My Lords, as I have said throughout the passage of the Bill, my aim is to secure practical improvements in the care and support that children entering care receive. We have such a responsibility to help improve the life chances of that most vulnerable group of children, given their troubled start in life.
On Report, I was very grateful when the noble Lord, Lord Nash, agreed to meet me to discuss my concerns about why the current approach to identifying and responding to the emotional and mental health needs of children in care is simply not working—a point confirmed in the Care Quality Commission’s report Not Seen, Not Heard earlier this year. I found my meeting with the noble Lord, Lord Nash, and Edward Timpson extremely helpful and constructive, and I was particularly grateful for the opportunity to hear direct from the two co-chairs of the expert advisory group set up by Ministers to develop care pathways for children with mental health problems. I look forward to their report, which is due in October 2017.
It was clear from that meeting that there was much that we agreed on, but there is no time to be lost. The Bill presents an excellent and timely opportunity to make further progress, given that children in care are four times more likely than their peers to have a mental health difficulty and 45% of children entering care have a diagnosable mental health condition—such as anxiety and depression, hyperactivity or an autistic spectrum disorder—a figure that rises to a truly alarming 72% for children entering residential care.
I listened very carefully to what the Ministers said, most particularly to their wish for flexibility and the ability to test out approaches to improving mental health support for children in care. I understand why they do not want legislation that is overly prescriptive. I reflected very carefully on this, and my new amendment is cast very much in that light. In short, my amendment today seeks to ensure that local authorities, supported by clinical commissioning groups, assess and promote the mental health and emotional well-being of children entering care. It does not prescribe the time, form or manner of any mental health assessment, and provides for the appointment of a designated health professional, a designated doctor or nurse, to help commissioners to
fulfil their responsibilities to improve the health of children in care, including their mental health and emotional well-being.
I want to stress a few points to address some concerns that I know have been raised. First, in this amendment I have sought to avoid prescription in terms of the nature, the timing and the staff who undertake the assessment—the who, when, how and where, if you like. I recognise that the expert advisory group is well placed to advise on such matters. My amendment is very much about the “what” and offers an important opportunity to ensure that the commitments made in Future in Mind—to address fragmentation, to support co-ordination and to intervene early to promote good mental health and prevent escalation to significant mental health conditions later on—are delivered.
Secondly, a physical health assessment is already in place. My amendment would simply result in an extension of its scope so that an initial mental health assessment was undertaken as part of the existing health assessment—that is, its scope would be extended to include both physical and mental health. It would not mean the introduction of a brand-new process, with the inevitable burdens attached.
Thirdly, the integrated approach that I am proposing would also avoid concerns that a separate mental health assessment might be stigmatising. It recognises the close links and interactions between physical and mental health—all part of parity of esteem, course.
Fourthly, given the nature of the trauma that many children will have experienced before entering care, the initial assessment could be undertaken by a range of health professionals, including nurses, with appropriate training and knowledge of the emotional and mental health needs of this group of children, particularly such issues as attachment style. Of course, any more serious needs identified in the initial assessment could be referred to a more specialist clinician in the normal way.
Fifthly, there is no presumption that every child assessed will need a specific clinical intervention. For some it will be about emotional support, which may come from a teacher responsible for pastoral care, a social worker, some other form of therapeutic support, peer support, group work, school counselling and other ways of supporting emotional well-being and building good relationships. Of course, those assessed with higher levels of clinical needs may well need a clinical intervention and, indeed, should receive it as soon as possible to prevent further escalation.
I remain convinced that this approach would assist greatly with finding appropriate placements for young people, with the right support built in both for them and for foster carers and other support workers, and would therefore lead to greater placement stability, which is so critical to a good-quality experience in care. I am aware from my researches that a range of integrated assessment models are already being used in other settings, such as the CHAT model in the youth justice system, where all young people aged 10 to 18 entering secure accommodation are assessed for their mental health needs, or what is called the DAWBA model, which I will not spell out in detail but which can be used for a younger age group. I certainly would
not wish to prescribe the appropriate model myself, but it must be child-centred and age-appropriate. Implementing this amendment would provide an ideal opportunity to test out such approaches.
In conclusion, the amendment, which has strong support from the children’s sector and three royal colleges, would ensure that the emotional and mental health needs of children in care are identified early and that they and those caring for them can receive the support required to meet their needs and prevent the current unacceptably high rate of escalation to mental health conditions, which can affect children long into adulthood.
I look forward to the Minister’s response and know that he shares my wish for further practical progress. I beg to move.
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