Over the weekend, I was told the story of a professional club player who was very clearly concussed but refused to leave the pitch. The good news is that the referee refused to carry on. That might be easier to do at club level and it should be hugely applauded. But at a lower level, where there is a lot of pressure from parents and the children themselves who want to play, we should not be asking the children, “Are you okay to play on?”.
I have had a lot of help with preparing for this debate. The RFU has showed me a lot of information. Rupert Moon, a great Welsh rugby player and also a friend of mine, put me in touch with a lot of professional people within the sport who are trying to filter the information down. But we have to do so much more than we currently do. We have to recognise that, while there are many stories about rugby, the problem is about so much more than rugby. Yesterday, in the New York Times, there was a story about a young man, a 29 year-old former soccer player who died from chronic traumatic encephalopathy. He is the first named player to have died from this condition. On a four-point scale of severity he was considered to be at stage 2.
Part of all this is education and getting people to think about the issue, no matter whether it is lacrosse, hockey or any other sport we can think of. We also have to recognise that sport is dangerous. There were a number of concussion injuries during the recent Winter Olympics, while Maria Komissarova was injured during ski cross training. She has undergone a number of operations on her spine. My own husband broke his back cycling, and indeed many of my friends are in wheelchairs due to playing sport. I have twice been hit by cars while out training. By the end of my career I also knew that, despite all the benefits of doing sport, I would probably end up with some severe damage to my back, neck and shoulders, which has happened. But I still believe that the benefits far outweigh the risks.
I was trying to find some kind of context for this. Stories about sports injuries will obviously hit the headlines in lots of media outlets, but it is a question of trying to figure out what the comparable data are. Statistics from Headway using data extracted from the NHS show some massive figures for head injuries. During 2011-12, 213,752 people were admitted to hospital. There has been a 33% increase in UK head injuries over the past decade. The number of severe traumatic brain injuries is running at between 10,000 and 20,000 per year in the UK. Interestingly, men are twice as likely to sustain a brain injury as women, and if we look at the target groups, it is 15 to 24 year-old males and people aged over 80. Those figures are important in terms of putting the issue in context and showing how many people are injured. However, it is hard to find data for the UK, so measuring data is an area in which we need to do more work.
Mortality rates due to blunt trauma in the USA among athletes aged under 21 in organised high-school and collegiate sport show that there were 261 trauma-related deaths, 1,139 cardiovascular deaths and 427 deaths
from other causes. If those numbers are broken down by sport, American football is responsible for 56.7%, track and field 10%, baseball 6.9% and then gymnastics at 1%, hockey at 1% and weightlifting at 0.4%. The average number of deaths per year is nine. Again, comparing these figures against deaths in the general population, some 12,000 are killed in road traffic collisions, there are 6,000 homicides, 2,500 young people die of cancer and, bizarrely, 50 are killed in lightning-related incidents, which is interesting. That is why we need some context in the UK.
I am also very conscious as a mum whose daughter plays a lot of sport that the temptation is to stand on the sidelines and say, “Come on, you are all right”. My daughter has never hit her head playing sport, but when they skid across the hockey pitch one says, “Come on, darling. Give it a bit of a rub and you’ll be okay. Get back out there”. That is because there is pressure on people to carry on playing, and that is much more the case for boys. We have a culture where it is cool to be a sporty boy but not so cool to be a sporty girl. I think that that kind of pressure on boys is huge.
I have received some interesting information from a colleague of mine, David Sutton, who is the strength and conditioning coach at Northants Cricket. He has worked in numerous sports. He sent me some information on fencing, which I had never considered to be a sport where there was a risk of traumatic head injuries. What is looked for is the natural position of the arms following concussion. Immediately after moderate forces have been applied to the brainstem, the forearms are held flexed or extended, typically in the air, for a period lasting up to a few seconds. It is interesting that there is a lot of work in this area through fencing. David Sutton said that this ultimately comes down to three simple things. We need to educate our PE teachers and coaches. We need to be unafraid of running a SCAT score in order to check whether a young person has been injured. It is not enough just to say, “Are you okay?”. We also need much more training through accident and emergency departments and GP surgeries so that health workers understand the realities of concussion.
I am really pleased that we are discussing this subject in a debate and I hope that we will return to it again in the future.
4.29 pm
Lord Storey (LD): My Lords, first, I thank my noble friend Lord Addington for initiating this important debate. I must say at the beginning that I am speaking on this issue while being aware that there are noble Lords here who have far more experience and understanding of the subject than me. I wanted to speak in the debate for a number of reasons, which will become apparent in the next few minutes. I am a former teacher, and the importance of sport in general, and team sports in particular, is there for all to see. I do not need to catalogue the details of that importance. We are becoming an increasingly sports-mad nation, with more and more people participating in sport in so many different disciplines.
Every parent wants to know that their child is as safe they possibly can be, whatever sport they take part in. Parents want to know that their child has the right and suitable advice, equipment and medical support if something goes wrong. Of course, accidents do happen, and I am mindful of that myself. Having taken up skiing late in life, I was standing at the side admiring the view, completely out of anybody’s way, when a snowboarder hurtled towards me. The next thing I knew I had broken my tibia and torn my cruciate ligament. I had to be rushed off to hospital through no fault of my own. These things do happen.
In contact sports, the problem of concussion must be taken seriously. A cursory browse through the newspaper headlines shows what a real issue it has become: “Brain Damage Fear Hits Junior American Football”; “Concern over the Effects of Heavy Knocks to the Brain is Rising among Contact Sports”; “Rugby Union Doctor Warns of Legal Cases over Brain Damage”; “Concussion is a Massive Problem for Rugby, Says Players’ Union Manager” and so on.
I have been rather disappointed by Answers to some Questions in the other place. Jim Shannon asked the Secretary of State for Health,
“what recent discussions his Department has had with the Rugby Football Union regarding the problem of concussion in that sport”.
The Reply was that there had been,
“no discussions with the Rugby Football Union regarding the problem of concussion in the sport”.—[
Official Report
, Commons, 27/1/14; col. 435W.]
Sir Bob Russell asked the Secretary of State for Culture, Media and Sport what advice players were receiving regarding head injuries and was told:
“It is a matter for National Governing Bodies”.—[Official Report, Commons, 20/11/13; col. 921W.]
I do not think it is a matter just for the governing bodies of those sports. We should not think is somebody else’s problem—it is an issue for all of us. I think that all of us would expect that the Government take these issues seriously and work with the national bodies and relevant partners to see what can be done.
One of the delightful—or less delightful—things about debates is that you have to do some research. The noble Baroness, Lady Grey-Thompson, mentioned Ben Robinson, who I did not know about until I did some research. I was saddened by the case of this lad who suffered a double concussion and died while playing a sport that he loved but, as in so many other cases like this, the parents immediately took up the issue, and a campaign was started. There was a meeting with the Scottish Government, there are leaflets available on what can be done and the message was developed, “If in doubt, sit them out,” which has been taken up by American football authorities. Out of this personal tragedy, a really important campaign has started. In my own city, a young boy called Oliver King died while swimming due to sudden arrhythmic death syndrome. He was 12 years old. As a result of that terrible tragedy, his father set up the Oliver King Foundation, which campaigns for defibrillators to be placed in every school. I am pleased to say that the
Minister, the noble Lord, Lord Nash, is going to meet with the parents in the next few weeks. Again, some good has come out of a tragic sporting death.
It is not just a matter for sporting authorities. What should we do? First, we should not assign contact sports some sort of pariah status, but nor should we pretend that there is not a problem. We should not believe that there are quick and easy answers, such as a mandatory three-week rest that will solve the problems. Nor should we believe that we can spend 15 minutes looking at a cut as a result of a contact sport, but only a few minutes if there is concussion.
After doing the research, the person who best summed up for me what our attitude should be is the rugby player Dean Ryan, and I will leave his thoughts with you. My noble friend Lord Addington will know that Dean Ryan had six caps for England and is currently director of rugby at Worcester Warriors. Bizarrely, he was concussed not while playing rugby but in the victory celebrations after winning a match when somebody, in moment of hilarity, actually hit him. Examination showed that he had a large bruise on the side of his head. As he said in a newspaper article:
“The rule then was that concussion brought a mandatory three-week rest from the game, hence me missing that final league game at which the cup was presented”.
He had to give up the sport, as he started having 20 to 30 seizures per month and so on. I think that what he says is very telling and sums up my thoughts:
“To rid ourselves of the effects of a poisoned history and the macho culture which still pervades the issue of concussion, players have to believe in the guidance they are getting and this is where my frustrations lie. The game, the professional game, isn’t getting it. I’ve been to recent conferences on the subject hoping to learn the way forward, but instead came away with yet more conflicting views and argument. What the professional game needs is to be told what it must do. It must be authoritative and convincing. And until it gets that guidance there is little chance of persuading players that there is a way forward; that they can stop running away from the doctor, that they can stop hiding behind a wall of lies which prevents appropriate and sensitive treatment”.
4.37 pm
Baroness Billingham (Lab): My Lords, I thank the noble Lord, Lord Addington, for this debate. After listening to all the previous speakers, there is not much left to say. That is a good job because I have just been told that I have two minutes. Despite that, I am undaunted.
The purpose of this debate is to show that we are living in changing times. Only days ago, we were being thrilled by the Olympics and seeing people whizzing down slippery slopes on trays and so forth—all potentially lethal. At the weekend we saw the England and Wales rugby; if ever there was a clash of titans, that was it. In past times we would have accepted the odd bang or fall and expected play to resume fairly quickly. However, these are new times. The recent medical evidence has brought with it a far more cautious approach. The long-term effects cannot be ignored. In fact, the medical evidence has already affected the views of parents and participants in a whole range of sports. Rugby union, as has been said, is under more scrutiny than ever. It is now apparent that parents are refusing to allow their
children to play that sport, which is something we all ought to be concerned about.
All sports played at either a competitive or non-competitive level share the possibility of injury. However, life is strange, and it is not only contact sports which have become the focus of public attention and apprehension. Three weeks ago, I went to the ballet at the Royal Opera House. Before it began, the house manager came forward and said that two of the dancers had collided at the matinee that day and had mild concussion. Previously, there would not have been an issue, but the manager said that he was very sorry but they were unable to dance tonight and the ballet was cancelled. In the old days, it would have been on with the show.
We have to be very careful now. This is a game-changing period. We cannot ignore advice, and we have to be sensible. The Government must take their responsibilities keenly. We do not want to spoil or lose the beauty and wonder of our sport, but we must ensure that people taking part are fully protected. I look forward to the Minister’s reply.
4.40 pm
Baroness Jones of Whitchurch (Lab): My Lords, I am extremely grateful to the noble Lord, Lord Addington, for tabling the debate today. As a couple of other noble Lords have admitted, I also have to admit that this is not an issue that I knew a great deal about prior to this debate but, now that I have looked into it, I agree with him that this is a serious problem. I very much look forward to hearing from the Minister about how the Government are acting to address the issue.
As the noble Lord has pointed out, growing awareness has occurred because of very sad deaths, particularly among several young people. It is particularly sad when that happens on a school playing field, where pupils ought to be properly supervised and protected by the highest standards of safety protocols. Parents should be able to feel assured that their children are being looked after in that context.
However, there is also growing awareness of the more insidious and widespread threat of longer-term damage for those who play sports, particularly professional sports on a regular basis. It is becoming increasingly clear that a number of sports players who have suffered concussion on a repeated basis are suffering from dementia and other longer-term brain issues. That is obviously a particular cause for concern. While it might not be possible to eradicate the danger completely, we owe it to amateur and professional sports men and women to invest in research to understand the dangers better; to provide rules for safe play; to ensure that staff are educated in diagnosis and response; and to ensure that there are strict regulations regarding return to play.
What does this mean in practice? First, we should welcome the latest Zurich consensus statement on concussion, mentioned by the noble Lord, Lord Moynihan, which provides a well informed and practical set of recommendations for those involved in the healthcare of sports men and women. Their advice provides diagnostic tools about what should happen should concussion be suspected, and emphasises the
importance of standard emergency management procedures to ascertain the extent of the injury.
Importantly, the advice recommends that it should never be permitted for a player to return to play on a day where concussion is suspected, not least because, even if they get up and say, “I feel all right”, or if their mum and dad say, “Come along, pull yourself together and get back on the field”, there may be post-injury damage that is not immediately apparent. This is a particular challenge in high-level high-contact games such as rugby and football, where both the player and the medical team may be keen to downplay the injury and allow the player back on the field. However, as evidence grows of the longer-term health risks, it becomes more apparent that we need strict enforcement of the rules on the principle about returning to play.
The guidance that I have just referred to also makes it clear that any return to play should be on a graduated basis—over a period of a week is recommended—while tests continue. Again we need to ensure that this approach becomes standard practice. I would be grateful if the Minister would confirm whether his department is taking on board the Zurich conference recommendations and what discussions are being held with the Department of Health to ensure that health professionals are more aware of the dangers of this type of sporting injury and understand the signs that they should look for.
Secondly, we need a clear set of rules specific to children and adolescents, recognising the particular health dangers for this group whose brains can swell uncontrollably after a single bang on the head. All schools need to be aware of the dangers and the steps that need to be followed immediately an injury is suspected. Every PE teacher should be trained in the assessment procedures, and should be expected to carry a card that lists the nine red-flag symptoms that warrant urgent action. Parents and governors should be expected to check that the necessary staff training and awareness has taken place and should have a system for monitoring the responses to sporting accidents, as well as rules for rest, rehabilitation, and return to play. I agree with many of the points about the improvements in school procedures made by the noble Baroness, Lady Grey-Thompson. Will the Minister give details of any discussions held between his department and the Department for Education about the need to raise standards of care in sporting accidents, specifically on school premises?
Thirdly, at the professional end of sports, all players and coaches should be trained to understand the dangers of concussion and its diagnosis. This should follow the initiative already taken by the rugby union, to which the noble Lord, Lord Addington, referred, and should extend to other sports. This is increasingly necessary in the light of the rising number of concussions that have been recorded per 1,000 hours of play since 2011. Andy Hazell, who was forced to retire from England rugby after failing to recover from a concussion injury, rightly made this point, which was echoed by the noble Lord:
“Players are getting bigger and faster, and the collisions are getting a lot bigger”,
so the challenges in this particular sport remain high. It is not just rugby union, though; concussion remains
the most common injury in premiership football. Training and awareness for both players and coaches across all sports have to be key to improving safety, so will the Minister give details of discussions held with the governing bodies to roll out a programme of training for players and coaches across the spectrum for all sports?
Lastly, there needs to be a review of what further preventive measures can be undertaken. It is not good enough to say that these games are inherently dangerous and that this is the nature of the sport. Where changes can be made to the rules to protect players from dangerous practices, they should be introduced. Most sporting rules are not set in stone; they are constantly being reviewed and updated by their governing bodies. For example, rugby union rules have been regularly updated to provide greater protection for individual players without taking away any excitement of the game, and that can be done across the board in other sports. We should be asking all sports bodies to review their rules to see what further steps can be taken to limit impact on the head, and what penalties should be introduced against those who flout the rules.
We should also be encouraging more research into helmets and other head protection to ensure that the best possible guards are available and permitted in the games. Will the Minister reassure us that dialogue is continuing with sports bodies to encourage research into safety equipment and to develop safer rules of play? Will he give serious consideration to the proposal of the noble Lord, Lord Moynihan, for a meeting to discuss the establishment of a national research centre? I thought that he made the case very well in his contribution.
The solution to many of the problems that we debate in this House is better liaison between departments and more joint working, and that is certainly true in this debate. The solutions lie in better education, better awareness among heath professionals and more responsible sports governing bodies. I hope that the Minister is able to persuade us that he is taking all these issues on board, and I look forward to hearing what the department is doing to liaise effectively and improve performance on this important issue.
4.48 pm
Lord Gardiner of Kimble (Con): My Lords, I, too, congratulate my noble friend on securing this debate on such an important subject. I thank noble Lords for this illuminating debate. As the noble Baroness, Lady Grey-Thompson, and my noble friend Lord Storey acknowledged at the outset of their speeches, participating in sports greatly benefits individuals and society, but we must ensure that risks are minimised and that appropriate medical treatment is available to all.
Any head injury sustained on the sports field must be treated seriously. Instances of serious injury are, thankfully, low, with many patients recovering fully without special intervention. However, a minority experience complications that must be minimised
or avoided with early detection and appropriate action. The noble Baroness, Lady Grey-Thompson, spoke movingly about the tragic death of Ben Robinson and about his brave parents.
Instances of concussion are undoubtedly of concern to governing bodies. From what I have seen, I believe that they take this matter increasingly seriously, and responsibly. The Football Association and other sports with experience of head injuries, such as rugby, American football and ice hockey, are working together to establish appropriate internal guidance. This point was raised by my noble friend Lord Addington. The equestrian community, to which my noble friends Lord Addington and Lord Moynihan referred, is very much at the forefront of this. We need to ensure that the experiences of the equestrian world are incorporated into what other sports are doing.
The FA rules on head injuries are extensive but, in essence, a player suffering a head injury must leave the field of play and may then return only if he is given medical clearance to do so. My noble friend Lord Addington referred to the amateur and community level of sport—what I would call the grass-roots end of the game—where a medic may not be present. There, the default guidance to all affiliated clubs in the FA is that the player cannot resume play, and the reintroduction of the player to football in the following weeks should be tightly controlled. The FA emergency aid certificate provides club representatives and volunteers with crucial skills and gives prominence to head injuries and concussion.
As the leading body on concussion management in sport, the Rugby Football Union works proactively with the International Rugby Board and independent experts to raise awareness, stay at the forefront of research and promote best practice, to which the noble Baroness, Lady Jones, referred. My noble friend Lord Moynihan mentioned the importance of global exchanges of experience. I have the leaflet produced in Scotland and supported by Scottish Rugby, the Scottish FA and sportscotland, to which the noble Baroness, Lady Grey-Thompson, referred, entitled, If In Doubt, Sit Them Out. Rugby has taken specific steps to reduce risk in the game and these messages are being cascaded to clubs.
My noble friend Lord Storey referred to the “Don’t be a HEADCASE” initiative, which educates players and coaches—it is very important to mention coaches as well—below professional level to recognise and remove players with concussion. Some 200,000 concussion awareness cards have been distributed, and posters have been sent to every member club and newsletters to every member school. The “HEADCASE” website has also been adopted by the Medical Officers of Schools Association. The RFU’s first-aid course for volunteers, coaches and officials also gives prominence to concussion. Its pitch-side immediate trauma care course for healthcare professionals also includes specific concussion training.
The noble Baroness, Lady Jones, rightly raised the important issue of safety within schools. Many young people engage in sport at school. Indeed, the Department
for Education expects schools to provide a safe environment for their pupils and they must ensure that their training includes child safety and well-being. There is, of course, also the DfE advice on health and safety. Indeed, the Association for Physical Education and the Royal Society for the Prevention of Accidents provide professional advice to schools on how to manage activities safely and reduce the risk of injuries. My noble friends Lord Addington and Lord Storey mentioned that advice.
The noble Baroness, Lady Jones, rightly referred to the need for dialogue. DCMS Ministers meet DfE Ministers monthly as part of the ministerial board on PE and sport. The board also includes external partners, such as the Association for PE, that play a lead role in health and safety in PE lessons. The departments continue to work together to ensure that schools have the necessary resources to deliver high-quality PE and sport, including through professional external partners such as the Association for PE, and provide guidance and advice on ensuring the safety and well-being of their pupils when playing sport. The Association for PE guidance on safe practice in physical education and sport is available online through the Department for Education. This comprehensive guide provides examples of issues that schools should consider in risk management for school sport, and advice on managing and applying safe practice.
All sports governing bodies working with schools should ensure that participation takes place in a safe environment. All national governing body coaches working in schools should obtain the level 2 coaching standard, which includes basic first-aid skills as a minimum requirement. Indeed, as part of the school games initiative, in which around 17,000 schools take part, national governing bodies have developed competition formats designed to ensure that schools can provide safe, meaningful and appropriate competition to all pupils regardless of age, ability or disability. As to guidance on sports-related concussion, the national governing bodies and schools do good work in disseminating advice to prevent injury and improve pitch-side care. However, it is clear from the examples given today that undoubtedly more needs to be done.
At an international level, my noble friend Lord Moynihan and the noble Baroness, Lady Jones, referred to the Zurich consensus of 2012. I am pleased to acknowledge and endorse what the noble Baroness said about the welcome for this statement, which of course forms part of the learning that is increasingly being developed in the area of head injury. This outlines that when an individual shows any symptoms of concussion they must either be assessed on site by a licensed healthcare provider using standard emergency management principles or be safely removed from practise or play for urgent referral to a physician. The statement also highlights that a player with diagnosed concussion should not be allowed to return to play on the day of injury; that sufficient time and adequate facilities should be provided for the appropriate medical assessment, both on and off the field; and that the final determination regarding a diagnosis of fitness to play should be a medical decision.
Standards in sport and exercise medicine are set and maintained by the Faculty of Sport and Exercise Medicine, a faculty of the Royal College of Surgeons and the Royal College of Physicians. The faculty works to develop and promote the medical specialty of sport and exercise medicine, and oversees the training and assessment of doctors working in this discipline. In November last year, the faculty outlined key messages of concussion management in sport at all sporting events for athletes of all ages.
The noble Baroness, Lady Jones, asked about advice to health professionals. The National Institute for Health and Care Excellence, established by the Government to provide evidence-based clinical advice, issued updated guidance last month to support clinicians on the diagnosis and treatment of head injuries, including concussion. The faculty helped to develop this guidance.
The noble Baroness, Lady Jones, asked about the rules for children and adolescents in these matters. The recent clinical guidance, CG176, is on the Triage, assessment, investigation and early management of head injury in infants, children and adults. So the guidance refers to it all.
My noble friend Lord Moynihan raised the issue of a research centre. The Department of Health’s National Institute for Health Research is supporting a research project in Birmingham that is looking at the effects of repetitive concussion on athletes from sports such as rugby, football, cycling and gymnastics. The institute has awarded a research professorship to Peter Hutchinson at the University of Cambridge to study head injury. The institute at the moment has an annual budget of over £1 billion and I hope that this will be an important resource. I shall of course be pleased to have a meeting with my noble friend to discuss his proposal and see how best we can all help on these important matters.
There is so much more to say. The noble Baroness, Lady Jones, mentioned guidance. A lot of this further public awareness, which is so important, is on the NHS Choices website.
Concussion is one of the most complex injuries to assess, diagnose and manage. Clinicians will make a diagnosis on a case-by-case basis, using their training and clinical judgment, and take into account the individual circumstances of each case. Much has been said in this debate. If there are any outstanding points that I have not raised, I will write to your Lordships. It is important to say that I have consulted officials from all three departments in preparation for this debate. It is clear that all three are working together. UK Sport, as part of DCMS, is working with the governing bodies. The system is working, but I think we can always work better. It is important that individuals engaged in sport, which is such a force for good and benefits society so much, are safe and secure. We must make sure that participation is in the right environment and that, in the event of injuries, all steps are taken to secure a full recovery.
Young People: Suicide
Question for Short Debate
5.02 pm
To ask Her Majesty’s Government what steps they are taking to reduce the levels of suicide among young people in the United Kingdom.
Lord Eames (CB): My Lords, each year in the United Kingdom, between 600 and 800 young people aged 15 to 24 take their own lives. Under the age of 35, the number rises to more than 1,700. In England and Wales, around 24,000 attempted suicides are made by 10 to 19 year-olds. To put this in another way, as appeared recently in the national press, that represents one every 20 minutes.
In Northern Ireland, since the signing of the Belfast agreement, the number of suicides almost equals the number of killings during the years of our Troubles. Professor Tomlinson of Queen’s University has concluded that the steep increase in the Province’s suicide figures is accounted for in part by those who lived through the Troubles as children in the 1970s—some of the worst years of our violence.
These are truly shocking figures. The statistics from across the United Kingdom are the reason for my Question to the Government this evening. Last week’s release of the latest UK suicide statistics shows a welcome decrease in the number of young people under the age of 35 who took their own lives during 2012 compared with the previous year: 1,625 compared with 1,746 in 2011. This fact is welcomed by the many charities that do such valuable work among young people. I will quote the words of the chief executive of one of those charities, PAPYRUS Prevention of Young Suicide. He said:
“While we welcome this downward trend, suicide remains the highest cause of death for men and women in the 15 to 34 age group in England and Wales.”
Taken against the figures for suicide in the United Kingdom as a whole across all age groups, it might seem as if I am asking noble Lords to consider a small proportion of this tragic problem. However, any of us here or further afield who in our professional lives have seen first-hand the emotions of parents and families where a young person has succeeded in taking their own life, or indeed attempted to do so, have little doubt of the impact on family life and community reaction.
So what are we talking about in this debate? A future of possibilities, a lifetime of promise and usefulness cut short; shattered hopes unfulfilled; hopes never realised. There are the inevitable questions, none of which have easy answers: why, how, and could it have been prevented? Then there is the agony of parents—“Where did we go wrong?”. Much research over the years has been devoted to seeking answers to those questions. That research has produced a complex and at times contradictory picture. It has spoken of broken homes and family relationships, drug and alcohol abuse, mental and emotional conditions, bullying, the
influence of the social network on vulnerable lives, and the impact of certain aspects of television and some films that seem to cheapen the gift of life and paint a picture of the glorification of self-inflicted sacrifice of life.
However, a single fact emerges: each case represents individual circumstances and needs. Therein, I suggest, lies the problem, not just for government but for society. Prevention calls for a multifaceted and multidimensional approach. It calls for many disciplines to work in collaboration—social services, the medical profession, charities and the churches, to name but a few—and for a sharing of information. However, research is expensive, and in today’s economic climate many charities ask about government priorities in this field.
The recently published Preventing Suicide in England: One Year On was the first annual report on the cross-government outcomes strategy to save lives. Of the regions of the UK, Scotland, with its “Choose Life” campaign, was well resourced and had a clear implementation strategy, with a 20% target to reduce the rate of suicide. In Northern Ireland, some £7 million is allocated annually to suicide prevention, but here in England there is concern on the part of charities when comparisons are made with Scotland and Northern Ireland. PAPYRUS claims that had there been as clear a strategy and sense of purpose as in Scotland, probably 814 lives could have been saved. There is a genuine feeling that the Government have not granted new resources to deliver their strategy and have failed to present a clear implementation strategy. That may be the view of one charity, but I found that it is shared by others. Equally, there is a growing concern that in various parts of the country children and adolescent mental health services are seriously underresourced to meet the growing demands on their services.
I could point to many more aspects of this tragic scene but time permits me to mention only two. First, how accurate is the picture we have of the enormity of this problem? In a coroner’s court, a suicide verdict cannot be given for those under 10 years of age. That means that many of the figures published tell only part of the tragedy. Equally, how can we gain an accurate figure of those children attempting suicide or inflicting self-harm?
There is one option that I suggest could be followed and would be welcomed. There is an urgent need to change the burden of proof used by coroners to reach a suicide conclusion. The continued use of the criminal standard of proof is surely unacceptable in this day and age. It contributes immensely to what so many of us refer to as the stigma surrounding suicide—a stigma that a lot of us feel inhibits many from seeking help.
I will end on a positive note. There has been a general welcome for the support of the Department of Health and the Royal Colleges for the sharing of information in a suicidal crisis. However sensitive though the issue may be—and I fully accept the sensitivities of patient confidentiality—many support the words of the chief executive of PAPYRUS:
“The duty of patient confidentiality should not be allowed to outweigh the chance of saving someone’s life”.
I hope that this debate, short though it is, will give the Minister ample opportunity to reflect on some of the challenges that we know are there in everyday life across the UK, and to put on record the Government’s reaction.
5.12 pm
Baroness Bottomley of Nettlestone (Con): My Lords, I warmly congratulate the noble and right reverend Lord on securing this debate on a critical and all too often overlooked subject. It is a source of huge pain for all those concerned, not just from the loss of life but for the family, friends and community in which the individual lived. A traumatic, violent death is bad, but when it is self-inflicted it is hugely confusing.
Of course, suicide is historically fraught with stigma—not least, I do not need to tell the noble and right reverend Lord, in the church. Some 20 years ago, when I had to formulate the “Health of the Nation” strategy, there were five areas where we wanted to see improvement, which the health service or government departments could not deliver but which required the co-operation of the community and the charities. Under mental health, my targets in 1992 were indeed reducing the overall suicide rate by at least 15% by 2000 and reducing the suicide rate of severely mentally ill people by at least 33% by then. However much prejudice there was against mentally ill patients at that time, the greatest danger that they posed was to themselves, and the rate of those officially receiving mental health care was appalling.
I do not want to encroach on the area of the noble Lord, Lord Ramsbotham, but in today’s environment the terrible loss of life in young offender institutions is of great concern, as is the extraordinary influence of the internet, which in one way can be a source of befriending those at risk of suicide but, it seems, has somehow been distorted, misused and abused to actually precipitate suicide events. It is my view that, rather like when the Member of Parliament for Worthing was very preoccupied with reducing road accidents, there was a time when more young people lost their lives in road traffic accidents. Now, of course, the figure for suicide is higher, and has been for some time.
A campaign to tackle that could not be done just by allocating money. I fall out with the noble and right reverend Lord for simply thinking that charities need more money so that they can abuse the Government further for not giving them more money. The answer here is more subtle and requires broad ownership.
In the voluntary sector I want to commend Cruse Bereavement Care, of which I am a patron. It provides support for those whose relations and friends have taken their own lives. As the noble and right reverend Lord touched on, the result is intense anger—how could the individual have done it?—shame and isolation. You can tell somebody that your relation died of cancer, but it is still very difficult to say it of suicide. There is guilt—what more could we have done? There is confusion—why?—and endless reproach. It is very hard to achieve a sense of peace when a close relation has taken their own life. As we know, there are all too many in our parliamentary family whose children have done that.
The parents of Charlie Waller set up a wonderful charity when their son took his life in 1998. It works with health, education and the private sector on tackling depression and giving practical advice to people whose children and friends might be thinking of suicide. These people might think, “If I mention suicide, will the individual go over the top and take their own life?”. Many people are uncertain what the toolbox is. Traditionally GPs were particularly poorly equipped in mental health skills, but they are improving.
I congratulate the Government very warmly. I have looked closely at the suicide prevention strategy. I think it is a tremendous step forward. It is in the context of the “No health without mental health” keystone of government policy in relation to health. I am not sure it is just a question of more money. I am sure that it is constantly reminding us that this is a critical issue, a serious threat to life that people should not be afraid to discuss and draw to other people’s attention. For that, again, I praise the noble and right reverend Lord.
5.16 pm
Baroness Linklater of Butterstone (LD): My Lords, I apologise for arriving late. If it is the Minister’s feeling that I should not continue, having missed a very large part of the opening speech, which I bitterly regret, I will sit down.
Lord Ahmad of Wimbledon (Con): It is the normal convention to hear the person who is moving the Motion, so I think my noble friend knows my advice in the matter. It is really a matter for her to consider.
Baroness Linklater of Butterstone: I will go on. I will focus on suicide among young people in the criminal justice system. They are the most disadvantaged and damaged in our society, with enormous mental health needs while being in the care of the state—our care. We lack adequate skills to recognise and understand the degree of the vulnerability of many of these young people, with the result that, since 2000, 282 children and young people have committed suicide while in custody. Untold numbers of others have tried but did not succeed.
One example is that of a 19-year-old girl with no previous convictions and a long history of self-harm who set fire to her mattress as an act of self-harm and was remanded in custody for arson with intent to endanger life—her own. She was recognised as having a personality disorder but could not be sectioned because she was deemed to be untreatable, so she continued to self-harm until she strangled herself to death. Meanwhile, her twin sister, also a self-harmer, found appropriate support in a therapeutic community.
Prison staff greatly need training and skills to understand better the needs of this very vulnerable group, but so do the Government, as their plans demonstrate. Hence, although restraint is now understood to be hugely distressing for these children, future plans, under the new Criminal Justice and Courts Bill, will allow restraint to be used by prison officers if their orders are not followed. Places at secure children’s homes—the one source of real security—are now
going to be reduced by 17%, and fortified schools will cater for children who offend. A huge secure training college taking 320 young offenders—the antithesis of what these children need—is being planned. Young people over the age of 18, who are indeed just as needy and immature, will be left only the option of prison. Vulnerability is an explicit element in remand decisions in the court but not, amazingly, when it comes to sentencing, apart from mitigation if imprisonment is being considered. Crucially, sentencers too must be made more aware of what provision is locally available to them and what is appropriate for children in such desperate straits.
I am delighted that there is going to be an independent review into deaths in custody, chaired by the noble Lord, Lord Harris of Haringey. It must include children as well as those over 18 if they are to have a chance. Children’s lives depend on our getting plans for them right. Prison is for the most violent, dangerous and prolific offenders in society, not vulnerable children who are at risk of taking their own lives.
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Lord Ramsbotham (CB): My Lords, I congratulate my noble and right reverend friend Lord Eames on obtaining this debate. As was forecast by the noble Baroness, Lady Bottomley of Nettlestone, and as the noble Baroness, Lady Linklater, has done, I shall focus on young people in custody. I am conscious that what I am going to say may not strictly be the province of the Minister, but I hope very much that in the context of this important debate he may relay some of what I am going to say to his colleagues in the Ministry of Justice.
In 2012 I launched a report by the Prison Reform Trust and the charity INQUEST, titled Fatally Flawed: Has the State Learned Lessons from the Deaths of Children and Young People in Prison? The answer to that question was clearly no. Of the figures that my noble friend gave, 46 of this age group died in custody by their own hand between January 2011 and January this year. This report showed that there is commonality between the children who had committed suicide. They all had multiple disadvantages: substance abuse, mental health difficulties, learning disabilities, ADHD, special educational needs and personality and conduct disorders, plus all the other neglect.
Added to that, one has to remember that the adolescent brain has not fully formed at this stage, and cognitive behaviour and the development process are not completed until, possibly, the mid-20s. Therefore the problems that young people face are first, acute, and secondly, different from those of adults.
Last week the Youth Justice Board published the report Deaths of Children in Custody: Action Taken, Lessons Learnt. This was the result of long analysis, and it included the conclusion that the Youth Justice Board must work with providers of custody to enable them better to understand how to support children who are at risk of being suicidal or self-harming. There are other factors in this, but the clear finding was that there were common features in all the reports on all the suicides of this group, which surely gave an opportunity to identify common solutions.
Having called for an independent review and having had that call rejected by the Ministry of Justice, when I raised a Question about this three weeks ago I was disturbed to hear that the review to be carried out by the noble Lord, Lord Harris of Haringey, will not include children. This was also mentioned by the noble Baroness, Lady Linklater. Well, why on earth will children not be included? The factors include, inadequacy of management in the custodial centres, inadequacy of staff training, multi-agency failure in communicating individual vulnerabilities and needs, and failure to listen to children. There is also failure to circulate and implement recommendations which have been laid down in countless reports by the ombudsman and others, and recommendations made by coroners in inquests under Rule 43 of the Coroners’ Rules.
The Ministry of Justice’s reasons for rejecting the report were that, instead, it would have internal reviews by Ministry of Justice agencies; it would have discreet specialist reports into such things as the use of force; it would have better publication of information; and it would try to expand the scope of the law governing inquests. That has absolutely nothing to do with the subject of this debate, which is the prevention of children committing suicide, particularly in custody. I therefore ask the Minister to do all that he can to persuade his colleagues to include children in the review by the noble Lord, Lord Harris of Haringey, so that, among other things, it can include the Youth Justice Board report which contains many of the factors that it will need to carry for a slightly younger part of the same age group.
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The Lord Bishop of Lichfield: My Lords, I, too, thank the noble and right reverend Lord, Lord Eames, for initiating this debate.
The Association for Young People’s Health recently published its key data on adolescence. At present, the statistics show that the levels of self-harm are relatively stable, although for such a sensitive topic there is likely to be low reporting. It is clear that girls are at least three times more likely to self-harm than boys; on the other hand, suicide is much more prevalent among young males, particularly those aged between 20 and 24. This coincides with the evidence from ChildLine. Numbers have fallen fractionally in more recent years but the report questions whether this will continue.
How this correlates with child well-being needs careful consideration. We all remember the United Nations report about the unhappiness of children in this country. ChildLine reports that the number of children contacting it about suicidal feelings has risen for the third year running, including a rise of 33% in the last year. Overall, child well-being in the UK, according to the United Nations, has improved from 21st out of 21 to 16th out of 29 countries. Economic reasons have been stated and there is much correlation with the commentary from the Association for Young People’s Health.
Clearly the motives towards suicide are varied but the underlining factor seems to be lack of self-worth. This is underlined by the evidence of high rates among
minority groups. I shall say a word about that later. Whether or not bullying is a component, although often it is, the social isolation and lack of affirmation which these young people feel are key components. It is both encouraging and concerning that more young people are contacting ChildLine about this. Obviously it is good that they are communicating, but bad because they say that when they have rung up other places or have been online, they have not really felt the understanding or acceptance that they were hoping for. All this shows that we, as a society, may not be providing sufficient support in the early days when these young people’s foundations in relational networks are initially developed.
I have time to mention two particular topics in relation to this. First, bullying is often directed at those who are different and it is well known that disability frequently gives rise to despicable behaviour in others. This is starting to appear insidiously in the area of assisted suicide. Recently a young man in Northern Ireland telephoned a radio phone-in to complain that since the increasing coverage of assisted suicide cases, he had noticed a change in people’s attitudes towards his own motor neurone disease, that he was being asked with increasing regularly if he had considered suicide. This shows, if nothing else, that the messages we give young people about their self-worth and their dignity as human beings are crucial.
Secondly, on asylum seekers and refugees, many children from these groups suffer high levels of mental health issues, which is unsurprising given that many of them have experienced hugely traumatic events. Add to this their poverty, homelessness, practical and emotional insecurity, let alone the hostility from the natives, it is not surprising that levels of well-being and self-worth are significantly diminished.
The conclusion of all this is that a society will be judged on how it treats its most vulnerable members, a matter over which all of us have deep concerns. Let us at least seek and do all we can to make sure that those who are struggling, or who are different, do not go on falling through these gaps.
5.30 pm
Baroness Buscombe (Con): My Lords, I, too, thank the noble and right reverend Lord for obtaining this valuable debate. I also declare an interest, of which I am very proud, as chairman of the advisory board for the Samaritans. I want to talk about how both government and the private sector are working to try to reduce levels of suicide. I will focus upon the internet and the need for free phone numbers to break down access to help and support, particularly among young people.
There has been considerable debate in recent weeks about the influence of the internet and social networking sites on young people vulnerable to suicide. The truth is, it is much more difficult to reduce access to potentially harmful information when it is online. The Samaritans has been focusing on this for a number of years, and its experience shows that the most effective approach is to both expand the sources of support to vulnerable people online and also to encourage organisations which run highly popular sites to develop responsible practices and to promote sources of support.
In pursuing this approach, the Samaritans have worked in partnership with major companies to develop practical initiatives to support people at risk of suicide online. In November 2010, an initiative was launched in partnership with Google which adds a new feature to search results. The Samaritans helpline number and a highly visible telephone icon is now displayed above normal Google search results when people in the UK use a number of search terms related to suicide. We have also launched a pioneering new scheme in partnership with Facebook which allows the 30 million Facebook users in the UK to get help for a friend they believe is struggling to cope or feeling suicidal. People who are concerned about a friend on Facebook can report suicidal content such as status updates or wall posts through the help centre page on the website. The distressed person then receives an email from the Samaritans offering to open a line of communication with a volunteer so that they can access our services.
We also expect organisations that run these websites, such as social networking sites and online news media outlets to take action to reduce the availability of harmful content hosted on their sites. As part of the Samaritans media monitoring work, we contact newspaper staff directly to suggest amendments to the online version of articles with potentially harmful content.
One of the main difficulties in reducing the risk of suicide online is that the current research on the internet and suicide is extremely limited. The Samaritans are therefore working on new research in partnership with the University of Bristol, funded, I am pleased to say, by the Department of Health’s policy research programme on how people with suicidal feelings use the internet and the impact that this has on suicidal behaviour. We are hopeful that this research will provide new evidence to help to inform policy and best practice.
However, an important element of suicide prevention is that support is immediately available to people in distress, and that people know how to access it. The Samaritans national helpline number currently uses an 0845 prefix, which means that, while calls from landline phones are relatively inexpensive, calls from a mobile phone can cost considerably more. Several years ago, the European Commission decided that certain services of social value should have the same memorable telephone numbers in all member states, and should be free. In 2009, therefore, Ofcom awarded such a number to the Samaritans, which has since launched a successful pilot of this new free number in limited areas.
The problem is funding. At the moment, thankfully, the Big Lottery Fund is funding the rollout of the free-call service in just 10 areas, targeting those most in need of a free-to-caller service. This will allow Samaritans to understand how a free-to-caller number targeting people in socioeconomically deprived areas will change the nature, volume and pattern of calls. But the issue that Samaritans urgently needs to resolve is how to make the service financially sustainable in the long term.
Here I turn to a debate on this subject that I initiated in your Lordships’ House last July. Following that debate and the very helpful, supportive response
from my noble friend the Minister, the Department of Health agreed in principle to host a round-table meeting with the telecoms industry and Ofcom to discuss how the telecoms industry and others can fund free-call for the longer term. This was discussed when the CEO of Samaritans met Norman Lamb in October and it was agreed that this meeting should take place. A suggested list of stakeholders has been submitted to the Department of Health. We understand that the meeting is still in the pipeline, but progress is slow and there is still no date for the meeting in the diary. I urge my noble friend the Minister to follow this up.
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Baroness Brinton (LD): My Lords, I declare my interest as a co-chair of the bullying APPG and a patron of Red Balloon. I thank the noble and right reverend Lord, Lord Eames, for instigating this debate so that we can discuss the root cause of so many avoidable deaths in young people. He was quite right to quote PAPYRUS’s data on the number of attempted suicides by young people: one every 20 minutes. That is three during this short debate.
The 2012 government report Preventing Suicide in England identified nine categories needing customised care, including children, those with untreated depression, LGBT people and ethnic minority groups. Although I am pleased by the emphasis placed on children as a separate category, we do well to remember that children can fall into most of the other groups as well.
A major factor leading to suicide is bullying. It is shocking that 69% of children in the UK report being bullied. The National Centre for Social Research report on bullying showed that each year 16,000 children are out of school long-term with depression because of bullying, and that there are at least 25 confirmed suicides as a result of bullying, but there are probably many more that do not meet the criminal standard that the noble and right reverend Lord, Lord Eames, spoke of earlier.
Early intervention is vital. Most children do not suddenly decide to kill themselves. ChildLine says that there has been a,
“trend towards younger and younger children dabbling in self-harm, with a 50% increase among those aged 12 in the last year alone”.
However, even younger children are at risk. Last year nine year-old Aaron Dugmore hanged himself after being targeted by a gang of older bullies at his school simply because he was new. Ayden Keenan-Olson, aged 14, overdosed on prescription pills after homophobic and racist bullying by his classmates. He had reported up to 20 instances of bullying since joining his school but no action was taken. He eventually bypassed security settings on his computer to research suicide.
That raises the issue of online suicide forums and cyberbullying. Later this year, family-friendly content filters will be set automatically for new broadband users. However, most kids are so tech-savvy that they are able to bypass these settings in minutes. There is much more to fear from the “dark web” free of filters than from known, visible sites, so we must educate and support our young people to protect themselves.
The launch of Zipit, ChildLine’s first app for smartphones, is great news. It is packed with humorous tips for teens and advice to help them to cope with flirting and messaging, equipping them to protect themselves from online sexting, bullying and trolling. In the two months since its launch, more than 45,000 young people have signed up.
Frankly, CAMHS are struggling to deliver mental health services or reduce the number of young people killing themselves. Pressure on services can mean many months’ wait for urgent appointments, or having to travel 300 miles to get a bed in a tier 4 clinic. I heard on Monday of a child who had had to go from Birmingham to Glasgow for such a bed. I ask the Minister what is being done to speed up access to CAMHS facilities and to minimise the distances that must be travelled in instances of urgent child referrals. The coalition Government are rightly demanding parity of esteem for mental health services, but we have yet to see it happen.
I want to end on a more positive note, although it may not seem that way at the start. First Capital Connect asked to work with Red Balloon, a specialist bullying charity, after three bullied children threw themselves in front of trains. One was a 14 year-old ballerina and the second two were a young Goth couple who jumped together in front of a train. Red Balloon works with suicidal bullied children, offering intensive recovery and education support so that children can return to mainstream school and to their friends and society. However, only a handful of places are available nationally, and CAMHS beds are also limited, not to mention the constant problems around funding. My worry is this: does that reflect the value we place on these tragically short lives? Much more is needed to get early support to youngsters before depressive thoughts of death turn into the horror of young suicide, which affects family and friends for ever.
5.40 pm
Lord Black of Brentwood (Con): My Lords, I join others in expressing gratitude to the noble and right reverend Lord for securing a debate on this tragic and important subject. I want to highlight one particular group of young people for whom suicide and attempted suicide is a very real issue. Gay boys and girls are vulnerable because they are struggling with how to come to terms with their sexual orientation and they can face an unacceptable degree of bullying because they are different from others in their school or local community.
I am indebted to Stonewall, as is so often the case in these debates, for providing me with some deeply disturbing figures. According to a study conducted for the organisation by Cambridge University two years ago, almost one in four lesbian, gay and bisexual young people say that they have tried to take their own lives. That is a truly shocking figure when compared with the estimate of 7% of young people in the general population. The same research showed that gay young people who are bullied are tragically much more likely to take their own lives. More than seven in 10 of those who suffer homophobic bullying contemplate suicide
at some point, and half of them have symptoms consistent with clinical depression. Let me put these appalling figures into the human context. The Stonewall study highlights the case of a 15 year-old boy called Rabi, who reported as follows:
“The bullying went on for the whole five years of secondary school. I tried to fight back. I was depressed. I cut myself. I was on the verge of suicide. For one year, I came home every day crying into my mum’s arms”.
Rabi was lucky enough to be given the support that helped him get through it. One young man who did not was 14 year-old Essex schoolboy, Ayden Keenan-Olson, whose case has just been highlighted by my noble friend Lady Brinton. He was found dead in his bed by his father in Colchester almost exactly a year ago. His case was highlighted by the publication Pink News, which does an excellent job of campaigning in such crucial policy areas. As my noble friend said, Ayden, who had come out to his parents just a few months before his death, left two suicide notes outlining the homophobic and racist bullying he had experienced. He had been targeted with consistent violence, abuse and malicious allegations because of his sexuality and his Japanese origins.
Although huge strides have been made in recent years in the battle for equality for gay men and women, it is a sad fact that there is still too much homophobic bullying in some schools, much of it now done through the internet, which can all too often lead to tragedy. There are too many Aydens, but there need not be. There is a great deal that schools can do to turn the tide. Much of it is set out in Stonewall’s excellent “Education for All” packs, including schools having clear and promoted policies on tackling homophobic bullying, whether it is physical bullying or cyberbullying. It makes clear that school staff should be trained to spot problems and to provide young people with information and support to keep them safe, signposting them in the direction of professional help when they need it. It means that school nurses should make clear that young people can talk to them in confidence about their sexual orientation, and be aware, too, of the particular mental health issues they may face, intervening as necessary to support them. Local health services have a role to play in working alongside schools to focus on early intervention, a subject mentioned by my noble friend Lady Brinton, which is absolutely crucial because early intervention is the sort of thing that might have saved the life of a young man like Ayden. Local health services can also help train their staff on the particular issues that young gay boys and girls might face as they struggle with their identity.
When we passed the Marriage (Same Sex Couples) Act last year, with a huge majority in this House, many may have believed that the dark shadow of inequality, prejudice and intolerance was now behind us. It is a deeply regrettable fact that in too many communities those basest of human instincts are alive and well and, as we have heard, have deadly consequences. It will take many years to tackle that, but in the meantime we can and should do a great deal more to protect those who we know are most vulnerable—young people who are struggling because they are different. Will the Minister restate the Government’s strong commitment to tackling this issue and encouraging all
schools and local health services to ensure that they have the policies and procedures in place to spot trouble, intervene where they can, and provide the support that too many frightened, lonely young people desperately need?
5.45 pm
Baroness Royall of Blaisdon (Lab): My Lords, this has been an excellent, albeit painful, short debate, for which I, too, thank the noble and right reverend Lord, Lord Eames. We have heard the devastating facts and figures. Each and every young life lost through suicide is a tragedy, of course, to the young person, but also, as has been said, to the family and friends who love them.
I am ashamed that in the 21st century in a wealthy developed country with so many advantages and where we know the effects of bullying behaviour, too many young people contemplate or attempt suicide, too often successfully. I recognise the strains and stresses in our society, where there is great pressure to succeed and where much is expected of individuals, but who are not always able to live up to their own expectations, let alone those of their peers or society. Feelings of inadequacy, of being different, can be made acute by the media, including social media. The report, Alone with My Thoughts, produced last year, showed that nearly one-third of young people have contemplated or attempted suicide. This is a shocking statistic that I discussed with a friend in the forest who works in mental health. She suggested that there needed to be better training for staff in schools to identify the difference between perceived lack of motivation and depression and between anxiety and apathy, and that more support was needed around low confidence and self-esteem, especially in the world of social networking, where cyberbullying is rife.
I also know from talking to students that there is a similar problem in some colleges and universities. The Government have a suicide prevention strategy which includes the development of an e-portal for children, young people and those working with them. This is welcome, but will the Minister say how he will ensure that young people and their teachers will know about it? I also wonder what training, if any, teachers have to enable them to identify those children with mental health needs or those who are being bullied. Should not all staff working with children and young people receive training in mental health, including suicide prevention training? Some excellent charities are working in this area, including YoungMinds, but they rightly say that, despite the Government’s rhetoric or good intentions, we are a long way from seeing parity between physical and mental health.
Young people’s mental health is a vital issue that must be prioritised. It is not acceptable that in 51 of England’s 58 NHS mental health trusts there were 350 under-18s admitted to adult wards in the first nine months of 2013-14. This marks a 36% increase on the previous 12 months. Will the Minister say what action the Government are taking to ensure that under-18s are not admitted inappropriately to adult psychiatric wards and that, when they are sent to young people’s units, they are not hundreds of miles from home? Young people aged 16 to 25 are going through a
number of transitions. If they are in contact with mental health services, there is the additional transition from child and adolescent services to adult services. I would be grateful for an assurance that steps are being taken to ensure that adequate care and support is given at this difficult time. A difficult transition can make young people disengage with services, with the risk that their mental health problems will become entrenched and harder to treat.
The Prince’s Trust has produced an excellent report, Youth Index 2014, the message of which is clear: long-term unemployed young people are in desperate need of support. Some 40% of jobless young people say that they have faced symptoms of mental illness, including suicidal thoughts, feelings of self-loathing and panic attacks as a direct result of unemployment. I pay tribute to the extraordinary work of the Prince’s Trust, which is helping these young people, many of whom grow up in poverty and face an increased risk of mental health problems as a result. The same is said in a recent report by the Samaritans, which reports that there are systematic socioeconomic inequalities in suicide risk defined by job, class, education, income or housing. Whatever indicator is used, people in the lower positions are at a higher risk of suicide.
Some recent reports suggest that the changes the Government are making to social security, including the bedroom tax, are exacerbating or creating problems for people who are already struggling, so clearly it is important that the Government rapidly monitor the effect of the changes and take the requisite action. My friends in mental healthcare tell me that, as a consequence of the changes, the pressure on their services grows by the day with a tidal wave of referrals each week, including from young people. These people working in mental health are themselves overstretched, and they feel that no one is listening to and addressing their concerns.
The Government have a suicide prevention strategy and a mental health strategy, both of which are welcome. I look forward to hearing that they are being implemented and, most importantly, that they are adequately resourced.
5.50 pm
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con): My Lords, I am very grateful to the noble and right reverend Lord, Lord Eames, for raising this important issue, and for the valuable contribution made by all speakers today. The Government take the issue of suicide very seriously, and are working hard to reduce the number of people who take their own lives.
The suicide rate among teenagers is below that in the general population and has remained steady over the past few years. However, we know that this group is vulnerable to suicidal feelings, as has been made abundantly clear in this debate. The risk is greater when they have mental health problems or a behavioural disorder, misuse substances or alcohol or have experienced family breakdown, mental health problems or suicide in the family. However, any suicide is one too many.
Suicide is devastating for loved ones left behind, and it is especially tragic when the victim is a child or young person. That is why children and young people
have an important place in our 2012 publication,
Preventing Suicide in England: A Cross-Government Outcomes Strategy to Save Lives
. The report identified those groups of children and young people who are thought to be particularly vulnerable, including looked-after children, care leavers, children and young people in the youth justice system and gay and lesbian young people.
The noble and right reverend Lord mentioned funding. This strategy is backed by £1.5 million of funding for research. One of the funded projects will be exploring the use of the internet in relation to suicidal behaviour and identifying priorities for prevention. I assure noble Lords that the Government are committed to continue working with the internet industry in the UK to keep people safe online and to promote access to positive support for all suicidal people, including children and young people.
Education is also key. A number of noble Lords have mentioned bullying, including my noble friend Lord Black. The Government have sent a very clear message to schools that all forms of bullying are totally unacceptable and should not be tolerated. The Department for Education is in the process of reviewing behavioural guidance, which will be made available to all teachers.
The new national curriculum will see children aged five to 16 taught about internet safety in a sensible, age-appropriate way, a really important step to help children and young people to understand some of the issues. Furthermore, the major internet service providers are working on a parental awareness campaign, due to launch in the spring. This aims to raise parents’ awareness of, and ability to effectively use, the filters that they provide, and to provide parents with information about how to keep their children safe online.
We have also been clear that social media sites need to take responsibility for inappropriate content that is made available on their sites, which includes images of self-harm and suicide. We expect social media companies to respond quickly to incidents of abusive behaviour and inappropriate content on their networks. This includes having easy-to-use reporting tools, robust processes in place to respond promptly when abuse is reported and, where appropriate, suspending or terminating the accounts of those who do not comply with the acceptable-use policies. The Minister for Culture, Communications and the Creative Industries met with a number of leading social media companies to discuss what more might be done to protect young people when they are online, and we will continue to discuss this and work with the social media companies.
It is good to report that the industry has already worked on positive initiatives in this area. I want to echo the tribute paid by my noble friend Lady Buscombe to the excellent collaborative work that Facebook and Google have done with the Samaritans’ mental health strategy. The Samaritans have been facilitating a call to action for suicide prevention in England. More than 50 national organisations have signed this call for action, committing to work together so that fewer lives are lost to suicide and to support those who are bereaved or affected by suicide. My noble friend prompted
me on the issue of the promised round table. I reiterate to her that free-to-caller access to the excellent Samaritans service would be an important step forward. Work to set up that meeting is in hand, and a date will be fixed shortly.
The Samaritans have also been instrumental in developing media guidelines for the reporting of suicide. Those guidelines are aimed not only at journalists reporting suicide but also at authors and producers of television and film dramas. Research tells us that reports of suicide can lead to copycat suicides. I am sure that all noble Lords will agree that it is important that any media reporting should be sensitive.
The noble and right reverend Lord, Lord Eames, mentioned stigma. The Government are very pleased to be supporting Time to Change, a campaign to end stigma and discrimination faced by people, including children and young people, with mental health problems. It is clear, thankfully, that attitudes towards mental illness are improving in the general public, with the latest national surveys showing continuing improvement. Any incidence of self-harm, however, must always be taken seriously. In all cases of self-harm, all noble Lords will agree that it is important for health professionals and others to intervene early, before it is too late.
Last month my right honourable friend the Deputy Prime Minister, with the Minister of State for Care and Support, launched the mental health action plan. Of the 25 actions, one relates to our commitments to change the way frontline services respond to self-harm and to ensure that no one experiencing a mental health crisis should ever be turned away from services.
I now turn to what the Government are doing to protect vulnerable young people in custody, an issue raised by my noble friend Lady Linklater and the noble Lord, Lord Ramsbotham. It is very sad that three young people in custody took their own lives in 2011 and 2012. My right honourable friend the Secretary of State for Justice has established a working group to learn from these tragic deaths. The group has identified and disseminated the key learning points from the deaths, highlighting common themes and actions to be taken to prevent further deaths of children and young people. Additionally, a review of the assessment, care in custody and teamwork procedures for young people is being undertaken. I shall convey to my colleagues in the Ministry of Justice the points made so powerfully by the noble Lord, Lord Ramsbotham.
The Government strongly support the recommendations in the report of the Children’s and Young People’s Health Outcomes Forum and the Chief Medical Officer’s report, Prevention Pays—Our Children Deserve Better. We are working with key partners to consider options for taking this important work forward, to look at the prevalence of mental health conditions in children and young people. The Government are very keen that all professionals who work with children and young people have access to information about mental health. I am delighted to tell my noble friend Lady Bottomley and the noble Lord, Lord Ramsbotham, that my honourable friend the Minister for Care and Support is launching an interactive e-learning tool for children and young people’s mental health on 25 March. This is aimed at health professionals—teachers, social
workers and others—who are not necessarily mental health specialists and who work with children and young people. I want to pay tribute to the consortium of organisations headed by the Royal College of Paediatrics and Child Health for developing this exciting tool.
The mental health services for children and young people are very much in the Government’s sights. Between 2011 and 2015 we will be investing £54 million in children and young people’s improving access to psychological therapies, the CYP IAPT programme. This will give children and young people improved access to the best-evidenced mental health care.
My noble friend Lady Buscombe referred to the problem faced by children when they had a long distance to travel. Our aim must of course be to support children and young people with mental health problems near to where they live. Admission to hospital should be a last resort for a young person, quite clearly. We recognise the difficulty if people are treated away from home but the decision, inevitably, will depend on what facilities are available locally and the clinical needs of the individual.
The noble and right reverend Lord, Lord Eames, rightly pointed out that a multifaceted approach is needed. We completely support and agree with the need for such an approach. The role of the voluntary sector here is key and I pay tribute to the excellent work that is being done by the third sector—for example,
by PAPYRUS, an organisation mentioned by the noble and right reverend Lord, and by CALM, which supports families who are concerned about suicide or have been bereaved by it.
My noble friend Lady Linklater and others raised the vexed topic of self-harm, which should always be taken seriously. Child and adolescent mental health services are there to support children and young people who self-harm. There is evidence that self-harm is a symptom of stress and mental illness. Clinical care must always focus on these causes and on coping strategies rather than on the self-harm itself. In 2004, NICE published clinical guidance on the management of self-harm which covers the care that people who self-harm can expect to receive.
Finally, as we have debated frequently in this House, the Government are working towards parity of esteem between physical and mental health. We have been clear that there must be equal priority between mental and physical health services. One of the 24 objectives in the mandate to NHS England is to put mental health on a par with physical health and to close the health gap between people with mental health problems and the population as a whole. We expect the NHS to bear this in mind when taking decisions about how to spend NHS money on services for local people, including young people.
Committee adjourned at 6.02 pm.