The case for new Mental Health legislation was made following the Wessely Independent Review of the 1983 Act.
The Review (although welcome) said little about the specific mental health needs of children; largely grouped together with ‘young people’ and discussion centred on parental consent for treatment.
The 2017 Green Paper, ‘Transforming Children and Young People’s Mental Health Provision’ was followed by a Public Consultation and Government Response. Progress included the emphasis on a multi-agency approach; early intervention, new ‘Mental Health Support’ teams and a presence in school via ‘designated Senior Leads for mental health and pilot or trailblazer area projects to test the proposals. However, the assumptive yoking together of ‘children and young people’ continued; there was a strong reliance on voluntary as opposed to statutory provision and a lack of clarity around training and qualification needs, workforce specification, the particular nature of treatments and therapies/parent and carer involvement and financial resources
The blanket Brexit predominance in parliamentary activity, followed by the Conservative leadership election, arbitrarily relegated mental health reform to the bottom of the priority list; with the Green Paper mothballed and provision for children completely off the radar.
During the Conservative leadership election the issue of mental health reform was a ‘non-runner’. It did not feature in a single question to candidates in the televised debates. A Child Mental Health Charter personnel visit to Johnson team campaign members found that there was no prior awareness whatsoever of the issue and the team’s subsequent attempts to brief the candidate resulted in a bizarre and confused candidate ‘announcement’ on the front page of ‘The Daily Telegraph’ that the growing national mental health crisis could be ‘solved’ if people who thought that they had a problem ‘could get a suitable job.’ There was again, no mention of children’s needs.
In the meantime, Ministerial replies to Written Questions about a) a date for the introduction of a Bill to reform the 1983 Mental Health Act and b) a guarantee that such legislation would prioritise the urgent needs of children were evasive and repeated platitudes about ‘trailblazers’ and ‘pilot schemes.’
However, the Queen’s Speech of 19th December 2019 included a specific promise to introduce a Bill to reform the 1983 Mental Health Act during the course of this parliament. The announcement was an unexpected ‘game -changer’ and efforts of voluntary and campaigning bodies such as the Child Mental Health Charter Campaign centred in the immediate future on securing a date and a parliamentary timetable for the Bill; the important inclusion of children’s needs at the heart of the legislation remaining as a non-negotiable requirement.
CHILDREN’S MENTAL HEALTH AND THE COVID-19 PANDEMIC
Children were, at best, afterthoughts in arrangements put in place by the Government to deal with the pandemic and inform the nation.
The daily press conferences had a ‘theme of the day’, conveyed by a relevant Cabinet Minister and supported by ‘the science’ in the form of Government Scientific Advisors; key representatives from SAGE and Professor Chris Whitty.
The Children’s Commissioner, Ann Longfield, was not invited to make a presentation and children’s issues were never given single subject status during the entire course of the lockdown and the duration of the daily press conferences themselves.
However, far from ‘not being an issue,’ or ‘not featuring in the media or contemporary research projects,’ the mental health needs of children (at crisis point pre-Covid-19) have now escalated out of all proportion as a direct consequence of a pandemic that has as yet no end in sight.
The examples below are representative of the situation:
- As part of a report into children’s wellbeing during the pandemic, The Children’s Society found 1.1 million teens feeling unhappy with their lives during lockdown. The charity is now calling on the Government to introduce regular measurements of young people’s wellbeing and dedicated funding to improve children’s mental health. Andrew Fellowes, Associate Head of Policy at NSPCC responded to the survey saying that more (and often younger) children are struggling with their emotional wellbeing while the NSPCC Helpline has seen a surge in concerned calls about children facing abuse behind closed doors. The organisations argue that teachers must be equipped with tools to support children when they return to school and the Government must ensure that children’s services have the capacity to deal with a likely surge in children needing help (‘Politics Home’, 29th June)
- A survey by Young Minds of children with a history of mental health needs carried out between Friday 20th March and Wednesday 25th March found that measures designed to prevent the spread of the virus were having a profound effect on many children with a history of mental health problems. 32% said that the pandemic had made their mental health much worse, 51% said that it had made their mental health a bit worse. Among more than 1,000 respondents who were accessing mental health support in the three months leading up to the crisis, 31% said that they were no longer able to access support but still needed it. Young Minds is calling upon the Government to commit to a recovery plan for children and young people’s mental health as of urgency
- Sarah Hammond, Director of Integrated Children’s Services in Kent and Medway noted that five children with special educational needs killed themselves within the space of three months following lockdown. All five had special needs including ASD and ADHD. Research published on 13th July from the National Child Mortality Database (NCMD) found that there were 25 likely child suicides in the first 56 days of lockdown. The study said that ‘Restrictions to education and other activities, disruption to care and support services, tensions at home and isolation appear to be factors.’ (‘The Guardian,’ 14th July 2020)
- A survey carried out online by Action for Children between 16-22 June of over 2000 parents of children under the age of 18 found that 36% of children were feeling lonely and isolated; 28% reported as anxious and unable to sleep. Lynn Giles, Parent Talk Manager said ‘This pandemic has triggered a crisis for mums, dads and children on an unprecedented scale…huge numbers of children will need extra support over the coming months and parents are telling us they don’t know where to turn.’ The charity has asked the Government to prioritise children’s mental health in its Covid recovery planning and provide adequate funding to meet the demand. Sarah Hannafin from the NAHT commented on the findings and said that there will be children returning to school who will need additional, targeted support and more specialist support from health or social care services. Government must ensure that capacity is increased, that schools are able to access support quickly and that there is also support provided for parents.
- On 23rd July, ‘The Daily Telegraph’ reported that more than 40,000 calls had been made to the National Domestic Abuse Helpline since the start of the coronavirus lockdown, with a rising demand. The telephone helpline of Refuge saw an increase of 77% in calls for help from women, friends and family members in June. Domestic Abuse Commissioner Nicole Jacobs told ‘The Daily Telegraph’ that the Government funding promised until the end of October was inadequate ‘The one thing Government needs to do is to put in place a plan post-October and it is important to do so NOW as the evidence is right before us.’
- On 19th July, Ross O’Brien of the Central and North West London NHS Trust said that ‘There’s a real risk that the mental health impact of Covid-19 will be worse than the physical effects. Research published by the Chartered College of Teaching raises fears about a mental health crisis in schools with fewer than 5% of teachers expressing confidence about supporting vulnerable and traumatised pupils in September. Teachers are concerned for pupil’s wellbeing and specific mental health needs and teachers reported concerns about dealing with issues including domestic violence, death of family members and suicide as well as a need to direct families to food banks and charities. They felt isolated and ill-equipped to provide advice. (‘The Observer,’ 19th July )
- ‘Hundreds of psychiatrists’ have signed a letter to Gavin Williamson, Secretary of State for Education urging the Government not to fine families for refusing to send their children to school in England and warning of anxiety if children were forced to return to classrooms when they were not ready. The Chair of the Faculty of Child and Adolescent Psychiatry at The Royal College of Psychiatrists, Bernadka Dubicka said that the threat of fines forcing families to send overly anxious children back to school could ‘have serious consequences on their mental health, especially if they are worried about family shielding. Fines could bring more financial stress as we’re entering recession, severely affecting children’s and parents mental health.’ The letter was signed by 250 psychiatrists. (‘The Guardian,’ 26th August)
- On August 22nd, Dr Max Pemebrton wrote in ‘The Daily Mail’ that while he sympathised with children who had been affected by the A and GCSE examination mix up, ‘while I don’t doubt the distress caused and their anxiety about their future prospects, this pales into insignificance when compared with the mental health implications of the coronavirus pandemic for hundreds and thousands of younger children.’
In face of the above examples ( there are many more) there is no sense that the Government has a plan in place plus financial resources – to address the worsening and aggravated crisis in children’s mental health that will burst upon schools and health services that are unprepared for it in September and beyond.
THE POSITION OF THE GOVERNMENT
This remains vague; especially following the exchange between the Prime Minister and Darren Henry (Broxtowe) Con at Prime Minister’s Questions on 16th July. Mr Henry said:
‘After such a difficult few months for everyone, people with mental health conditions are especially suffering from increased anxiety, the effects of isolation, the months without treatment and, most importantly, a lack of early interventions. Will the Prime Minister outline what steps the Government will take to make sure that people with mental health conditions are not left alone or behind?’
The Prime Minister’s reply was in line with his unfocused statement to ‘The Daily Telegraph’ on mental health prior to his election as Conservative Leader. He was unable to supply Mr Henry with the information requested but instead offered the information that ‘We are also, as he knows, now publishing our new strategy for disabled people, which will cover all types of disability, including physical and mental health.’
The confusion at the heart of Government strategy is further compounded by evasive answers in response to letters and questions to Ministers including the Education Secretary Gavin Williamson’s assurances that there will be new ‘online training materials’ to equip teachers to deal with mental health problems experienced by their pupils and the detail that from September 2020, all children will be taught about mental health alongside relationships and sex education. There is no sense of a strategic plan.
At the same time, in a Written reply to Dan Carden MP, the Minister with responsibility for Mental Health, Nadine Dorries announced an intention to produce a White Paper on the reform of the 1983 Mental Health Act to be followed by a Bill when parliamentary time allows.
It would therefore seem that the case for a Health and Social Care Select Committee Inquiry into Mental Health Policy for Children is fully justified and would be widely welcomed.
It would benefit from the widest possible input and should be launched as soon as possible; impelled further by the extra needs occasioned by the Covid-19 ongoing pandemic.
17th August 2020: Helen Clark, Campaign Manager, Child Mental Health Charter Campaign.