolescent Psychiatry Faculty, Royal College of Psychiatrists, Honorary Reader at the University of Manchester, and Inpatient Consultant Child and Adolescent Psychiatrist, welcomed the breadth of the paper and ambition on waiting times. She had concerns around workforce recruitment and retention but welcomed the idea of mental health lead in schools.
She said there was no additional capacity in child psychology to meet the anticipated need within the Green Paper and that they were trying to do what they can to increase recruitment.
She also said parenting is a big gap in this document- it is one of the big areas we have where we know it actually works. With parenting groups for parents of children with behavioural difficulties as early as possible we can do an awful lot of good. The evidence shows it works, it’s missing from this document and needs to be addressed.
Rowan Munson, a former member 2015 Youth Select Committee, said cuts to local authorities were hitting young people’s preventative mental health services. He welcomed the emphasis on improving CAMHS waiting times but felt that high thresholds often meant there was no point in referring someone to the local CAMHS service unless they are literally on the verge of suicide.
Stuart Rimmer, Principal and CEO of East Coast College, said that colleges could be dealt with separately as their small numbers mean they could mobilise much faster.
He said the transition period from 16-25 is important and the Green Paper doesn’t go far enough in understanding what might be behind the bottleneck.
Paul Whiteman, General Secretary, National Association of Head Teachers said that the situation is characterised by a lack of resources- e.g. when the Green Paper talks about waiting times for referrals we know we are talking about months rather than weeks.
He said we have a high stakes system at the moment due to exam pressure and this is going to be there no matter what teachers and parents do. There are limits to what schools can do. Their job is to educate children and then to rely on services outside of the school gate. They can’t do everything and aren’t resourced to do everything.
He said head teachers sometimes use their own budgets to fill the gaps but this is becoming harder and harder. He argued that bringing agencies together is the right thing to do but wondered whether there are really sufficient resources.
Mr Whiteman also raised a point about basic funding, suggesting that the number of Teaching Assistants schools could have at the moment is a real stretch. Losing a lot of one to one support is going to have an impact on mental health.
The Mental Health leads
Anne Longfield said the role should not be put onto an existing member of staff and had to be someone who is able to link up with health teams.
She said the issue of resources is important as we can’t just keep stitching together what’s already there because we know that access levels are poor. There needs to be additional funding there to boost the numbers that are available to work with children, given that only 6% of the mental health budget currently goes to children. Only if it was three or four times higher could it start to address the probem.
Paul Whiteman said there needed to be more clarity around the parameters of the role. It should be clear about what point they will be expected to refer to more specialist services. He aired concerns about the training of the mental health leads, saying that there needs to be national guidance to ensure standards are consistent.
He went on to talk about the lack of recognition of increased workload as the mental health leads pick up new work. A lot of that work won’t be accepted by CAMHS due to the high threshold and there’s a danger that the mental health leads will be expected to deal with them themselves, affecting morale, recruitment and retention. He worried that it may become “another stick” to beat school leaders with.
Dr Tamsin Ford, Professor of Child and Adolescent Psychiatry, University of Exeter argued that the mental health leads need to be trained consistently, need to be comfortable with the role and need to have the time to do it. We need to make sure they are delivering interventions to children that are evidence based and then monitoring their outcomes and reflecting and improving on the basis of that. She said the role needed to be better defined as it blurs the lines between clinician and educator.
The trailblazer areas
Dr Pooky Knightsmith questioned whether some areas would have the capability to be trailblazers and expressed concerns that it may fall to areas that are already more advanced to go ahead with the pilots.
Anne Longfield said she wanted consistency across the country as early as possible. She said IAPT has been rolled out and got to 1.5 million people in 10 years and there is consistency and clear accountability framework.
Dr Bernadka Dubicka said there should be a variation of sites between areas that are doing well and areas that struggle. However, we can’t select sites that are going to fail and there needs to be some kind of commitment to making this happen.
Tamsin Ford said that having tried to get research about parenting and teaching groups going in disadvantaged areas and not having much success she recognised that you do need a mix of areas. When some areas are successful tougher areas see that success and get on board. Some areas that face real challenges can end up being amazing.
Stuart Rimmer suggested looking at sectoral approaches rather than geographical ones.
Opportunity Areas / Disadvantage
Committee Chair Robert Halfon MP asked if there was evidence of joined up thinking between the Green Paper and the Social Mobility Action Plan and opportunity areas.
Anne Longfield said she’d like to see a lot more of it and we shouldn’t look at education or health in isolation. The opportunity areas should be embracing all of these things. She called for targeting in broader terms around areas of high disadvantage.
She said there are pockets of disadvantage hidden in rural areas where deprivation can be awful.
She agreed with Ian Mearns MP that the number of opportunity areas was too small and said it was “very strange” that there isn’t one in the north east.
Pooky Knightsmith said that trailblazer areas are really important but would welcome a very wide range of different sizes, types and geography.
Rowan Munson said that the more diverse data we have the better the intervention would be.
Dr Bernadka Dubicka mentioned that the introduction of the Green Paper talks about helping vulnerable groups but there isn’t much substance on this in the document. She went on to ask how the new GDPR data protection regulations would impact on the ability of youth offending teams, housing officers and broader social support to share information on young people.
Dr Tamsin Ford said we need to be better able to support high-functioning autistic children who may cope well in the classroom because it is structured but struggle with the social aspects of school such as break time. This has implications in SEN training and resources. She said they shouldn’t have to choose between academic achievement in mainstream schools or mental health and wellbeing in more specialised settings. She said the answer to this is adequate support for them to cope with the social structures. That might mean a child having a Teaching Assistant with them during the break and teachers having training around autism.
Data on mental health
Dr Bernadka Dubicka said the Green Paper’s Impact Assessments do not use accurate data and are based on a lot of assumptions. We need to have good figures and data on what the unmet need is.
She said there is a prevalence survey coming up so we’ll find out what this is soon, however, the survey won’t be repeated for 7 years so in the intervening period we will not know what is happening. There is a unique opportunity to get that data. If the Government funds this on ongoing basis year to year we would have that data and know what impact the green paper is happening.
Dr Tamsin Ford said the data used in the Impact Assessment for the Green Paper was over a decade old.
Rowan Munson said the real issue is that we are not talking to children and young people enough. We need more data but we also need to be asking young people where their first point of contact is and what works for them.
Rowan Munson argued there was a link between social media and poor mental health. He mentioned the NHS Go app which was popular among young people as it was promoted innovatively. He said the impact of social media can be positive and negative.
Dr Pooky Knightsmith said children on the ASD spectrum can make meaningful relationships on social media that they may struggle to do face to face. She said social media should form part of any PSHE curriculum and more needs to be done with teachers and parents to understand it.
Anne Longfield said she would like to see a starting point that looks at children at birth and recognises that problems develop early and the nearer to home they’re treated, the better. Schools are a great place to get intervention but there should be intervention before that.
Dr Pooky Knightsmith said she was concerned about the focus on schools and said it needed to be more on those who are not accessing services at school. To this end she argued that virtual mental health leads were a good idea.
She went on to say more needs to be done around transitions. There needs to be more joined up thinking and colleges need to be involved more, the mention in the Green Paper was somewhat tokenistic. The transition is just a small part of the picture however, as some of the most vulnerable young people are not in services at all.
Rowan Munson talked about teacher stress, saying they have their own mental health pressures, such as the focus on exam grades and league tables, and related a story of one teacher at a local school had a panic attack in the middle of the class.