The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)

My Lords, I congratulate the noble Baroness, Lady Maclean, on securing this timely and highly relevant debate. I thank all noble Lords for their contributions. There is not unanimity in this House on what is behind the drivers of prevalence—I will come to that shortly—but I have listened closely to everybody on that point. The debate has covered the state of the nation’s mental health and has raised points about the rising demand for mental health services. These matters exercise us very much in government. I am grateful to my noble friend Lady Shah for sharing her personal and family experience in the way she did, setting it against what the world more generally is. It is difficult to bring up personal experience, but, as the noble Baroness, Lady Cash, said, it really does bring this to life, so I am most grateful. Nearly two years ago, we found that we inherited a system of mental health services under significant pressure. Demand for mental health support had risen sharply: between 2019 and 2024, over a million more people had come into contact with secondary mental health, learning disability and autism services. Straightaway, that raises the question: why? I agree with observations that have been made that access to support has often been too slow and fragmented and has not met the need that it should do. Too many have been waiting too long or have received help only once their needs have escalated. To my point about the difference of opinion across the House, it is a fact that there is real uncertainty about what has been driving these trends. That is exactly why we commissioned Professor Peter Fonagy to lead an independent review into the rising prevalence of mental health conditions, ADHD and autism. I thank Professor Fonagy for leading this, along with his vice-chairs, Professor Sir Simon Wessely and Professor Gillian Baird, because they too are shining the light we need. I am particularly glad to hear that there was welcome for this approach from the noble Baroness, Lady Tyler and the noble Lord, Lord Kamall, as well as other noble Lords, because this is a complex debate. The purpose of the review—and I want to emphasise this—is not to question the reality of the difficulties that are faced by people but to understand more clearly what is and has been changing over time, who is affected and why. The Government commissioned the review so that we could have—again, I want to emphasise this—an evidence-based understanding of trends in prevalence, distress, diagnosis, referral and support. Crucially, we also wanted a review of how well current systems were responding. The noble Lord, Lord Kamall, said that we would be failing in our duty if we were not considering these things, and I certainly share that view. The interim findings of the review published in March have already strengthened our understanding of what is happening. There is a real increase in psychological distress, particularly among younger people—my noble friend Lord Davies spoke to this point—with adverse effects on education, work and everyday functioning. The noble Baroness, Lady Maclean, asked whether we accepted that reform was needed to reduce what she described as the ballooning rise in mental health conditions. To reiterate, this review is considering the value of a needs-based approach to mental ill-health that better matches support to severity of need in day-to-day functioning, because I feel that there is a great misalignment here. Population surveys suggest that around one in five children and young people have probable mental health conditions, compared to one in eight in 2017. Indeed, the announcement today on social media speaks very much to this point. Among adults, the prevalence of common mental health conditions, such as anxiety and depression, rose from around 15% in the early 1990s to around 23% by the mid-2020s. In relation to ADHD and autism, the interim report finds that self-identification, referrals and recorded diagnoses have risen sharply. I emphasise again that we do not know exactly why, but that is what the review will help us with. The interim findings suggest that rising demand is likely to reflect a very complex combination of factors—i.e. no one thing. These include changing recognition; improved identification of some, frankly, previously missed groups who deserve to be seen; systems in which diagnosis seems to function as a route to support, rather than the need for support, and broader changes in public and professional understanding. I am sure that we could all add more. The interim report also finds that access to diagnosis and support remains, frankly, very uneven, and that is not acceptable. There are groups and individuals who are under-identified, while others are entering diagnostic pathways in growing numbers. The next phase of the review will build on those findings and will make recommendations on how systems can respond better and improve outcomes, and I can certainly confirm that we look forward to those recommendations. Bearing in mind that it was this Government who commissioned the review, I think noble Lords can be assured about how seriously we will take those recommendations. The noble Baronesses, Lady Maclean and Lady Cash, and other noble Lords referred to Alan Milburn’s review of NEETs. I can confirm that Professor Fonagy is working very closely with Alan Milburn on the NEET review and has also met the Secretary of State for Work and Pensions. Indeed, to the point that the noble Baroness, Lady Cash, raised, we will be working cross-government to ensure that the review’s findings are translated into action, because our focus is on improving outcomes. Indeed, the mental health strategy is cross-government; it is led by our department but goes further than that. Through the 10-year health plan, we have already taken significant steps to stabilise and improve mental health services and recognise that deeper reform is needed. We have recruited more than 8,500 additional mental health staff—that is three years ahead of schedule—and we have increased capacity across the system. We are expanding access to evidence-based support, including mental health support teams in schools and colleges to provide earlier help for children and young people. My noble friend Lady Nargund asked us to ensure that women’s health services and mental health services are connected; I can confirm that we are committed to ensuring that every woman gets the mental health support that she needs as soon as possible. We have asked ICBs to maintain and develop women’s health services as part of neighbourhood care. I also say to the noble Baroness, Lady Pidgeon, that we are piloting community mental health centres, such as the one I visited recently in Birmingham, for people with severe mental illness, bringing together clinical support alongside housing, employment and wider support in one place. We should be addressing the needs of the person as a whole, not individually. I say to my noble friend Lady Nargund that the forthcoming mental health strategy will emphasise addressing disparities across access to services, experience of care and outcomes. The noble Baroness, Lady Pidgeon, made a number of suggestions that could be considered. I would say that they are the kinds of things that the mental health strategy will want to consider. The call for evidence is open until 10 July, and I am sure that noble Lords will ensure that they make their views known. I am very enthusiastic about the mental health strategy. It will bring together many of these aspects, call upon the findings of the review and align with the 10-year health plan. In other words, it will set out how we intervene before distress escalates to diagnosis or crisis. I am grateful to all noble Lords for their contributions; it has been a thoughtful and challenging debate. As I said, there is not unanimity—I listened carefully to the noble Baroness, Lady Murphy, with her considerable experience—but I am confident that the review will give us the information that we need. I will be pleased to write to the noble Lord, Lord Kamall, to answer his questions and I am also very pleased to have announced the mental health strategy, because I think that is what will really power this forward.