My Lords, Amendment 118 places a duty on police forces to refer children under 18 who are the victims of a sexual offence or other forms of child abuse for a mental health assessment by an appropriately trained professional. It mandates a currently poorly used referral pathway. I listened carefully to the Minister’s response in Committee and have changed the amendment that I bring forward today.
I wish to stress that this amendment does not mean that all these children will need a CAMHS intervention or will have a diagnosable mental health condition. It is designed not only to support children who are the victims of these awful crimes but to inform commissioning decision-makers about the magnitude of the problem, so as to ensure that the right services are in place. We cannot rely on the numbers that reach the clinical threshold for intervention, because these thresholds are far too high, given the shortage of child and adolescent mental health services.
The amendment is deliberately not prescriptive as to who “an appropriately trained professional” would be, leaving this to regulations and local flexibility. This person could be a nurse, school councillor, trained social worker, councillor in a sexual assault referral centre or another appropriate local professional. The amendment strikes the right balance between local and national responsibilities. It introduces a national requirement for a referral pathway and assessment, but it does not set out the how and where, which will be up to local areas to determine. This is responsive to the level of need of these children and the evidence we have that they are not receiving the therapeutic support they need for their recovery.
As I said at the outset, the amendment would not mean that all victims of a sexual offence or other forms of child abuse would meet the clinical thresholds. Some may, but some may need other types of support—for example, school or community-based child sexual exploitation support groups, family support services, or support for parents and children to equip them to understand the emotional impact of abuse. The amendment would deliver the recommendation in Future in Mind, which the Government are committed to implementing in full, that,
“those who have been sexually abused and/or exploited receive a comprehensive assessment and referral to the services that they need, including specialist mental health services”.
The evidence for the amendment is compelling. In the past year the Children’s Society has calculated that more than 40,000 crimes of a sexual nature were reported against children. Each of these 40,000 is a child suffering the effects of horrific crimes, which come with a multitude of long-term effects that need to be addressed. We have only to read the recent media accounts of many footballers who were abused as children to understand the lifelong effects of these terrible experiences. They destroy lives and careers. Analysis by the Children’s Society of referral pathways for vulnerable groups found that less than half of mental health trusts identify children who have experienced sexual exploitation in referral and initial assessment forms. The NSPCC review of local transformation plans found that only one-third of these plans mentioned provision of services to meet the needs of these children. Yet while these figures are appalling, the experiences of the victims themselves show the need for the amendment even more.
Last week the noble Lord, Lord Kennedy, and I attended a meeting organised by the NSPCC and the Children’s Society and I want to share with noble Lords the account of Sarah—not her real name—who told her story. I record my thanks to her for sharing her experiences and her powerful message as to why
this amendment is needed. Sarah was abused from a very young age by a member of her extended family and this had a long-term impact on her life. As her understanding of consensual relationships developed, Sarah realised that what she had experienced was abuse and as a teenager she suffered from clinical depression and was extremely suicidal. She was later referred to counselling and gradually came to terms with what had happened to her. The abuse had a long-term impact on her mental health, including eating disorders, drug abuse, PTSD and abusive relationships. At the meeting Sarah told us that the support she received was invaluable for her recovery. She thought that the amendment would support young people who had experienced sexual exploitation and help them recover more quickly by ensuring a direct referral from the police.
The amendment will also contribute to parity of physical and mental health. Recently, nine ex-Health Secretaries wrote to the Health Secretary to encourage the Government to,
“make good the promise to achieve genuine equality”,
between physical and mental health. Parity of esteem was enshrined in law by the Health and Social Care Act 2012, yet examples of this being enacted in policy are still rare. We know that nine out of 10 children who have experienced abuse at an early age will develop a mental illness by the time they are 18. Without assessment, how can we know which 10% will not need help? Issues faced include post-traumatic stress disorder, anxiety, self-harm, depression and, as we have heard, suicide attempts.
This is not a novel idea. There are numerous examples of where preventive public health initiatives have been set up in response to data on the prevalence of certain conditions affecting the physical health of a population. For example, cervical screening is now offered to all women over the age of 25. My first job out of university in the late 1960s was scanning the cervical smears of women with symptoms, so I know how effective screening is at picking up early cancer and pre-cancerous cells so that the patient can be treated early. The current rate of cervical cancer is 12 cases per 100,000 women—0.012%. Since its introduction, the screening programme has led to a decrease in the number of cervical cancer cases by about 7% each year, and it is estimated that up to 5,000 cases of cervical cancer are prevented annually because of cervical screening. That is a terrific record but the prevalence of cervical cancer is a great deal less than nine out of 10.
8.30 pm
Just as screening for cervical cancer does not assume that all those screened need follow-up cancer treatment, so we are saying here that not all children who have experienced abuse will require full-blown mental health support. However, we know that most of them will need something and we know that targeting high-risk groups, which these children are, will identify mental health needs early in much the same way as cancer screening does with physical health.
Amendment 118 mandates a much-needed and underused referral pathway. It requires a young person to be known to the police, which we know that many
will not be, but it means that when children are known to the police, services can respond appropriately to their needs and help their long-term recovery, and help and support them while they are engaging with the police to bring their perpetrator to justice, which can only be a good thing.
The effect of child sexual exploitation can have a terrible impact on young people in later life, and therapy or other help gives them a better chance to rebuild their lives. I urge the Government to consider this very modest amendment and accept its recommendations. I beg to move.