47.Children and young people’s mental health provision extends to the age of 18 (in some areas it is 16), after which young people transition to adult mental health services. We were told by some witnesses that the age of transition to adult mental health services should change. We heard that a better transition age would be 25 and that some areas have already adopted a mental health service which supports young people from ages 0–25. This was suggested as a model to move towards in the Department of Health Future in Mind strategy published in 2015. In the Green Paper, the Government commits to assessing “whether further action is required to improve the experience and outcomes of transition”.
48.Witnesses told us that the lack of action on transition was a failure of ambition. The Office of the Children’s Commissioner told us that it is “a patient safety issue”. The Association of Colleges said that “eighteen is not an easy age for the transition” and Stuart Rimmer, Principal and CEO of East Coast College, told us that colleges reported a “bottleneck” in mental health support. Dr Pooky Knightsmith told us that “our members [of the Children and Young People’s Mental Health Coalition] come back again and again saying 0 to 25, absolutely”. Rowan Munson told us that transition was a “cliff edge” and referred to the 2008 SDO TRACK study which found that “only 4% experienced an ideal transition” with a third of young people dropping out of mental health care altogether. The Health Minister told us that she is “particularly concerned about [ … ] how we transition people from young people’s services into the adult system” but the Green Paper takes no definitive action, and does not commit to using the trailblazers to innovate.
49.Young people are falling through the gaps and not receiving the services they need as they enter adulthood. It is disappointing that there are no substantive plans to deal with the transition from CAMHS to adult mental health services in the Green Paper.
51.The Green Paper indicates a clear awareness of the higher rates of prevalence of mental ill health found in particular demographic groups, including looked-after children, those in the criminal justice system, and those not in education, employment or training (NEETs). However, the Green Paper does not commit to specific action reflecting that higher level of need, beyond the brief mention that Mental Health Support Teams “could be available more widely” beyond mainstream education. The British Psychological Society told us in written evidence that
The Green Paper proposals do not cover those most at risk [ … ] There are some particularly vulnerable groups who currently have limited access to CAMHS, despite high levels of need. These children are omitted from the Green Paper.
52.Dr Bernadka Dubicka, Chair of the Child and Adolescent Psychiatric Faculty, Royal College of Psychiatrists told us 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 [ … ] [They] need a disproportionate amount of mental health input.
53.Witnesses told us that there is a correlation between social disadvantage and higher rates of prevalence of mental health issues. The Education Policy Institute told us in written evidence that
Socioeconomic disadvantage acts as a psychosocial stressor, and can work through poor housing and unsafe neighbourhoods to negatively impact young people’s mental health and wellbeing.
The British Psychological Society told us that a 2018 HeadStart study “concluded that there was a strong and consistent association between deprivation and emotional and behavioural problems”, the Chief Medical Officer’s 2012 Annual Report noted that children and young people in the poorest households are “three times more likely to have a mental health problem than those growing up in better-off homes”, and the Centre for Mental Health noted that “poverty increases the risk of mental health problems and can be both a causal factor and a consequence of mental ill health”.
54.It is therefore concerning that Professor Tim Kendall—involved in the evidence review underpinning the Green Paper—told us that “it was not part of our brief to look at that”. It is disappointing that despite the well recognised connection between mental health and social disadvantage, the Green Paper does not tackle this issue head-on. It was also worrying that Jackie Doyle-Price states that the Green Paper is about the particular partnership between schools and the Department for Health and Social Care and that addressing health inequalities would dilute the focus on what is a very ambitious and radical programme. This is also out of step with the commitments made by the Prime Minister in her first speech, in which she spoke of tackling the burning injustices of health inequality.
56.The mental health of looked-after children has been the focus of a previous Education Committee inquiry. We are pleased that a number of recommendations have been acted upon by the Government, and that the Green Paper’s Mental Health Support Teams will test models which link to social care services. However, we are disappointed that some of the most important recommendations have not been accepted, including the following recommendation:
In recognition of the distinct challenges which looked-after children and young people face, we recommend that they should have priority access to mental health assessments by specialist practitioners but that subsequent treatment should be based on clinical need.
57.The Green Paper recognises the high levels of mental health prevalence amongst looked-after children: it states that “an estimated 45% of looked after children have a diagnosable mental disorder”. Professor Kendall agreed that this was an issue, telling us that “looked-after children, for example, a lot of whom are not attending school properly, are kids with very high levels of mental health problems”. Ofsted’s written submission explained that mental health services for looked-after children have been identified as good in “less than a third” of local authorities, and while some areas demonstrate well-established partnerships between agencies, this is not the case in a majority of areas.
58.There is also an absence of reference to social workers in the Green Paper, despite their key connection with looked-after children and their links to other services across the mental health care system. Looked-after children represent a group with higher levels of need and can struggle to access the support required, yet the Green Paper does not commit to targeted action.
59.Mental health support for children and young people who move between carers and in and out of care is often patchy and disjointed, and sometimes non-existent. The proposals in the Green Paper will not meet the needs of looked after children, in fact, they may well exacerbate them.
60.We echo our predecessor Committee’s recommendation to ensure that looked-after children and young people have priority access to mental health assessments by specialist practitioners but that subsequent treatment should be based on clinical need. We also recommend that the Government’s response to the Green Paper include a distinct and separate set of proposals for looked after children accessing mental health services.
61.The Green Paper recognises the high prevalence rate of mental health conditions among children in the criminal justice system: “one quarter of boys in Young Offender Institutions reported emotional or mental health problems”. The Howard League for Penal Reform told us in written evidence about the 900 children in secure custody—600 of whom are in prisons—and that Her Majesty’s Chief Inspector of Prisons had concluded “that none of the prisons holding children were safe”. The Howard League went on to say that:
Children who end up in prison have complex and multiple needs [ … ] There is a lack of continuity of care and their mental health has deteriorated in prison. Mental health provision for children in custody should be age appropriate and based on their individual needs, not on the type of establishment they are held in.
We regard the Green Paper’s indication that provision “might extend” to areas such as young offender institutions and secure children’s homes as wholly insufficient in the face of considerable need.
62.The Green Paper sets out that “NEETs have more mental health and substance abuse problems than their non-NEET peers” but does not suggest any direct action to address this issue. The Equality and Human Rights Commission told us in written evidence that the Green Paper could go further to ensure that
Children who have not yet started school, those who do not attend mainstreamed education, young people in apprenticeships/traineeships, those not in education, employment, or training, those who do not want to access mainstream services and those are in prisons can access the support they need [ … ] unless these issues are also addressed through a broader cross-departmental strategy, the impact of the proposals in this Green Paper is likely to be limited.
63.We are surprised that despite clear evidence of particular need for certain groups of young people—including the most socially disadvantaged children and young people, looked-after children, children in the criminal justice system, and NEETs—the Government has not recommended policy interventions to ensure that support is available for them. The Government should ensure that it is providing mental health support for the young people who are most likely to need it and should set out how it will reduce health inequality in the mental health of young people.
64.The Association of Colleges told us written evidence that 764,000 14–18 year olds are studying in colleges. The Association, through mental health surveys, provided data that “85% of colleges said that they had experienced an increase of students declaring mental health issues”. Stuart Rimmer spoke of the proactive actions of colleges in relation to getting young people the help they need, and said
If it costs the college money, that is what we are prepared to do. That does not make economic sense from the college’s perspective, but it is certainly a moral imperative that we will not turn back on.
65.Schools and colleges offer different environments and different challenges for implementing the Green Paper’s proposals. We do not believe this difference was adequately recognised. Neither Minister referred to colleges or further education at all, nor have the specific opportunities of colleges been recognised. For example, we heard compelling evidence that mobilising colleges in a sectoral approach to implementing the Green Paper’s proposals could offer faster generation of evidence of best practice.
66.The Government often referred to schools and colleges interchangeably, and did not adequately recognise the substantial differences between schools and colleges. We recommend the Government utilise the potential of a further education sectoral approach in implementation alongside other approaches.
67.Another large group outside the day-to-day structures of schools and colleges are the 119,000 apprentices under the age of 19. The Green Paper makes no mention of apprentices: while it references workplace support initiatives from the Department for Work and Pensions and the Department of Health and Social Care briefly, it does not offer further actions for young people. Stuart Rimmer told us that “it is a fairly inconsistent approach across access for apprentices to support services”. Nick Gibb assured us that the Green Paper is “explicitly for people up to the age of 18”, and “will incorporate those young people [apprentices] as well”, but the Green Paper was not clear and did not refer to any specific actions. This appears to be another example of a failure to join up relevant policies: the Government is expending resources to promote apprenticeships; yet failing to provide support for this growing group of young people.
48 Department of Health and Department for Education, , December 2017, para 127
49 Department of Health, , March 2015
50 Department of Health and Department for Education, , December 2017, para 128
51 Children’s Commissioners Office ()
52 Association of Colleges (); Q43
54 Singh et al., “”, BMC health services research, vol 8 (2008); Q31
56 Department of Health and Department for Education, , December 2017, para 78
57 British Psychological Society ()
59 Education Policy Institute ()
60 British Psychological Society (); Department of Health, , October 2013; Mental Health Foundation, , page 4
63 “”, Prime Minister’s Office, 10 Downing Street, 13 July 2016
64 Education Committee, Fourth Report of Session 2015–16, , para 27
65 Department of Health and Department for Education, , December 2017, para 7
67 Ofsted ()
68 British Association of Social Workers ()
69 Department of Health and Department for Education, , December 2017, para 11
70 Howard League for Penal Reform ()
71 Howard League for Penal Reform ()
72 Department of Health and Department for Education, , December 2017, para 91
73 Department of Health and Department for Education, , December 2017, para 10
74 Equality and Human Rights Commission ()
75 Association of Colleges ()
76 Association of Colleges ()
79 Department for Education, , 25 January 2018, page 6
Published: 9 May 2018