The Government’s Green Paper on mental health: failing a generation Contents

1Introduction

1.Half of all mental health conditions first occur by the age of 14, and three quarters by the time someone is 24.1 The most recent available data from ‘Mental health of children and young people in Great Britain, 2004’2 find that one in ten children are living with some form of diagnosable mental health condition. Mental health issues often persist into adulthood, leading to individual harm and wider societal costs. Effective prevention and early intervention helps to reduce both and it is essential that the Government ensures that all children and young people who need it have timely access to quality care. We welcome the publication of the Department for Education and the Department of Health and Social Care’s Green Paper on Transforming Children and Young People’s Mental Health Provision which outlines proposals to improve the timeliness and quality of care.

2.The Government’s Green Paper outlines a ‘three pillar’ strategy: a Designated Senior Lead for Mental Health in every school and college, new Mental Health Support Teams linked to groups of schools and colleges, and trials of a four-week waiting time for access to Child and Adolescent Mental Health Services (CAMHS). It also provides information about the ongoing work to improve mental health provision, and several supplementary proposals. Two of the three pillars will be tested and evaluated in different trailblazer areas; the Green Paper suggests that the trailblazer approach will reach between a fifth to a quarter of the country by 2022/23.3

3.This inquiry builds upon work done by the Education and Health Committees in previous Parliaments, including the joint inquiry into Children and young people’s mental health—the role of education.4

4.We are disappointed that the findings and recommendations of our predecessors’ report have not been taken fully into account. Our inquiry also follows up the Education Committee’s inquiry into the Mental health and well-being of looked-after children5 and the Health Committee’s inquiry into Children’s and adolescent mental health and CAMHS.6

5.It is not our intention to replicate the information provided through the consultation process for the Green Paper. Instead, this report builds on the work of our predecessor Committees and draws together evidence from a wide range of stakeholders, including children and young people, to provide an overview of the scope and implementation of the Green Paper’s proposals. We also scrutinise the foundations and development of the Green Paper.

6.In our inquiry, we heard evidence from Ministers from the Department for Education and the Department of Health and Social Care. We also heard from key stakeholders, including representatives from NHS England and Health Education England, the Children’s Commissioner for England, the Children and Young People’s Mental Health Coalition, and the National Association of Head Teachers. We invited written evidence from certain key stakeholders and received over 40 submissions. We also hosted an informal discussion forum in Parliament, facilitated by Place2Be, with pupils and teachers from George Green’s School as well as young people from the Totnes Community Development Society. We are very grateful to all those who have contributed to our inquiry.

7.We welcome the publication of the Government’s Green Paper. However, we consider that it lacks any ambition and fails to consider how to prevent child and adolescent mental ill health in the first place. The narrow scope does not take several vulnerable groups into account, the proposals put more pressure on the teaching workforce without sufficient resources, and the timetable for implementation ignores hundreds of thousands of children over the next twelve years. We are also concerned that the funding for the Green Paper’s proposals is not guaranteed and contingent on an unspecified level of success.

The state of children and young people’s mental health provision

8.Since October 2017, the Care Quality Commission (CQC) has published a series of reports on the current state of the quality and accessibility of mental health services for children and young people. The phase one report indicated that “too many children and young people have a poor experience of care and some are simply unable to access timely and appropriate support”7 and that “children and young people’s mental health is marked by variation” in terms of the needs of children in different circumstances or ages, across the quality of services, and in how different parts of the fragmented system are organised.8 The precise prevalence of mental health conditions in children and young people is estimated, since the latest prevalence survey took place in 2004 and looked at ages 5 to 15, but findings from that survey indicated that 10% of children are affected by mental health problems.9 There is considerable variation of prevalence across different groups of children and young people, with significantly higher prevalence seen in looked-after children, care leavers, those in the criminal justice system, LGBT children and young people, those with disabilities, and those from economically disadvantaged families.10

9.The CQC published its phase two report into children and young people’s mental health services in March 2018, which drew on fieldwork carried out across ten health and wellbeing board areas in England. They reported finding “examples of good or innovative practice” in each of the areas that they visited, but that this occurred “despite how services are structured, commissioned and overseen, not because of it”.11 The report makes several recommendations to local and national organisations involved in ensuring the delivery of mental health services, across both the health and education sectors. The CQC plan to follow up on the progress made against these recommendations in 2019/2020.

10.There are many areas across the country with highly effective and integrated service provision, yet there are also areas with “poor quality care where the different organisations that support young people are not joined up”.12

11.The Royal College of Psychiatrists notes that “correctly identifying a mental health problem and its severity is not an easy task.”13 Even if a mental health problem has been identified, not every child or young person will be able to access support. According to Public Health England only 25% of children who need treatment receive it.14 For those who meet the high threshold for access to care, they can be faced with a wait for an average of 12 weeks from referral to treatment, with longest waits of up to 100 weeks.15 NHS Providers told us in written evidence that

Children and young people are waiting longer to access services, or escalating into a greater severity of crisis before they are referred. This displaces demand to the later, more intensive and costly end of child and adolescent mental health services.16

12.In addition, services which provide mental health support to children and young people have experienced cuts in recent years and are faced with significant workforce issues. 62% of school leaders have reported difficulties in recruiting and retaining teachers, psychiatry has the “slowest growth in new recruits and the highest drop-out rate of any clinical specialty”, there has been a reduction of counsellors and educational child psychologists in our schools, and mental health nurses are reportedly among professions where providers find the greatest difficulty in recruitment.17


1 World Health Organisation, Mental Health Action Plan 2013–2020, 2013, para 69

2 Office for National Statistics, Mental health of children and young people in Great Britain, 2004, 31 August 2005

3 Department of Health and Department for Education, Transforming children and young people’s mental health provision: a Green Paper, December 2017, para 64

4 Health and Education Committees, 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;

5 Education Committee, Fourth Report of Session 2015–16, Mental health and well-being of looked-after children, HC 481

6 Health Committee, Third Report of Session 2014–15, Children’s and adolescents’ mental health and CAMHS, HC 342

9 Office for National Statistics, Mental health of children and young people in Great Britain, 2004, 31 August 2005

10 Care Quality Commission, Review of children and young people’s mental health services: Phase one report, October 2017, page 7; Centre for Mental Health (SGP0018)

12 Department of Health and Department for Education, Transforming children and young people’s mental health provision: a Green Paper, December 2017, para 17

13 The Royal College of Psychiatrists (SGP0017) para 3.4

14 Public Health England, The mental health of children and young people in England, December 2016, page 6

15 Department of Health and Department for Education, Transforming children and young people’s mental health provision: a Green Paper, December 2017, para 17

16 NHS Providers (SGP0040)




Published: 9 May 2018