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

2Development of the Green Paper

Evidence based review

13.The Green Paper states that the Government used the findings of a “systematic review of the evidence relating to the mental health of children and young people”—conducted by Professor Tim Kendall, Professor Peter Fonagy, Professor Steve Pulling and University College London—to inform its proposals.18 This review has not yet been published. Professor Tim Kendall, Mental Health National Clinical Director for NHS England and NHS Improvement, told us that the Departments provided the remit and instructions for the evidence review: “the scope was given to us, so the evidence we then excavated was appropriate to that scope”.19 It is a source of disappointment that rather than provide a “systematic review of the evidence”, the Departments limited the scope of the Green Paper from the outset, which may have resulted in vital evidence being missed.20

14.Jackie Doyle-Price MP, the Parliamentary Under-Secretary of State for Mental Health and Inequalities, told us that the sole focus of the Green Paper was “the partnership between the Department [of Health and Social Care] and schools”.21 However, the Green Paper does not outline this restricted focus; it includes several supplementary proposals outside that remit, and makes the point that Mental Health Support Teams “would not be limited to those children in mainstream education”.22 For that reason, the scope of this report goes beyond the partnership between the Department of Health and Social Care and schools.

15.We believe that the Government limited the scope of the Green Paper too early by restricting the terms of the evidence review. Scrutiny of the Green Paper has been made more difficult because we did not have access to the evidence review on which it was based.

16.We recommend that the Government publish the evidence review alongside the response to this report.

Lack of joined up thinking with social mobility strategy

17.We are concerned that in developing the Green Paper, the Government has missed opportunities to join up with other relevant initiatives. There are several strategies which should connect to each other, yet do not. For example, the Department for Education’s social mobility report Unlocking Talent, Fulfilling Potential was published ten days after the Green Paper, yet only mentions mental health and the Green Paper once.23 The Green Paper refers to certain vulnerable groups with greater prevalence of mental health issues, but does not refer to social mobility. We heard from witnesses about the correlation between social disadvantage and mental health; the Centre for Mental Health told us in written evidence:

The green paper also makes little recognition of the wide inequalities in children’s mental health. At age 11, children from the poorest 20% of households are four times more likely to have a serious mental health difficulty as those in the wealthiest 20% (Morrison Gutman et al 2015).24

18.The Minister of State for School Standards, Rt Hon Nick Gibb MP, told us that the social mobility strategy and Green Paper are “two separate things”, but Jackie Doyle-Price said that “a silo culture in Government is the enemy of good policy making”.25 For the Green Paper’s proposals to be effective, there will need to be coordination across Departments and services. However, we see from the development of the Green Paper a lack of coordination between the Departments, and a lack of join up with other relevant initiatives which could have beneficial impacts. In particular, we know that there are key factors which are more likely to give rise to child mental health problems such as deprivation/poverty, chaotic family circumstance, behaviour problems and school exclusion, parental mental health especially perinatal mental health, Adverse Childhood Experiences, being in care and so on. Yet there is little or no mention of these issues in the Green Paper and virtually no proposals for targeting and joining up services to address them early.

19.Mental health sits within a complex landscape, and with this policy area as with many others, there must be effective coordination with other initiatives from across Government when building a new strategy.

Building a new strategy

20.Witnesses have told us that a “seismic shift” is needed in children’s mental health provision.26 No matter what changes are proposed for children and young people’s mental health provision, we want to ensure that the needs of the children in question are at the centre. James Kendrick, Chief Executive of Youth Access, told the Health Committee in November 2017:

The absolutely key principle should be that services are built around the needs of children and young people, not the needs of the system. That is the seismic shift, which was mentioned before, that is needed.27

21.Stakeholders raised concerns that the Green Paper’s three pillars are additional proposals made on top of existing complex and often fragmented health and education systems. The education system has seen significant change, to qualifications at both primary and secondary level and a push for academisation across the whole country. The health sector has also seen the introduction of local transformation plans, and NHS vanguards developing new care models. Some stakeholders raised concerns that Government was “tinkering” rather than using the opportunity to “truly transform” the system, and that there is currently “a patchwork of disjointed services, of varying access and quality across the system”.28

22.In phase 2 of its review of children and young people’s mental health services, the CQC sought to achieve a better understanding of the patient experience by looking at how individual children moved through the system, and emphasised the importance of having a “person-centred” approach to provision.29

23.However, we heard concerns in oral evidence that children and young people had not been placed at the heart of the Green Paper strategy. Dr Pooky Knightsmith, Vice Chair of the Children and Young People’s Mental Health Coalition, said “we would want to see more cohesive working between health, education and social care all working together, ideally with the child at the heart of it”.30 Rowan Munson, former member of the 2015 Youth Select Committee, said that

We need to be asking where the first point of contact is, how we get that right, what works for you, very simply, and developing that so that we do have young people at the heart rather than the system.31

24.The Green Paper does not adequately connect to other relevant policies and we are concerned that it misses opportunities to address fragmented and, in places, poor services.

25.When the Government publishes its response to the consultation on the Green Paper, we want to see more evidence that the changes it proposes will join up services in a way which places children and young people at their heart. The Government’s response must also address and recognise the constant change and fragmentation of both the education and health systems.

26.The Government should also place a greater emphasis on, and provide a strategy for, prevention, early intervention and dealing with some of the root causes of child mental health problems.

18 Department of Health and Department for Education, Transforming children and young people’s mental health provision: a Green Paper, December 2017, para 21

19 Q90

20 Q77–82

21 Q166

22 Department of Health and Department for Education, Transforming children and young people’s mental health provision: a Green Paper, December 2017, para 78

24 Centre for Mental Health (SGP0018)

25 Q147; Q199

26 Q41; British Psychological Society (SGP0027)

27 Health Committee, oral evidence taken on 21st November 2017, Child and adolescent mental health services: access and funding, HC 522, Q64

28 British Association of Social Workers (SGP0037); NHS Providers (SGP0040)

30 Q16

31 Q42

Published: 9 May 2018