Even before the pandemic, there was overwhelming evidence of a significant and growing decline in the mental health of our children and young people. Much of this evidence was set out in APPG reports 10, 12 and 14 available here: https://fhcappg.org.uk/?page_id=2171 and there are many other sources. The APPG is currently preparing a further relevant report scheduled for March publication entitled: ‘The Covid Generation: A Mental Health Pandemic in the Making’.
Government seemed to accept that ‘something must be done’ and on 9th January 2017, former Prime Minister Theresa May announced the publication of a Green Paper: ‘Transforming children and young people’s mental health provision.’
In a press release, heralding the Green Paper and captioned ‘Prime Minister unveils plans to transform mental health support,’ Mrs. May said:
‘What I am announcing are the first steps in our plan to transform the way we deal with mental illness in this country at every stage of a person’s life: not in our hospitals, but in our classrooms, at work and in our communities.
This starts with ensuring that children and young people get the help and support they need and deserve – because we know that mental illness too often starts in childhood and that when left untreated, can blight lives, and become entrenched.’Prime Minister Theresa May, 2017
In July 2018, the Government published its response to the public consultation on the Green Paper with a joint Ministerial foreword by the Rt Hon Matt Hancock MP, then as now, Secretary of State for Health and Social Care, and former Secretary of State for Education, the Rt Hon Damian Hinds MP.
‘The government is delivering on manifesto commitments, taking focused action to provide the support needed by children and young people…Our aim is for the proposals we set out in our Green Paper in December 2017 to transform support for children and young people’s mental health, linked to and building upon what is already done by schools and colleges. We want to make sure that young people have access to the services they need, whilst teachers and schools – who are often on the front line of recognising and supporting a young person’s mental health problems – have access to the training they need…. we are determined to drive this programme forward as quickly as possible with the ultimate ambition for national roll out.’Rt Hon Matt Hancock MP, Secretary of State for Health and Social Care, and former Secretary of State for Education, the Rt Hon Damian Hinds MP, in July 2018
Hopes that the Green Paper reforms would not be blown off course under the new Prime Minister were high when in the Queen’s Speech of 19th December 2019 Boris Johnson announced his intention to reform the 1983 Mental Health Act ‘during the course of this Parliament’.
It was therefore reasonable to expect that the first comprehensive mental health legislative reform since 1983 would enshrine the principles and major proposals of the Green Paper.
There was concern that the Government-commissioned Wessely Review of the Act was strongly focussed on detention issues nevertheless the sector remained hopeful that the Green Paper reforms would not be lost. However, when the White Paper was published on Wednesday 13th January 2021, it became clear that there was little intention to roll out those Green Paper reforms.
The White Paper was laid before Parliament by the Rt Hon Matt Hancock MP, then as now, Secretary of State for Health and Social Care, the same Minister quoted above saying in July 2018 of the Green Paper proposals that he was ‘determined to drive this programme forward as quickly as possible with the ultimate ambition for national roll out’.
Insofar as children and young people feature in this White Paper, it is largely in respect to the law on detention and inpatient care.
Undoubtedly, detention issues required addressing and those proposals have been well received but this impacts only on a minuscule number of people compared to the widespread and growing mental health challenges affecting so many children, young people and adults.
The White Paper as it stands represents a sad scaling down from the Green Paper vision of widespread reform to stem the tide of large-scale and growing mental health deterioration especially amongst children and young people, part of the trajectory, further fuelled by reducing levels of physical activity and health, towards the next generation becoming the least healthy adult population in the UK in living memory.
The narrow perspective of the 2021 Johnson White Paper may be best described as polishing the edges of continuity.
Parliamentary support for the Green Paper approach
It is to be assumed that if the recommendations of the Green Paper are intended to persist at all, this will be via the familiar limited trialling of strategies or in the form of ambitions in the NHS Long Term Plan.
At Westminster, however, Parliamentarians have continued to press for the adoption of ‘Green Paper-style’ approaches. Some examples:
- It was left to a now Backbench Theresa May MP, responding to the Statement of the Secretary of State, to introduce a dissonant note on the White Paper: ‘I fear though, that the legislation might not be on the statute book until 2023. Meanwhile, GPs and hospitals caring for my constituents tell me that there is an increasing problem of mental health and increasing numbers of people with mental health problems, particularly young people,’ https://www.theyworkforyou.com/debates/?id=2021-01-13a.329.0
- Robert Halfon (Harlow, Con, Chair of the Education Select Committee) to the Secretary of State for Education the Rt Hon Gavin Williamson MP, 18th January 2021:
‘….While schools are closed and children are remote learning, mental health worries for millions of children have rocketed, as highlighted by the Royal College of Paediatrics and Child Health and others. Will my right hon friend work with charities such as Place2Be to put mental health counsellors in all schools now, so that children can access support whenever they need it and their attainment levels will not suffer even further?’Robert Halfon MP
- Munira Wilson (Twickenham, Liberal Democrat) writing in ‘Politics Home’
‘The availability and access to counselling in schools would be a lifeline to many young people, allowing them to get the support they need before they reach crisis point…….The Liberal Democrats are calling on the Government to invest in the future by prioritising access to counselling to children and young people who are already dealing with so much…’ https://www.politicshome.com/thehouse/article/the-pandemic-has-taken-its-toll-on-the-mental-health-of-our-young-people-we-can’t-just-ignore-it?Munira Wilson MP
- Baroness Fall (Con): Questions for Written Answer, tabled on 12th January and due for answer by 26th January:
‘To ask her Majesty’s Government what percentage of referrals of children with mental health issues referred for treatment from (1) GPs and (2) other health professionals, have been treated through child and adolescent mental health services since 23 March 2020; and what was the percentage of such referrals from 23 March 2019 to 22 March 2020.’Baroness Fall
Queries and discussion points that stem from the omission of the 2017 Green Paper ethos and content in the January 2021 White Paper might include the following:
- What help will the new legislation afford a child or young person before they are in crisis? The White Paper leaps straight to emergency inpatient treatment and misses all the steps beforehand that could have prevented the emergency from happening. Also absent is the great swathe of professionals in the community such as play therapists and counsellors prior to detainment in a hospital or secure setting
- The Green Paper of 2017 commits resources to the recruitment of therapists, supervisors, training teachers in mental health awareness and ‘puts schools and colleges at the heart of (our) efforts to intervene early and prevent problems escalating.’
- The Green Paper system to facilitate Mental Health Leads in schools with links to parents and carers with promised Mental Health Support Teams to be supervised in cross-departmental spirit by NHS Children and Young People NHS staff is missing
- The Green Paper focused on the ‘right help in the right setting’ on early intervention and school-based therapy and support. This differs sharply from the White Paper concentration on ‘invasive’ or ‘other medical treatment’ in an inpatient surroundings
- There is no recognition of the value and existence of the current workforce in schools to include clinically trained therapists and professional counsellors
- There is no reflection of the plans in the Green Paper for teacher training and support when dealing with emergent mental health problems in schools
- If there is little support available for children and young people experiencing mental health problems before they enter crisis, what therefore is proposed for ‘afterwards’ when a young mental health inpatient is discharged? Therapists and counsellors are needed in schools as a matter of statute (not option) both for early intervention, prevention and recuperation after a crisis to help a child to regain health and resilience and go on to thrive in school as is their right
- A gap is perpetuated between the initial worries of a concerned parent, carer or teacher and a full-blown CAMHS referral. What about the crucial ‘in-between’ stage where the services of trained teaching staff, on-site play therapists and counsellors can make the difference and avert a full-scale inpatient stay?
The call for mass urgent action
Without a determined and concerted effort, there is a real risk that the Green Paper proposals will be ‘sometime, never’ and now is the time for action.
The aim of the action is to press for ‘Green Paper’ inclusions into the current White Paper and to build a concerted, determined campaign for the Green Paper proposals to be enacted, either through the White Paper or otherwise.
It is not the intention of the APPG or of the meeting to define precisely what organisations or individuals might wish to say. Each will have their own perspectives and variety in approach will be an important factor in distinguishing the campaign from a standardised template letter-writing campaign.
It is however important to act swiftly.
Who to approach
In essence, write to or copy in every political contact you have including:
Constituency MPs where relevant
The email address for submissions to the White Paper (do not attempt to answer the largely irrelevant standard questions in the White Paper)
Rt. Hon. Jeremy Hunt MP (Chair of the Health Select Committee)
Robert Halfon MP (Chair of the Education Select Committee)
Rt. Hon. Matt Hancock MP (Secretary of State for Health)
Links and contact details will be provided prior to the meeting.