14/11/18 – Hopes and Prospects for Children’s Mental Health Services

Speakers: Jeffrey Hugh Thomas, CEO, Play Therapy UK; Dr. Aric Sigman, Independent Lecturer and Author; Michelle Lee-Izu, Corporate Director Children’s Services (England) Barnado’s.

14th November 2018

All-Party Parliamentary Group on a Fit and Healthy Childhood

Title: Hopes and Prospects for Children’s Mental Health Services

Chair: Baroness (Floella) Benjamin

Speakers: Jeffrey Hugh Thomas, CEO, Play Therapy UK; Dr. Aric Sigman, Independent lecturer and author; Michelle Lee-Izu, Corporate Director Children’s Services (England), Barnardo’s

Chair’s Opening Remarks:

This is our 39th meeting! Give yourselves a round of applause. It’s great that people are slowly beginning to see our work and our vision and it’s crucial that people see it. I think if you can see it, then you can do something about it. Like being an alcoholic, you’ve got to admit the addiction before you can do something about it.

It’s our task to get people to see that as a society we are not thinking about children in the way that we should be, and once we get that, then we can make change.

This evening we’re discussing mental health services for children, which we’ve been talking about for years. I’m delighted to welcome the amazing Dr Aric Sigman, who wrote to me when I first arrived in the House eight years ago. I had made a speech and he wrote to me to say, “at last, someone who thinks like me!”

This is no doubt one of the most pressing issues we have at the moment because there is more and more talk about it. Last year, the Government published a green paper. Since then there have been consultations, a Select Committee report, and we ourselves published a report in June of this year. And then we had the budget, when the Chancellor announced mental health services would get a real boost in investment. Specialist teams for young people would be created, with schools having new dedicated support units to help pupils with “mild and moderate mental health problems”, which is really great.

We’ve been saying over I don’t know how many years in the House of Lords that we want something like this to happen, and it’s happening – they’re beginning to see it.

We must always praise Government when they take steps in the right direction. I’m a very positive person. Even though bad things are happening, I’m always looking at the good, and praising people. The more you praise people, the more they think, “hey! this is good!” and want more. So I would like all of you to write a letter to the Government to say thank you, thank you – BUT – they’re not seeing what we’re seeing yet. Many questions remain, and new problems are emerging.

Who, for instance, was not appalled to learn of the widespread use of isolation booths in schools? And particularly of their use for children with special educational needs.

Ah, what do we do? We need to help Government visualise what it’s like to be in one of these places with those young people. Visualise what it means to be someone caring for them. Visualise what it’s like if they are put into mainstream schools, how teachers are going to have to cope. Visualise the responsibility we are giving to teachers – and then come back and think about what we are doing.

My daughter is a teacher and she has to deal with this problem almost every day. She’s only 30 but she comes home exhausted from dealing with the issues that are in schools.

Think about the impact of these isolation booths on the mental health of children who are not quite sure why they are behaving the way they are behaving. We have to look back and see what caused them to behave like this in the first place.

Life to me is so simple. If only we could think childlike – not childishly but childlike. But there’s always a barrier and we’ve got to break those barriers down because it’s not fair putting those young people into those booths and it doesn’t help the problem. I do a lot of prison visiting and when you go to a prison you see exactly where those young people are going to end up. And they all cry, and they all ask why someone couldn’t have helped them when they were growing up. Why? Why? Why?

And that is the question we have to keep asking: why is society neglecting those children the way we are, and making them end up there? They didn’t put themselves there – we’ve put them there, because of the kind of world we’ve created for children. It makes me want to cry when I think about it.

The Children’s Commissioner for England, Anne Longfield, did not mince her words. She said isolation booths can be “distressing and degrading” and she is concerned it is “a gateway to excluding and off-rolling”, where pupils are removed from a school’s register. That can’t happen. We must not allow this to happen, because many of those children are going to end up in prison because they will end up joining gangs, starting a life of knife crime, gun crime, drugs – it just makes me weep to think of all the children going through that.

Let’s just take a moment to think of all those children.

So this evening we are going to be discussing how we can do whatever we can. We can’t do everything, we can’t solve all the problems, but we have three excellent speakers to help us look ahead to where mental services for children are going. They are:

  • Jeffrey Hugh Thomas, the CEO of Play Therapy UK and I want to thank Jeffrey in particular for sponsoring a further All-Party Group report on mental health
  • Then we will hear from the aforementioned highly-respected independent lecturer and author, Dr. Aric Sigman
  • And finally we will hear from one of the most significant children’s charities in the UK in the person of Michelle Lee-Izu, the Corporate Director of Children’s Services for Barnardo’s

I’ve run 10 consecutive marathons for Barnado’s, highlighting that “Childhood Lasts A Lifetime” and that some children’s lives are like a marathon.

Welcome all of you. I have asked them all for 5-7 minutes so there will be time for our normal Q&A. Thank you all for coming along tonight, may I please hand over to you, Jeff, to get us going.

Jeffrey Hugh Thomas, CEO, Play Therapy UK

In 7 minutes I would like to talk about 7 opportunities and 7 suggested ways forward, centred around what would we like to see in the White Paper or implementation of revised Green paper and key points arising from our paper on evidence-based practice.

Number 1 – Focus more on the needs of the children. This is more about minds not brains: it’s software, not just the hardware. Children’s mental health isn’t normally a physical medical problem, but it’s caused, as you said, by events – trauma, loss (41,000 children were bereaved last year), insecure attachment, being bullied, wanting respect, which is one cause of this horrific wave of knife attacks, and so on.

So it’s a psycho-social (software) as well as a neurobiological (hardware) issue.

You’re driving on a motorway in a car that is behaving erratically. It could be because one of the wheels is falling off (hardware problem – go to the garage). But more often it’s the mind of the driver: anger, lack of concentration, insufficient driving skills, etc., so that has to be treated in a rather different way.

Play and creative arts therapies heal unconscious parts of brain by generating healing neurotransmitters. This shows us the way forward: a need to integrate mind and body thinking at policy levels as well as in practice.

There are two other issues. Children are different from Young People, but how often are they grouped together? Children don’t usually have the capacity or the will to talk about problems. Our research shows that only 9% of session time is spent in talking by the children, so counselling (which is a talking therapy) is effective for young people but ineffective for children and we must make that distinction clearly.

This leads onto the schools where there are two different needs requiring two different skill sets. There’s the education/curriculum need to teach children about emotional wellbeing and basic mental health issues, but the second need, which is more urgent, is the therapeutic support for the 20% of pupils that have problems. That’s been neglected because schools can more easily put a tick in the box for the first need.

Number 2 – Children are insufficiently protected as there are too many unqualified and unsupervised persons practising. This was covered in the APPG report produced in June. Anybody practising, working with children’s minds therapeutically MUST be registered through an independent Government-approved agency, such as the PSA or the HCPC.  Now this brings up the role of the professional organisations who need to be consulted more thoroughly because they should know best what is happening in real life practice, since they assure the quality of their registrants’ work. So the way forward here is to improve the consultative process. Quite frankly we think that the consultation on the Green Paper, and the major consultation about three years before that, was poor. There was a lack of involvement of professional organisations and no weighting at all of the 2,000 professional responses with their experience and knowledge. Consultation shouldn’t just be about sending about questionnaires: there should be active face-to-face consultations with those who have the appropriate experience.

Number 3 – Ensuring value for money, and this is what makes me nervous as the Government are committing millions of pounds without adequate safeguards. There has been a shocking NAO report upon managing the adult therapy programme: insufficient and inadequate specification of objectives, and no effective measurement of outcome. We don’t want the same mistakes to be carried across to the funding for children’s mental health. The Department of Health and Social Care and NICE seem to be stuck in the 1970s. The existing evidence-based medical model was developed for pharmaceuticals and it’s about efficacy showing the potential of a new medication to to improve.  The emphasis is on random controlled trials, but they are trials and there’s a reproducibility crisis where we have evidence that shows that most trial results are not reproduced in practice. Trials are about what might happen, and this is what Government policy is being founded on at the moment, whereas it should be founded upon what actually does happen, which is effectiveness rather than efficacy.

This is the way forward: practice-based evidence uses continuous measurement and must have at least an equal place and its own hierarchy of evidence in policy setting.

Number 4 – We must also focus on parents’ needs. After all, parents are a major agent of change for children. So the way forward is to use primary schools as the most important service delivery channel.  Primary schools are more accessible and empathetic than the alternatives. Schools require not just a Mental Health Lead as advocated in the Green Paper, but also development of the teaching staff to deliver therapeutic play. We have found that using school staff in multiple roles works very well in the 1500 or so primary schools that are using this method.

We also need to address the balance in funding between education and health.

Number 5 – Growing a qualified workforce, which requires post-graduate training at level 7.  There’s existing capacity but trainees need financial support.  The way forward is through the apprenticeship scheme. This was revised in 2017 but it is falling behind its target numbers, so it needs to be opened up to training therapists to work with children. So there we have two opportunities and one solution to solve two problems.

Number 6 – Improving practice. We see the way forward here as joined-up working, There’s been a lot of talk about this but very little practice happening. There are two benefits: first of all for the individual children because disseminating appropriate data between schools, social services, health and police, will surely help. It’s a systemic problem and we can’t just pin it down to one service delivery channel. But there is also a benefit for all children, through the application of practice-based evidence, and the current phrase is “collective intelligence”.  Standards and quite advanced data collection systems are already being used.  They just need to be spread more widely and co-ordinated.

Number 7 – Finally, and perhaps most important of all, it’s no use having policies unless they can be made to work. As usual, managing change is the main hurdle. Our departmental fiefdoms and silos need to be opened up. The culture of the service in some cases impedes change and needs to be modified, and practitioners need new skills, new routines and new habits. Direction and control as well as co-ordination between all departments and agencies national and local is what is required. Hopefully, the appointment of a Minister for Children will help. And here is perhaps a revolutionary suggestion: perhaps the way forward is a Cabinet Office Panel, chaired by the Minister for Children.  These are major challenges, and we believe that a 4 – 5 year programme is needed. That’s about the same time as building an aircraft carrier. Aircraft carriers cost £3.1bn. To put it another way, if we have a perfect defence system what good is that if our citizens aren’t in a correct and healthy mental state? We must remember that the minds of our children is mankind’s greatest natural resource. Let’s build on the APPG’s work in the past and the teams that we have to achieve success for children.

Dr. Aric Sigman, Independent lecturer and author

My main interest is in preventing diseases and mental health problems in children. I went through the documents related to the Green Paper, and quite frankly when people talk about Government plans for dealing with children’s mental health, the notion of prevention is usually missing. It seems that mental health problems are considered a foregone conclusion, and where “prevention” gets a mention it usually means “spotting symptoms and getting help” faster than before. It’s damage limitation.

We’re putting the cart before the horse. Looking at some of the language that is being bandied about, we have “mental health checks in schools” for example, which assumes that children have problems that they need help for. Of course, this is very important and no one would argue with it. But I am very concerned because I am well aware that things can be prevented. Many mental health problems are to do with poverty, a genetic predisposition, unfortunate life circumstances and family events, but other causes of problems (or at least an exacerbation of them) are connected with lifestyle factors and the way children are being brought up. And these things are cheap and easy to modify. So that’s the direction that I come from.

So, the attention and focus on treating problems really needs to be shifted one stage back, to looking at lifestyle factors and family circumstances and things we can do something about. The second thing is the definition of mental health. I spoke to a head teacher yesterday who had asked her children (aged 5-13) what “mental health” means. She found that around 80% of them thought it was a problem term: essentially that mental health really means mental illness, whereas it should be a continuum from healthy to unhealthy.

Jeff talked about families . . .  it’s often the case that children are treated as independent entities. They are individuals that we deal with in schools or elsewhere, whereas in reality for most children parents and grandparents are the key factor in treatment and support. I think grandparents especially have often been sidelined, when they are a very important source of prevention and support. I think parents and grandparents are definitely a key factor and instead mental health has been institutionalised with talk of school curriculum changes – a whole list of them – to help children to understand mental health better.

I also have a lot of faith in parents. I remember that before passive smoking legislation went through it was assumed that poor, uneducated parents on sink estates would either not understand or not care about the effect of passive smoking on their children. Absolutely wrong! As soon as those parents started to hear about the effects, there was a massive decrease in passive smoking in those people’s houses. If parents understand why certain measures are good for their children they generally love their children and they will act. We need to exploit parents more as agents of change. It’s very important and also, it’s free! Governments don’t like spending money and parents can be energised for free. So we need more joined-up parenting.

People need to start asking why we have a longer and longer queue of mentally ill children requiring mental health services, but few people want to ask this question. We don’t want to face up to the uncomfortable fact that it’s the way society is structured, the economy, our values, parenting, our lifestyles and so on and so forth. I know that seems somewhat political and philosophical but we do need to have a pause for thought. It’s really necessary to go backwards or we’re going to have even longer queues ten years from now.

A couple of practical things: when I first came to these APPG meetings I noticed that there was a Science and Technology committee taking evidence for a report on screen time on children.  Now this is a great example of where some of the problems are. I’m very aware of the influence of “mummy groups” and vested interests influencing what Governments are told before they make policy. So, for example the documents linked to the Green Paper talked about educating children about the risks and so on of the internet. But where does that information come from that the MPs hear? It shouldn’t be coming from Science and Technology committees. Stop and think! Science is not medicine and technology is technology. These forms of information should come from groups like this which are not lobbied or linked to bodies that can benefit.

There has been a major problem in the alcohol industry. You may have heard that distillers and brewers were sitting on the decision-making committees of Public Health England, which led to the resignation of Sir Ian Gilmore recently.

So I’m not going off on a tangent when I say that policies are often informed by lobby groups who lobby MPs about things like technology and social media and screen time. It ends up being distilled and the right kind of information isn’t imparted to the MPs and the green papers and white papers don’t do what they are supposed to do. So keep your eye on lobby groups, especially technology. The computer games industry is earning £100bn this year which is more than twice the value of the entire world’s film industry. They have serious clout: they have dinner with ministers and American politicians. This is nothing to do with conspiracies – it’s just the way the world works. But there are certain areas, like children and alcohol, and children and lots of screen time, where I think that profit has to come second. But I won’t go on about that!

I don’t want to upset anyone here but I hate political correctness, and in the health education world we’re swamped with it. When I start to read a few reports every report has to dazzle people with terms like “gender equality”, “engaging with young people”, “diversity” and so on. It’s obviously at attempt to say “we’re modern, we’re with the people” and it’s great – but we really have to think about preventive measures that benefit the majority of children in this country irrespective of their background. And I also mean white middle-class children. I see them trying to kill themselves, even though they have money and private schools. There’s this notion that rich people are happy and stable but don’t you believe it. I see the scars on the wrists all the time, and it’s often the result of them having privileges and expectations, because they have the silver spoon. So we need to think about the majority. To give you one final example: about 3 years ago my son, then aged around 14, was completing some PHSE homework that required him to say which of 25 genders he was! The idea of having to have distinct categories for all this is getting in the way of other things. If we get rid of all that then there would be more paragraphs for tangible things of the type that Jeff was talking about. So please, please, play down the PC!

A final point: in my line of work an ounce of prevention is worth a pound of cure. The bottom line is, think of prevention and ten years down the line we won’t have to have the same type of meetings as we’re having now.

Michelle Lee-Izu, Corporate Director Children’s Services (England), Barnardo’s

Barnado’s is the largest children’s charity and, through 1000 services, last year we worked with over 300,000 children and young people, their parents and carers, including 32,200 through our commissioned mental health support services. For some time now, because of our experience, we have thought that the country is sleep-walking into a major mental health crisis. We also agree with Jeff and Aric that prevention and working with parents are absolutely key to tackling this.

As a result of this concern, Barnado’s has invested into what are called “Core Priority Areas”, one of which is mental health and wellbeing – that continuum of wellness. Through that programme we are also really engaging in listening to children, young people and carers to find out what is really going to work.

1 in 10 children has a diagnosable mental health problem, which is roughly 3 children in every classroom. Half of all mental health problems appear before the age of 14, with three-quarters of lifetime mental health conditions being present by the age of 24. Three in four children with a mental health condition don’t get access to support, and one in five wait almost 4½ months from their first appointment to getting the support and treatment that they need.

Vulnerable children and young people are more likely to experience problems than their peers, with 60% of children in care experiencing some sort of emotional or mental health problem.

So, we also have looked at the Green Paper and we fed into the consultation. However, even with the proposed changes, no change will be seen in three-quarters of England in the next five years. Only a minute amount of children will benefit from these changes. And, as we know, the funding is not guaranteed after 2021. So I think what we really would like to see is the Government intensifying this direction of travel. We’ve heard that some of the £20.5bn a year is going towards mental health services, but our hopes are that that funding could be used to roll out the geographical coverage must faster than is proposed, and for tighter timescales around when children and young people can benefit from services: a driving down of that waiting time.

We are running a really exciting service in partnership with an NHS trust and some local commissioners in Solihull. It’s called SOLAR and involves working at the really early stages to ensure that children and young people get the support really early on, and that’s what we’d like to see.

I echo what has been said before about early intervention and prevention. We’ve seen a real reduction in things like universal provision like children’s centres where under-5s were getting some intervention early on.

Adverse childhood experiences and trauma include issues such as physical, emotional and sexual abuse, neglect, domestic violence, mental ill-health, alcohol and drug abuse, parental incarceration, and so on. The mental health of children experiencing these issues is more likely to be impacted and therefore we’d like to see more research in this area to see how those children can be helped as children in those early years.

And obviously we want to say that we really want to see support for vulnerable young people such as care-leavers. We have invested ourselves into providing mental health and wellbeing support for 16+ and care-leavers, but that’s not a normal part of provision so for those children it’s really important that they get the support and help that they need.

So what we want to see is prevention right through to the right input at the right time, and really listening to children.

Questions and Comments

Charlotte Davies, Fit2Learn: How important do you see getting children to motor-sensory integration at 7-8 years old? If they fail to reach that stage, they will have lifelong problems.

Aric Sigman: We do have a major problem with children lacking the coordination they should have in motor skills, especially fine motor skills. They need to move more and play in the 3D world.

Jeff Thomas: We can’t ignore the responsibility of schools in this area and I think we are lacking adequate teacher training about this.

Paul Wright, WRS: I have had personal experience of adoption breakdown where various agencies (education, health, social care, etc.) were meant to work together but didn’t. How can we get agencies to work together more effectively? We’re not going to solve mental health problems if they don’t.

Jeff Thomas: Joined up working is necessary for this. There’s been talk about this for years but it comes down to practical ways to do it. As I mentioned earlier, we need to break down the silos which exist in central and local government. The data is certainly there but needs to be shared.

Gerald Griggs, University Campus of Football Business: If primary schools are wanted as a point of intervention, what can primary schools do themselves where these silos and structures exist, to make a change in their particular area and community?

Michelle Lee-Izu: Primary schools are well placed to make a difference but they need training for primary school teachers; more funding; and access to the right networks at the right time.

Monika Jephcott , Play Therapy UK: I’m all for preventative work as we can help 80% of the children with preventative programmes. However, such programmes do not help the other 20%. Both have their place but we must look at them separately and not keep mixing them up.

Aric Sigman: Some of the 20% will have problems that are as a result of a genetic predisposition, life circumstances, poverty, abuse, etc. but I do think there’s an overlap between the groups. Of course there is a difference between those that are acute and high-risk and vulnerable and those who are not, but both still need the preventative approach initially, because I think we could shrink down the 20% to a lower figure with preventative programmes.

Monika Jephcott, Play Therapy UK: Yes the Government’s own target is 10%. Of the 20% of children who are low risk at some stage – we don’t want them to become the 10% that are high-risk. In our experience of working with 65,000 children in schools, they’re not ready to work together with the 80% – that is a special group that we have to support, maybe in a slightly different way. How do we separate the funding for this?

Jeff Thomas: We have a spectrum from a child in need of a hug at one end, right the way up to those who are at risk to themselves and society. We recognise that those at the upper end of the spectrum probably need several specialists to work with them: not only a play therapist but maybe a child psychotherapist. So there’s a spectrum there and we do have ways to measure it.

Baroness Benjamin: By the time a child is 7, they are made. They go from very few brain cells at birth and our behaviour influences them: how they act, what they like and dislike, everything. So we’ve got to get this right.

Kiruthika Rajeswara, Simplyweight Ltd.: When we work with teenagers we always make sure to include the family. You can have the best therapists and excellent interventions but at the end of the day these children go back to their families. Parents have to take responsibility for their children, but maybe they don’t feel loved themselves. Maybe they have lots of problems. A person who doesn’t feel loved will find it difficult to give love to their children. How can we deal with this and target the family and help everyone?

Michelle Lee-Izu: You are absolutely right. Parents need opportunities to talk about their problems and learning from other parents is also very important. We’ve had a programme along these lines where we have five areas for parents to develop. Some parents need quite a lot of practice on what look like fairly obvious things.

Aric Sigman: I’ve noticed in this country that when the Government try to educate parents they get accused of “nanny state” behaviour, but it’s true that sometimes there are specialists who know better. We need to get to parents during pregnancy and even to schoolchildren to talk about parenting.

Baroness Benjamin: Yes, it’s all about breaking the cycle. I totally agree.

Aric Sigman: As well as teaching children how not to get pregnant we need to tell them what they should do when they are ready to have children – things to do and not do and so on.

Jeff Thomas: We’ve taken a coaching approach when we talk to parents. It’s usually at schools because parents typically go there to collect their children.

Patrick Myers, DWP Reducing Parental Conflict Programme: If the steer from Government is purely directed towards resolving the child’s mental health problems without directing some of that resource to addressing the environment in which the child is growing up, we won’t change anything. In the context of my work if a child goes back to an environment where the parents are in conflict we can expect pretty poor outcomes. How do we think we can influence things to make the introduction of this initiative to improve the mental health of children and young people to make it much more holistic and family-orientated, because trying to resolve the issue without addressing the cause will be problematic.

Baroness Benjamin: We do need a nanny state – I do believe in that. We can’t rely on government.

Keith Taylor: There used to be a Ministry of Information that was responsible for looking after citizens and informing them. I find that there is an interesting analogy here with plastics: public awareness has been raised recently so that we are hearing about the menace of discarded plastic on a weekly basis. We’re discovering things that we never knew, for example that washing a fleece results in plastic going into the sewers and the sea. People are now changing their behaviour because of this new awareness. Perhaps in 20 years’ time people will be saying the same thing about children as how we are damaging them. It’s what we are doing as a civilisation that is making these problems for children, and many people just don’t realise the terrible consequences of what we are doing. Advertising, pornography, gambling – we’re dealing with these issues on a daily basis.

Baroness Benjamin: Yes, we are constantly bombarded with this. I do believe though that people are starting to listen, and a good thing about the current Government is that a lot of them are young, and they have children, so they know what we’re talking about.

John Herriman, Greenhouse Sport: How do we stop ourselves building systems that contribute to and cause the mental health problems of children? The education system puts children and young people under tremendous pressure and the results are entirely predictable. The worldwide teenage suicide rate has increased by 50 or 60%. A lot of this evidence is already out there yet we seem to be failing to address this fact.

Baroness Benjamin: Please write a letter to your local council, and your local MP. Everyone should write letters – to politicians, to big companies like Google and Amazon. We need to bombard them with letters to let them know we are on to them, and that things need to change.

Jeff Thomas: In writing letters, please don’t forget the ammunition that we can give them in the form of evidence from our APPG reports.

Aric Sigman: These are big structural questions. Going back to what I originally said, we need to step back and decide what kind of society has created these problems? What are the structures and what are the values? These are very big questions and society is going to have to ask itself to make decisions between affluence and mental wellbeing and many other choices, which at the moment, they don’t want to make.

Baroness Benjamin: I’m on the Lords Communications Committee, and we’re looking at whether we should regulate the internet or not. And I’m telling you, no one will lobby us! We’re tough, and our report will be out in the next three months or so. We’ve interviewed everybody to get evidence, including people dealing with mental health issues, about how our society is affected by the internet. Progress does not always take us forward.

Martin Amor, Cosmic Kids: On the prevention side, what do you think the solution is? Can you split that into content (e.g. what’s the message?) and process. There’s been a lot of talk about how long it is going to take to do this and how deep we are into this problem. How do you change this fast?

Michelle Lee-Izu: I think there are concerns about some of the digital content, how it’s impacting on children and how we can regulate those things, but I also think there is a real place for on-line content for educational material and positive messages. We know from talking to children that they do like digital solutions: it gives them 24/7 access to information and support. Opening up that access to information and services to more children, preventatively, on-line, is a really positive thing, but we have to be able to manage the negative impact as well.

Baroness Benjamin: There’s got to be a way of separating the good from the bad and learning how to have time out. People creating digital content have got to have a moral understanding of what that they’re doing.

Martin Amor, Cosmic Kids: How quickly you can scale through content is the point. We’ve talked a lot about talking therapies (that the 20% need) but the 80% just need resilience training, awareness of their state, or techniques for getting themselves out of tantrums for example. I’d just like people to think about the way that you can create scale quickly, and it doesn’t need much money to create videos.

Jeff Thomas: I also think it’s about careful observation of children at all stages and hopefully coaching the parents to do so.

Baroness Benjamin: I’ve always advocated taking computers and phones out of bedrooms, and training children to resist temptation and learn how to turn things off.

Sharon Smith, University of Northampton: Thinking about the people who are going to be delivering this mental health questionnaire and getting the mental health input, how do we know that they are going to be trained sufficiently and supported? And how can we make sure that parents are part of that? I’d also like to add, as an Early Years specialist, that school is a bit late to start: we should be starting at pre-school.

Jeff Thomas: I think that psychometric instruments such as questionnaires are just one part of the information that we need to take into account. Our therapists also ask parents and the referring teacher what their objectives are: what they would like to get out of the therapy.

Michelle Lee-Izu: One of the things we’ve lost from teacher training is knowledge of child development. If all professionals working with children had an understanding of this it would make a big difference. We all have periods of not being well in our lives, and we accept this physically but not mentally. Sometimes we feel down or incredibly unhappy and sadly some children who haven’t got anywhere to express that may move into self-harming. Understanding that spectrum and knowing that teachers and Early Years workers can’t do everything is important: they need to understand where and when to refer or signpost.

Baroness Benjamin: In Japan they monitor biorhythms and their effect on people. We all have these cycles, and we need to understand and talk about the make-up of ourselves. We need to talk about this to young children so that they understand the ups and downs of life and the different feelings and emotions they will experience.

Keith Taylor: In Japan the first three years of education for a child concentrate on mental and physical development, philosophy and life. They don’t get to formal education early on.

Baroness Benjamin: Like the Montessori nursery system, which is a great system. Before we close, let’s return to our three speakers for a summing up of where we are and what they next steps should be.

Jeff Thomas: I really think that we have to influence the policy makers with what we’ve been talking about tonight. We’ve got to break down the silos and get co-ordination.

Baroness Benjamin: We should all have a copy of Jeff’s seven opportunities and solutions so we can all do whatever we can.

Aric Sigman: We need a real inclusion of the term “prevention”, including to go one stage back and include many of the things Jeff was talking about, including parenting education in schools. When young people are pregnant later on both parents-to-be should be taught about how they can optimise their child’s likelihood of being as stable as possible. So, start the education process early and also incorporate issues of prevention when lobbying ministers and policy-makers, and not just focussing on treatment.

Baroness Benjamin: Matt Hancock, the Secretary of State for Health and Social Care, is talking a lot like that now, and actually using those words, so perhaps somebody is lobbying him in the right way.

Michelle Lee-Izu: We need a better understanding of the mental health crisis we are facing and to respond to that for all – including prevention right the way through to responsive services.

Baroness Benjamin thanked all the speakers and the members, and then the meeting closed at 7.30 pm.