Contribution
My Lords, I welcome this timely and important debate. I want to start by addressing head-on the issue of the so-called overdiagnosis of mental health conditions. In these increasingly contested and often divisive debates, I find it hugely helpful to look at the facts. That is why I very much welcome the Government’s independent review into the prevalence of mental health conditions, ADHD and autism, alongside existing national survey data and academic research on the issue.
Simply put, the strongest available evidence does not support claims that rising mental health diagnosis, which undoubtedly exists, is driven simply by widespread overdiagnosis. Population surveys, clinical evidence and service use data all point to a genuine increase in mental health need over time and a worsening of the social determinants of mental health, alongside improved recognition, reduced stigma and a greater willingness to help.
As we have already heard in this debate, one in five adults now live with a common mental health condition, up from one in six 10 years ago, and, according to the King’s Fund, one in five children in England now have a probable mental health condition, up from one in eight 10 years ago. Yes, the increase in serious mental health illness is less sharp, but it is still going up. In short, the best available evidence suggests that mental health need has increased over time, particularly for common mental health conditions such as anxiety and depression. So, to my mind, the key policy challenge is not whether diagnosis rates are too high or too low but whether people can access timely, appropriate and effective support, and that is where I will focus the rest of my remarks.
First, on children and young people, charities such as Barnardo’s with many years of first-hand experience in this field are clear that the number of children and young people diagnosed with mental health conditions reflects primarily a rapidly-changing world—particularly the digital world—greater need and improved awareness. Also, as the Prime Minister acknowledged this morning, a rise in online and social media use can be a driver of poor mental health in some children. That is why in principle I welcome today’s announcement of a social media ban for under-16—indeed, action was long overdue—but, and it is a big but, we need to see far more details on how it is going to be implemented and enforced; we need to make sure that we learn the lessons from Australia, and we must never shy away from holding big tech companies’ feet to the fire for peddling harmful content and addictive algorithms.
According to a recently commissioned report by the Children and Young People’s Mental Health Coalition with Mumsnet, 87% of parents say that today’s children face more mental health pressures than they did. What parents say they really want is more school-based mental health staff and shorter NHS waiting times, particularly for specialist services. I have always supported the Government’s commitment to expanding enhanced mental health support teams for all schools and colleges in London and the enhanced pilot, but the model is not effective for all children and young people. There are those for whom mental health support teams do not provide sufficient support but whose needs are not acute enough to meet the threshold for child and adolescent mental health services. In my various Private Member’s Bills on this issue and my recent amendment to the Children’s Wellbeing and Schools Act—unsuccessful, I have to say—I have called these children “the missing middle” because they are falling through the gap in support and would greatly benefit from access to a schools-based counsellor as part of the funded rollout of mental health support teams. Sadly, I have not been able to persuade Ministers of this yet, but I will continue my campaign.
Mental health currently gets only 10% of total NHS funding but provides 20% of the disease burden, and it has costly knock-on effects on physical health. That is why I want to see the mental health investment standard reinstated—the Government dropped it quietly last year. We also need to see waiting time targets reintroduced, access standards introduced for community mental health services for adults with severe mental illness, and urgent crisis care for all ages. I am sure the Minister will also be delighted to hear that I have not given up my campaign for an independent mental health commissioner to represent patients and families and carers.
I conclude by emphasising that we urgently need a new mental health strategy with a strong focus on community services, early intervention and prevention. The Government recently issued a call for evidence, which of course I welcome, but it must be followed up with action. Indeed, the Government are more than welcome to borrow from the wealth of ideas and evidence in the Liberal Democrats’ recent policy paper entitled Whole-Person Mental Health. That includes a new offer for young people, mental health walk-in hubs in all communities and the introduction of mental health check-ups for adults going through major life events, and there is lots more too.