Contribution
My Lords, I thank the noble Baroness, Lady Maclean, for securing this important debate. There were around 1.8 million people waiting for mental health services in quarter 1 of this year, and long waits for access to mental health services seem to have become normalised. But rather than looking at the numbers negatively—as I think the noble Baronesses, Lady Murphy and Lady Cash, seem to—I see this as people starting to seek help as they would for their physical health. Removing that stigma in my lifetime, as people understand more and are willing to come forward when they are in need of help with their mental health, has been a positive move. I thank the noble Baroness, Lady Shah, for her very personal and powerful contribution to this debate.
As Mind, the mental health charity, has advised,
“the strongest available evidence does not support claims that rising mental health diagnosis is being driven by widespread overdiagnosis. Population surveys, clinical evidence and service data, point to a genuine increase in mental health need over time, alongside improved recognition, reduced stigma and greater willingness to seek help”.
As my noble friend Lady Tyler of Enfield rightly stressed, the key issue we should be debating is not whether diagnosis rates are too high or too low, but how we can ensure that people can access timely and appropriate support. I do not agree with the noble Baroness, Lady Maclean, and her talk about something having somehow gone wrong, and the need for grit. There is a danger that dismissive language will begin to undo the progress we have made, by reintroducing stigma and shame into conversations about mental health. As the noble Lord, Lord Davies, said, the experience is real and we do not need an extra layer of burden in this space. Rising diagnosis is occurring alongside rising symptoms, distress and impairment. That points to a genuine increase in need, rather than simply a change in labelling or lower thresholds for diagnosis.
The noble Baroness, Lady Nargund, rightly highlighted the increase in women—now up to one in four—and some of the reasons for this, including technology. That was really powerful. As we have heard in much of the debate today, nowhere is this more acute than among children and young people. Barnardo’s practitioners report growing complexity in presentations, including acute anxiety, depression and trauma-related distress. Yet less than 10% of the NHS budget is spent on children and young people’s mental health.
The Government’s commitment to expanding mental health support teams to all schools and colleges is welcome. But these support teams are not designed to meet every need. Younger children and those with special educational needs or facing more complex mental health challenges may simply not be able to engage with low-intensity cognitive behavioural therapy, or may need something that the model cannot offer. My noble friend Lady Tyler, and Barnardo’s, rightly describe this as the “missing middle”—children who do not quite reach a threshold for CAMHS referrals, yet whose needs exceed what the support teams can provide. Children experiencing moderate depression, self-harm, trauma or bereavement are left without appropriate help. Barnardo’s has called for mental health support teams to be expanded to include school-based counsellors: what it calls MHST plus.
The economic case is compelling, because every £1 spent on school counselling services can return £8 to the state. However, we on these Benches believe that resources in our mental health services too often kick in only at the point of crisis, and that families and communities also need to play a role in the lives of people with mental ill health. We have not been silent on some of the structural questions either. During the passage of what became the Mental Health Act last year, as we have already heard, we made the case for the creation of a dedicated mental health commissioner to provide independent oversight and accountability across the system. We have also continued at the other end, calling for mental health investment standards to be protected.
Both these measures go to the same point: without proper oversight and protected resources, warm words about parity of esteem just will not be enough. I therefore ask the Minister: as part of the Government’s new mental health strategy and the work they are doing there, will they look to offer regular mental health check-ups of people and those supporting them when they are most vulnerable to mental ill health? Will they ensure that all mental health services are integrated with money advice, and substance abuse, housing and employment advice services? Will they provide a dedicated mental health professional in every primary and secondary school? And will the Government look to make mental health referral and support services available following every miscarriage, not just after three? There is much to do to support people with their mental health. Claims that this is being overdiagnosed offer a simplistic headline to a far deeper and more complex area. I await the Minister’s response with interest.