Contribution
My Lords, I am a fellow of the Royal College of Psychiatrists, but what I am going to say this evening will, I fear, be unpopular in some quarters, including with my own royal college, which broadly says that these rising figures merely expose unmet need. I disagree. Rather, I agree almost entirely with the noble Baroness, Lady Maclean. I shall talk today particularly about children, because of the horrendous impact that this diagnosis problem has on children and their futures.
We have engineered a situation where far too many children are labelled as mentally disordered. They are indeed troubled and they need support but not a medical diagnosis. Since the early 19th century, every generation has believed that mental ill health was on the rise. As has been pointed out in epidemiological studies, prevalence has remained remarkably stable throughout the generations. What we see now has been referred to as the cultural inflation of morbidity, including the rise in so-called autistic spectrum disorder in children with average or superior intellectual gifts, attention deficit hyperactivity disorder—if noble Lords would like to test themselves on the myriad of online websites, they will find we have all got it—and a range of other disruptive and distressing behavioural abnormalities, plus depression and anxiety. All have been accepted as a suitable case for treatment.
Prescriptions of stimulants for ADHD have gone up by 50% since 2019. There is no such thing as bad behaviour anymore, but rather it is oppositional defiant disorder—and yes, there is a DSM-5 and an ICD diagnostic category for it. Society, of course, has made it a lot worse by providing huge financial incentives for parents and children to insist on being labelled in this way.
It is much worse in the United States, where there was recently a series of articles in the New Scientist pointing out how disastrous the mental therapy mania is for young people and its unfortunate impact on other children. In the UK, as of spring this year over 700 mental health support teams are now operational, and accessible to well over half the students in schools and FE colleges. Utterly predictably, they keep finding more customers to label and put on waiting lists, with the so-called undiagnosable middle who are not yet being tackled. The cost is nearly £500 million annually across the country. Is it cost-effective? The evidence is very poor. Not surprisingly, those engaged in the services—teachers and parents—love it, but I am sceptical and astonished that the Government would expand these teams on such flimsy evidence.
I emphasise that I do not underestimate the problems that many children face, especially inadequate parenting but also profound poverty, housing and health challenges, bereavement, being at risk of criminal or sexual exploitation, and having caring responsibilities. These are real problems and I do not doubt that early years and older children’s support is sometimes very worthwhile for these children. These are normal responses to often appalling circumstances and are the kind of things that effective social workers used to tackle but now do not.
There are two major adverse consequences to this problem. The less important, perhaps, is the extra time that children with problems are given to complete exams and tasks, with the consequence that they are believed to be capable of a lot more than they can achieve, leading to the truth of inadequacy emerging only on employment or in higher education. Much more importantly, children and young people with serious mental illnesses, such as incipient psychosis or a learning disability with associated serious mental disorder, have huge difficulties accessing care. It is they who need mental health support, but they get lost in the morass of others with less profound problems. These children are buried in a tide, waiting to see a CAMHS specialist. It is these young people we should prioritise. I would close these mental health teams and concentrate on the seriously unwell.