3Prevention and contributing factors
27.Building on the reports of our predecessor Committees, we recognise that there is a clear difference between protecting and promoting well-being, and diagnosing and treating mental illness. There is a need for both whole school programmes, such as those delivered in Personal, Social, Health and Economic education (PSHE) lessons, alongside early intervention and treatment from CAMHS and health professionals. Schools have a clear role in the promotion of well-being amongst their students and as part of this inquiry we heard of excellent practice through organisations such as Place2Be. Dr Zoe Brownlie, Clinical Psychologist and lead for Healthy Minds, Sheffield, told us in written evidence:
We very much support that a whole school approach to emotional well-being and mental health will bring about the most impact and that schools have a tremendous opportunity to provide emotionally healthy experiences for children as well as teach about emotional health and well-being and de-stigmatise mental health.32
28.For some students support for their well-being is not enough, and specialist targeted intervention both in school and through CAMHS is needed. CAMHS are delivered by a range of organisations including NHS mental health and community trusts, local authorities and the private and voluntary sectors. The services they offer range from counselling to in-patient care.
Factors affecting children’s mental health
29.The role of prevention appears to be a missing link in building better support for children and young people, especially in the early years. We heard throughout our inquiry about specific factors which can have adverse effects on young people’s mental health, including exam pressure and social media.
Exam pressure and curriculum narrowing
30.In our discussion forum with young people, participants told us that high-stakes exams were a considerable source of pressure and that they were concerned about adverse effects on their mental health and well-being.33 Other stakeholders held similar views: the Bethlem Maudsley Hospital School told us that “schools now operate with high expectations of exam success that can counter a wish to support the individual pupil in mental health recovery”.34 We raised this issue with Nick Gibb who said that “we do not want children to be under pressure with exams”.35 He also told us that although education reforms now mean that “the curriculum is more rigorous” and young people are assessed on one final exam, “nothing we have done makes it worse”.36 However, we are not persuaded that the adverse effects of the current exam system on young people’s mental health at both primary and secondary level have been adequately considered and are struck by the contrast between the views of young people and those of the Minister. Some of the young people we met were also very clear that their lack of curriculum choice in school added to their stress and that they had no creative or technical outlets to express themselves. They cited that the relentless focus on EBacc subjects did not suit all of them and led to low self-esteem and unhappiness.
31.We recommend that the Government should gather independent evidence concerning the impact of exam pressure on young people’s mental health, and what steps might be considered to build resilience to cope with it. This consultation should take into account the views of children and young people, teachers and school leaders, and health care professionals. It should consider the past 10 years, given the varied changes in examination policy in both primary and secondary schools.
32.We also recommend that the Government commission independent research, with young people at its heart, on whether the narrowing of the curriculum from Key Stage 1 to Key Stage 4 is also having an impact on mental health. This research should be considered when considering further restrictions to the accountability of schools in relation to curriculum offer.
School exclusion and alternative provision
33.Evidence suggests that young people excluded from school or in alternative provision are much more likely to have a social, emotional and mental health need than children not in alternative provision.37 Yet the Green Paper does not address this issue.
34.We recommend that the Department for Education’s review into exclusions focuses on the increase in pupils being excluded with mental health needs and how the mental health needs of excluded pupils are being met. The Government’s response to the Green Paper should ensure that Pupil Referral Units have sufficient resources and capacity to meet the particular needs of the pupils who attend.
Social media
35.The clear message that we heard in our inquiry was that we do not yet know the full impact of social media on children and young people’s mental health. Young people during our discussion forum shared both positive and negative impacts of social media on their mental health. They indicated awareness of dangers and methods of protecting their well-being. Dr Pooky Knightsmith warned that we can “miss out the positives” of social media, and that “more needs to be done to understand it, but it should be certainly something that young people, their teachers and their parents are learning about”.38 Rowan Munson told us that “we do not know whether people’s mental health is worse because of the social media or whether social media is their coping mechanism for their mental health”.39 There are particular concerns about the potential risks of cyber-bullying, and the ongoing work to determine the impact of long-term screen use on children. In addition, the Children’s Commissioner’s report Life in Likes concluded that there were “two sides of social media”, and while it has demonstrated positive effects on children’s well-being, it also carries a negative influence “when it made them worry about things they had little control over”.40
36.Given the widespread concerns about the impact of social media, we look forward to the outcomes of the working group of social media and digital sector companies in partnership with the Department of Health and Social Care and the Department for Digital, Culture, Media and Sport. We also look forward to the report of the Chief Medical Officer on the impact of technology on children’s mental health and to the House of Commons Science and Technology Committee’s forthcoming inquiry.
37.We repeat the recommendation of our predecessor Committees that PSHE should be compulsory in all maintained and academy schools. All schools should include education on social media as part of PSHE.41
Role of families and parenting
38.Stakeholders were concerned that the Green Paper does not address the role of families and parenting in children and young people’s mental health. The Centre for Mental Health told us that
It is disappointing that the green paper missed the opportunity to scale up provision of evidence-based parenting interventions and ensure targeted help is made available to the families who most need it.42
39.The Green Paper sets out an aspiration for “better support for families with children and young people at risk of developing mental health problems”. It also acknowledges the importance of early years brain development, good inter-parental relationships, and secure attachment with a parent or carer for children and young people’s mental health.43 However, there is no further consideration in the Green Paper of how improved support for families will be provided and it does not receive sufficient priority.
40.In particular, we know that Adverse Childhood Experiences, such as trauma, poor attachment, parental alcohol and drug abuse, domestic violence, and so on, have a known and significant effect on the child’s future mental well-being. However, adult services, such as adult perinatal mental health or drug abuse services, are not connected to or jointly commissioned with children’s services. Indeed, the child involved is often not even considered in such cases, which for new mothers in particular seems a major flaw.
41.We recommend more co-commissioning between adult and child mental health services for the whole family, especially in perinatal mental health support.
Early years
42.Another element of the wider picture missing from the Green Paper are the early years. Dr Pooky Knightsmith considered that “the age group 0 to 5 and thinking about prevention there” was missing from the Green Paper.44 A lack of focus on the early years means that opportunities are being missed to promote emotional resilience and prevent mental health and well-being problems later in life. There is no consideration given to the important role that health visitors and children’s centres can have in promoting emotional wellbeing in the early years or of the adverse impact reductions in funding for these areas might have on support for the 0 to 5 age group. Further, as we have an evidence base for the first 1,001 days of a child’s life and the Green Paper indicated how early years brain development is a key factor for a child’s future, with evidence suggesting links between brain development mental and physical health, we would welcome further consideration about how the Government can better support young children in their plans for children and young people’s mental health. We look forward to the publication of the Science and Technology Committee’s findings on evidence-based early-years intervention.
43.The evidence we heard indicated strong support for the inclusion of preventative measures to mental ill health in the Green Paper. The Children’s Commissioner for England, Anne Longfield, said “I would like to see a comprehensive starting point that looks at children from birth and pre-birth onwards, and recognises that problems develop along the way; and the earlier and the nearer to home they can be treated, the better it is going to be for the child.”45 Early years support and prevention of Adverse Childhood Experiences are referenced in passing in the Green Paper.46 Further, Dr Dubicka notes that “the introduction to the Green Paper talks about these disadvantaged and vulnerable groups, and recognises those needs, but, as you say, there is not much substance later on in terms of what is going to be done for them [ … ] if it really wants to be ambitious in trying to do as much prevention work as possible, it needs to target those disadvantaged groups as well as the very young children.”47
44.We recommend that the Government include the early years in their plans for children and young people’s mental health following the consultation.
45.We recommend that more work is done to integrate preventative approaches with vulnerable groups into the core strategy of the Green Paper.
Factors affecting children’s mental health: conclusion
46.The Green Paper fails to take fully into account the factors affecting children’s mental health and the need for preventative action in stimulating and protecting early years brain development, supporting loving and respectful inter-parental relationships and enabling secure attachments with parents and carers.
33 Appendix 1
35 Q160
36 Q178; Q183
37 Institute for Public Policy Research, Making the difference: Breaking the link between school exclusion and social exclusion, October 2017
38 Q36
39 Q36
40 Children’s Commissioner, Life in ‘likes’: Children’s Commissioner report into social media use among 8–12 year olds, 4 January 2018, page 37
41 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, para 47
43 Department of Health and Department for Education, Transforming children and young people’s mental health provision: a Green Paper, December 2017, para 118
44 Q11
45 Q12
46 Department of Health and Department for Education, Transforming children and young people’s mental health provision: a Green Paper, December 2017, pages 7–8, 31, 32
47 Q50
Published: 9 May 2018