Health and Social Care Committee

Education Committee

Oral evidence: Children and Young People's Mental Health, HC 239

Wednesday 10 June 2026

Ordered by the House of Commons to be published on 10 June 2026.

Watch the meeting

Health and Social Care Committee members present: Layla Moran (Chair); Jen Craft; Josh Fenton-Glynn; Joe Robertson; Gregory Stafford.

Education Committee members present: Helen Hayes (Chair); Jess Asato; Darren Paffey; Rebecca Paul; Manuela Perteghella; Mark Sewards; Peter Swallow; Caroline Voaden.

Layla Moran took the Chair.

Questions 1-72

Witnesses

I: Dr Alex George, Mental health advocate and former Youth Mental Health Ambassador for the UK Government

II: Abigail Ampofo, Interim Chief Executive, YoungMinds, Connie Muttock, Head of Policy, Centre for Young Lives, and Jo Hutchinson, Director for SEND and Additional Needs, Education Policy Institute.

III: Dame Rachel de Souza, Children’s Commissioner for England.

Examination of witness

Witness: Dr Alex George.

Q1             Chair: Welcome to this first session of the joint inquiry between the Health and Social Care Committee and the Education Committee on children and young people’s mental health services. I would like to start with a brief introduction, if you do not mind. Dr Alex George, who are you and what do you do?

Dr George: My name is Dr Alex George. For four years, I served as UK Youth Mental Health Ambassador, as a volunteer; I stopped a year ago. I am a campaigner and I educate a lot on mental health. My background is in A&E medicine, so I saw a lot of mental health on the frontline.

Q2             Helen Hayes: Thank you very much for being here with us to give us your evidence. Will you start by telling members of both Committees a little about your journey into mental health advocacy? I understand there are some hard parts to that story, but we are interested to hear about it, and to hear what, from your work, you think are the most pressing issues facing children and young people with their mental health.

Dr George: Absolutely, and thank you so much for inviting me to give evidence. On my background, I basically studied medicine because I saw what A&E was like on the frontline. I was interested in dealing with emergency care and I liked the idea of science, but I did not have a particular interest, when I was younger, in going into mental health. When I started working as a junior doctor, I think the thing that shocked me the most was not necessarily the car accidents and so on; it was the sheer volume of mental illness you see in A&E. In fact, it was utterly shocking, and not only the presentations, but the number of people who would come back.

I quickly realised that so many young people were coming in with, say, self-harm. I was patching up their wounds and getting them referred, then they would come back a few weeks or months later. In fact, I remember one girl whose wounds I repeatedly patched up. As a human being, that is just utterly devastating to see. I think that was my first realisation that we clearly have a problem.

I then started campaigning. In 2018, I first went to Downing Street to meet Theresa May, who was the PM at the time, and spoke about the changes that were needed in education, because I felt that that was a huge area where we could support young people. Then, as you alluded to, during the pandemic, while I was working in A&E in Lewisham, unfortunately my brother died by suicide. He was 19 at the time. He had a whole career and future ahead of him. He wanted to be a doctor, had a place at Southampton medical school and, yes, he took his own life. My life has always been before and after that moment. It has been pretty horrendous for my family, but we have tried to use what has happened to prevent it happening to other people, because it is utterly devastating. As my mum says, when you lose a young person—or anyone—to suicide, it is like dropping a pebble into a bucket of water. The ripples go far and wide. The effect on everyone he ever met is huge.

Off the back of that, I started campaigning and gained huge traction on social media with some of the key things that people felt needed to change. The Government at the time brought me in and said, “Let’s look at some of these issues. Why do we not have you as a volunteer?” My role as Mental Health Ambassador was to try to sit between No. 10 Downing Street, the Departments for Education and of Health, the charity sector and young people as a middle person. I saw many things that were positive, as well as things I think were quite challenging. I would like to acknowledge today that one of the biggest things I saw that was a real challenge for us was that different Departments did not really speak to each other enough. I also found that if I went to the Department for Education, they would say, “Actually, this is a Department of Health issue.”

Chair: We will come back and ask much more about that role in another question. Sorry, I did not want to stop you.

Q3             Helen Hayes: Thank you for telling us about how you got to be in that role, and I am sure all of us would like to convey our condolences about what happened to your brother and commend the way that you have been using that to make a difference for other young people.

You have managed to establish an enormous reach among young people on social media. What things are they telling you about what is affecting their mental health? What is driving the huge presentation across the population that we are seeing, of children and young people exhibiting mental health difficulties?

Dr George: So many factors seem to be contributing to what is happening right now, and it is not just young people, but parents. I hear from teachers—I did a talk the other day to about 600 people, and many of the audience were not just young people and parents, but teachers as well. Clearly, this issue is multifaceted, and many compounding elements come together to cause what we are seeing today. That is what I am saying about the need for a cross-Government approach.

Yes, social media is definitely part of the challenges that we are seeing—not just the harmful content, but the way in which the algorithms are designed to keep you endlessly scrolling, for example. There are huge concerns about the effect of that on the developing brain and on that causing loneliness among young people, who are not outside, meeting friends and doing those kind of things. I think that social media is definitely a big part of the issue, but also young people are saying that when they do want to get help—because they are actually much more emotionally literate than older generations perhaps—the waiting time for, say, early intervention or early support is incredibly long. What I heard literally the other day, when I was speaking to parents and young people, is that teachers are recognising, for example, emergent mental health issues, often quite early, but the time between seeing that issue and actually receiving the support they need can be very long. That allows a lot of time for issues to become very big.

That is one of the main reasons why I worked for a long time on the early support hubs initiative—I spoke to Keir Starmer just before the general election. I had worked on that for a very long time, because the point of the hubs is to sit there, in the middle of the community, to support people with emergent issues. That is such a key problem. It is all very well people talking more about mental health, but when someone comes forward with their struggles, they need to be seen and supported early. There is no doubt that the earlier you intervene, the quicker you can get people back into education or feeling well, but also economically—this is a big thing we worked on with the hubs—it is a hell of a lot cheaper as well. It is really expensive to provide care at tertiary level—seeing a psychiatrist—so community-based support is really important.

If I was to summarise: social media has a huge impact, definitely; we need early intervention, and also recognition of the challenges that young people face. In the report coming out about 1 million young people struggling to find work, one of the top-cited concerns is mental health and the challenges young people face in the working world. I think that a holistic view is desperately needed.

Q4             Helen Hayes: Before I hand back to the Chair, may I ask two quick things? First, you have talked a lot about social media as a driver of poor mental health among children and young people, but are there any other factors that we can think about? We can think about poverty and pressures of other types that bear down on young people. Is there anything else you would like to flag as a contributor to the scale of the crisis?

Dr George: Absolutely. The effects are unarguable really. A young person moves through many environments in their life; it is not just school, but their home environment with their parents, out in the community, their friends, obviously, and so on. It is absolutely clear, however, that inequality and poverty are a huge driving force for mental health struggles. We see that. We also know that certain groups are at much higher risk. I am autistic with ADHD, and those who are neurodivergent are much more likely to have mental illness. It is clear that we need to have an overall strategy, but also recognise that specific groups struggle and focus on driving forces—for example, poverty is a huge one.

Q5             Helen Hayes: You mentioned your involvement with early support hubs. Their funding is by no means certain at the moment. What has been the impact of that initiative? What if they were not to exist, or if support were delivered in a different way?

Dr George: To be perfectly honest, when I came into the role, I felt entirely overwhelmed because there was so much to do, but I had a very good bit of advice from someone in this area who said, “Focus on a key thing, and really target what you want to achieve.” For me, that was the support hubs. When I came into the role, the agreement was to get £90 million towards mental health support teams, which I achieved coming to the role, and I was calling for the national roll-out—but my focus was on the hubs. I was there since the start.

I have seen, even from hubs run in charitable ways, the impact that they have. It is utterly unbelievable. They bring communities together. Young people have a place to go and not only for support; there is a sense of belonging. As young people say, you don’t have youth clubs anymore. There is not the playground, I guess, that you can go to. There are many reasons why that has happened, but these hubs provide a real 360 for young people.

I was very happy to see the pilot hubs funded. I was slightly disappointed not to see us go to a national roll-out, because I think our evidence and what we put forward was strong enough to go for a national roll-out. To answer your question, I think this is so important—we are desperate. If you ask GPs, teachers and parents, they will say we need to have a community-based support system. The mental health support teams that are in schools and that I have visited are doing a great job. Obviously, CAMHS is there to provide for high-level need. But people are lost in the middle, and these hubs can provide that support. I genuinely believe that a national roll-out of early support hubs would be a cost-effective strategy, but also one that would be hugely welcomed by young people, parents, teachers and GPs.

Q6             Manuela Perteghella: I want us to reflect on the role of social media. You have already mentioned some of the harms from these platforms. Can you tell us a bit more about what role you see platforms playing in both harming and perhaps supporting young people’s mental health? Most importantly, what action would you like the Government to take on this?

Dr George: In relation to social media, it is important to say this. I educate through social media. I create content that goes out to millions of people. I have had hundreds of millions of views across videos where I have talked about spotting the signs of people struggling and how to look after your mental health. There are many other creators, big and small, who have a positive impact. Ben West is probably worth a mention with his Reasons to Stay campaign. He is a wonderful person. In many ways, we have parallel stories. I believe that as of yesterday, when we spoke, 3.5 million letters have been received by people looking for reasons to stay. So there are many reasons why social media is very good. But that doesn’t mean you can ignore the harm that it can cause.

When you look at that sector, my big concerns are a few things. First, are we actually regulating what social media companies do? I was very supportive of the Online Safety Bill. I am really pleased that that step has been taken. It is really important. It looks a lot at content, but what about design? How are these platforms designed? Do they allow children to endlessly scroll, for example? Yes, they do. I think a big part of our focus needs to be not just on content, which is hugely important, but on how they are designed.

I guess the question that comes up is: what do we do? I think part of this needs to be education at school. The education system was built, but the world is moving much faster than it evolves. AI and social media are things that young people are now going to have to deal with. They need to be educated on how to use them safely. There is a lot of conversation about a ban until 16. The challenge is that if you do not train people in how to use them, they will get to 16 and still have no idea. A lot of the parents I spoke to the other week were saying, “It’s really hard, because I am trying to support my child but I have no clue what half these apps are and how to use them.”

The education piece goes far and wide, but on the other side of it, we have to look, as I say, at the social media apps and consider this. Yes, they play an important role; there can be a positive impact, but we cannot just allow what is almost a free-for-all. There needs to be control and responsibility. These companies do need to take a look at themselves and think, “Actually, are we doing everything we can?”, because I don’t think they are.

Q7             Jen Craft: Just to follow up briefly on the issue of social media, I think it is fairly obvious that these companies don’t act in people’s best interests. Just walking into work today, I saw that there are massive advertisements from YouTube talking about the controls that parents can put on it. Do you think that, overall, the benefits that can be gained from social media outweigh the risks, or is it time for much stricter regulation about who can access them?

Dr George: The truth here is that when you look at the number of people benefiting from social media, it is huge. Even for me personally, after being diagnosed with ADHD and autism, the sense of community I have had from those communities who feel like me, look like me and have experienced what I have experienced has been, frankly, more important and helpful to me than any of the healthcare that I have received, because there is a sense of belonging. For many people who are marginalised, a lot of their connection comes through social media, so that’s important to recognise. But fundamentally for young people, the risk of harm through not only content but addiction to phones and the algorithms is something that you cannot ignore.

My concern about a ban would be: how are we going to police that? My understanding, as we speak today, is that in Australia there has been a challenge with enforcement. There is a ban right now: under-13-year-olds in this country are not allowed to use social media, yet all parents—and all of us—know that they are getting on there. The question is: if they cannot access that, will they go to darker parts of the web?

It is a very complex situation and my concern is that, if we focus too much on just the ban, without considering the role of social media companies and putting pressure on them, will we just miss this? Do you know what I mean? If we focus so hard on this, we might forget to push them, and that is my concern. I do not think social media is going anywhere; it is a huge thing, and it is a part of everyone’s lives. Now it is a question of how we manage it and, to an extent, police it.

Q8             Jen Craft: Thank you; I just want to briefly follow up on that. You have a dual perspective on the issues in young people’s mental health. What interventions have you seen that actually work in improving young people's mental health?

Dr George: Clearly, I have to say early support hubs—I believe in them wholeheartedly. They had cross-coalition support, which is not always the case for interventions. I would also say mental health support teams, not just from the data perspective in schools where they have been rolled out but from going to the school’s themselves. I went around many schools to speak—I went with Will Quince actually—and I went to one where the teachers were saying, “I cannot tell you the difference this has made, not just in the experience of the child but in the experience in the classroom.”

When you look at class behaviour, and even class attendance, if a child is struggling, unhappy and facing friction, that friction is held not just within the child; it is spread across the classroom. I have a person in my life who is a primary school teacher, and we were literally speaking about this yesterday. Supporting the mental health of young people is not just supporting their mental health; it is supporting teachers, and it is also supporting parents.

Let’s be frank; we are losing so many teachers. If we look at newly qualified teachers, the drop-out rate in the first five years is huge. We cannot ignore that, and one of the most commonly cited reasons is burnout, workload and managing classroom experience and behaviour, so mental health support teams are hugely important.

I have seen interesting things over the years; I guess I have an interesting perspective, because I do not see huge depth in everything—I have to see a little bit in a lot, which, in itself, is a useful perspective. I have learned that moving things upstream as much as possible seems to be the most effective way of supporting mental health, not just in terms of the individual but economically. The more you can move to an approach based on early intervention and prevention, the more it seems to really improve the outcomes. I guess that it is sometimes about stepping back and realising, “Are we actually preventing? When there is a problem, are we intervening early?” If we are not doing those two things, the problem is going to come back later.

Q9             Jen Craft: What kind of interventions or really practical things work? Are you looking at it more from the perspective of raising wellbeing and overall good mental health? Is it about intervening early for children who might have an underlying mental illness, or is it across the piece?

Dr George: I would go back to what I heard someone say the other day: if you look at the role of the teacher, for example, their role is very important in a young person’s life. We can easily be pulled into thinking about the exams, learning and education, but even one good adult in a young person’s life can provide stability and an ability for that young person to grow and move through that system, and to develop into a healthy, resilient adult. However, the pressure on teachers is so high that they are not able to spend time on that core relationship they have with children.

I guess what I am trying to say is that we need to make changes to create a whole-school approach towards young people’s health. Yes, that is educating them on how to look after themselves, but it is also finances. People are often shocked when I say that we should be teaching about financial health, but what is one of the biggest causes of stress and anxiety in adults? Finances.

I have gone to loads of universities and workplaces and said, “Hands up who here left school with a basic understanding of a savings account, inflation or interest rates?” For example, a topical question at the moment is, “How many people in this room who have gone to university actually understand how their student finance is funded? Do you have any clue what you have signed up to?” That is obviously a big cause of stress in adults. We need to teach people about all the things, directly and indirectly, that affect their health, and provide an environment that is supportive of that. Of course that goes beyond the classroom. It goes into your housing and social care, to policy and to supporting marginalised groups, for example. That is why it is not easy. The clear thing that I learned over four or five years is that what you have to do is not easy, but that does not mean that we should not take action. We have to pick our things and we have to go for it.

Q10        Jen Craft: Do you think that the Government place sufficient priority on children and young people’s mental health?

Dr George: If you look at the allocation of funding, you would have to argue no.

Q11        Jen Craft: Why do you think that is the case?

Dr George: Children can’t shout as loud. Children rely on adults to speak for them, so they are already one step removed from the people who are going to hear them. To be frank, that is partly why I did what I did, and why I do what I do, because I can shout quite loud compared with a 10-year-old in a classroom or even the young version of me. I really struggled at school. I was dragged out of class all the time. I was told by one teacher, in front of my parents, “Don’t expect too much of Alex,” when what was really going on was that I was an autistic ADHD child who, with the right support, would have done well. The reason why I am sat here today is that my parents moved heaven and earth to make sure that I was able to get the education I deserved and I moved forward. The second reason is that I had an amazing teacher in secondary school. It is about recognising that not everyone has that experience. We have to be a voice for young people and listen.

Q12        Jen Craft: Is there maybe a perception shift that needs to happen around the importance of mental health and wellbeing for young people, in order to shift the focus and the priority back on to it?

Dr George: Speaking quite frankly, I am speaking in a room of people who clearly care about this issue. We are all here because we care about it, right? But a lot of conversations that I heard when I was doing my work were not so positive—snowflake, or people had a view that it was over-hyped and almost making something of nothing. We have heard even recent comments about ADHD that are infuriating. People still ask, “Are we over-diagnosing? Is it a bit of a fuss?” A Cambridge University study showed that a woman with undiagnosed and untreated ADHD lives an average of eight and a half years less than a neurotypical woman, and it is six years for men—there is an interesting question about the disparity between the two, by the way.

A lot of that was very frustrating at the time. I think we have shifted on, and that is why I feel we are in a good position to act. I think there is political will. We sit in cross-party and cross-departmental conversations like this, we have multiple different inquiries and evidence sessions, and we discuss on social media what we are doing here today. We are well placed to do something, but we actually have to act. My concern is that one of these inquiries was done 10 years ago, and not a huge amount was achieved in that time.

My hope and my plea to all of you is that we act based on what we hear. That is not easy. There are difficult decisions and, as I was told by the Treasury and my Department, there is a finite amount of money, but money spent on young people is very well spent, because they are your working adults. They are the million people who are currently not getting into the working world. There is no area of life that will not benefit from a healthier group of young people.

Q13        Jen Craft: On that issue, is there one thing that you wish you had been able to change during your role as UK mental health ambassador? Is there one thing that you look back on and wish you had been able to make some progress on?

Dr George: I feel disappointed in myself that I could not get the hubs over the line with nationalised funding. To be perfectly honest, that was one of the most frustrating weeks in my whole experience. I had brought together a whole coalition, we had gone into No. 10 Downing Street and sat with the Prime Minister, Boris Johnson, and I had been grilled about these hubs back and forth for a period of time, including on that day. We left that meeting with a general feeling that the Prime Minister was saying that the hubs were a good idea and we should push forward. A week later he was gone. I got in touch with No. 10 saying, “Hey, about those hubs,” and the response was, “What hubs?” Obviously civil servants stay, but a brand-new team comes in.

It can be really hard. My concern is that even as we speak, we have a Health Secretary stepping down and a new one stepping in in the middle of this process. There is no doubt in my mind that the way politics is broadly affects how fast things happen and what happens. I remember that there were three different Mental Health Ministers in a period of three or four weeks. That in itself is not great for a very complex issue.

Q14        Jen Craft: So you need the political will and some stability behind it to drive it?

Dr George: I understand that politics is often run by the electorate and topical things, but we have to have a longer-term view, we have to take action, and we have to commit to that action.

I wish I had got the hubs done and I wish I had got that Government to commit to mental health support teams. I did not achieve that; that was done after I came through. I hope some of the noise I made helped. That was really important, but I plead that we go as fast we can to get that rolled out because it is only halfway at the moment.

Q15        Darren Paffey: Dr George, you are obviously grasping the opportunities to use social media as a mental health education platform and for advocacy, and you have a clinical background so we can have confidence in that. Is there any risk that if young people start to see social media as the place to go in general for mental health support or advice, they might see others who do not have the clinical background that you do? They might be well-meaning and well-intended, but could social media become an alternative to clinical or therapeutic routes? Is there a risk of that, and how do we mitigate for it if there is?

Dr George: There is a risk and I am aware that during the covid times, when I was in hospital saying, “Look, things are seriously bad here in Lewisham”, other people were trying to say, “No, it’s not a problem.” Sometimes very noisy voices become very loud and that is a challenge. Misinformation online is a huge challenge, but the opposite—staying silent and not contributing to that conversation—is a mistake in itself. It is important that social media is not the primary, and certainly not the only, place where people get information.

I have spoken about this recently, but part of what we need to do at school, particularly with AI, which is a separate broader conversation, and with social media is give young people the skills in critical, analytical thinking. It does not have to be at the same level as that we need to look at evidence or as I needed at medical school, but we should arm young people with the skills to question it: “Who is talking? What are their credentials? Does it sound too good to be true? Does it sound extreme? If I am in doubt, where do I check this?”

For example, I tell young people, “If you see something online about mental health that you are not sure about, look on the hub of hope or go to YoungMinds and actually check what they are saying. If in doubt, get information from your doctor.” Giving children those skills is important because ultimately, you are not going to silence those voices. Yes, it is a concern, but the answer is probably equipping children with the skills to deal with it.

Q16        Chair: Jen asked this, but if there were three things for this Joint Committee to really push on—you already said rolling out the early intervention hubs, but you are allowed to say two more—what would they be?

Dr George: Early support hubs have to be number one. I say this mindfully to the people coming after me who will call for very important things: please have and maintain a cross-Government approach to this. It is so important as it genuinely was the biggest barrier to us getting stuff done. That has to happen.

Third of all, take a multifaceted approach to the social media conversation. I do not think that one approach in either direction is going to fix it all. We need education, some level of restriction and the social media companies to be answerable.

Chair: Dr Alex George, thank you very much for your time.

Examination of witnesses

Witnesses: Abigail Ampofo, Connie Muttock and Jo Hutchinson.

Q17        Chair: Good morning. Panel two will be looking at policy. Can I ask you to briefly introduce yourselves and what you do?

Abigail Ampofo: Good morning. I am Abigail Ampofo and I am the interim CEO for YoungMinds.

Jo Hutchinson: Good morning. I am Jo Hutchinson. I am from the Education Policy Institute, and I lead our research on special educational needs and disabilities, and the overlap with mental health.

Connie Muttock: Good morning. I am Connie Muttock and I am the head of policy at the Centre for Young Lives. We are a think-tank and delivery unit designed to improve outcomes for children and young people. One of our key priorities is improving their mental health.

Q18        Josh Fenton-Glynn: I am sorry to be speaking from so far away—that is the weird thing about this Committee Room. I am sure there will be a lot of discussion about social media, but I want to start by looking at the other drivers that impact young people’s mental health. Our first witness mentioned poverty and neurodivergence, and posited the long lag of covid as part of it. Starting with Abigail and going along the panel, aside from social media, what do you think the main drivers of mental health problems in young people are?

Abigail Ampofo: Dr Alex George mentioned a range of things. The young people we work with describe it as a million pressures that build up. It is poverty, discrimination and racial injustice; it is a world environment that has been characterised by conflict for a very long time and concerns about climate change; it is school and the education system.

One thing I remember a young person saying to me not so long ago that really stuck with me is, “We just don’t have hope.” That is a really difficult environment for a young person to be living in. The jobs market is more difficult. This came out quite clearly in the Milburn interim report. The wider environment around young people has changed so much. Lots of things keep building up and are contributing to young people’s poor mental health.

Q19        Josh Fenton-Glynn: To follow up on that, you said it is about lack of hope, thinking about the job market and so forth. Is that for the older young people or is that throughout the piece, from quite young children up to young adults?

Abigail Ampofo: The lack of hope comes through more with teenagers, rather than the younger children.

Josh Fenton-Glynn: Thank you. That gives us a more complete picture. Jo Hutchinson?

Jo Hutchinson: I agree with all those factors; it is a perfect storm of many different things. To add a couple more to the mix, one thing that is very clear is that there is a gender divide in the sharp increases in children with mental health difficulties over recent years. We need to think about what factors surrounding girls and their experiences in society—with boys, with other girls and right across the piece—contribute to that.

There has also been a broad erosion of children’s services through years of austerity and focus on the pandemic—that is, other priorities in Government. That means that with groups such as such as children who are looked after, who have a very high expected risk of having mental health difficulties, we are not making sure that there are automatically services when it is very clear that there is a high risk.

Q20        Josh Fenton-Glynn: Just to follow up on that point, you talked about the gender divide. Is that a gender divide in the raw numbers of people with mental health issues, or in the types and acuity of mental health issues?

Jo Hutchinson: It is both. The raw numbers of girls are higher, particularly at adolescence, when it really takes off. You can see a clear pattern going into early adulthood as well: if you look at the prevalence of, say, post-traumatic stress disorder in young people, girls are clearly on a rocketing trajectory compared with boys. I cannot prove what the cause of that is, but there are some plausible potential causes around gendered violence.

In terms of the types, girls are typically a little more vulnerable to depression and anxiety, whereas with boys, their difficulties may be more likely to have some behavioural aspects or be linked to neurodivergence. In neither case is it true that you do not get boys who have depression and girls who have neurodivergence issues; it is just that the balance is different.

Q21        Josh Fenton-Glynn: To nail that down, the rate of potential gendered violence and so forth from young men has led to a spike in the number of young women and girls suffering from post-traumatic stress—or so it seems?

Jo Hutchinson: We cannot say that for certain, but to my mind, I struggle to think of an alternative, plausible reason why, particularly through adolescence and early adulthood, things go very wrong for girls in particular. I struggle to think of an alternative for why that might be, but I cannot show you a research paper that says it is because of that.

Q22        Josh Fenton-Glynn: Thank you, that is very powerful. Going back to the original question, Connie, what are the key drivers beyond social media of the increasing mental health problems among young people?

Connie Muttock: I agree with everything that has just been said. I would add a couple of things. I think if we look at when children and young people’s mental health starts to decline, we can go back to the early 2010s—their mental health starts to deteriorate around 2012. We need to look at some of the patterns of what has been happening over that time. We talked about rising child poverty, rising inequality and lower living standards, but it is also the infrastructure of support that builds resilient young people and children. That includes early intervention services like children’s centres and youth clubs in particular—there was a 70% decline in investment in youth clubs in that period, and we know they are really great for building young people’s resilience. The patterns in how young people have been playing have also changed. We know that play is fundamental to our development and wellbeing, but children play 50% less now than the previous generation. There is a range of contributing factors to that.

I would add the way that our education system has shifted in that time. We have gone towards an education system that prioritises attainment above all else. That relies on a high number of high-pressure exams that young people tell us make them feel very anxious. That period of their life is very high stakes and makes them worried about their future. I would also echo the point around uncertainty. Young people describe an incredibly turbulent time. There was the huge disruption of the pandemic but also the feeling of precarity in the geopolitical landscape, the worries they see their parents have about money and the future, and the worries they have for themselves about their own futures, which all create a feeling of anxiety. I absolutely echo the point about girls and young women. I think we too often forget girls and young women in the discussion about children and young people, particularly at that older age, when they experience almost double the rate of poor mental health as boys and young men in that 16-to-25 age group. I would encourage the Committees to look into that, too.

Q23        Josh Fenton-Glynn: Connie, since you are from a think-tank, I will ask a slightly more policy-heavy question. To go back on that, you are suggesting that the result of austerity—closing youth clubs and greater child poverty—has led to an increase in poor mental health among children and young people. Would you then posit that the cost down the line will perhaps be greater than some of the savings that Governments made?

Connie Muttock: Sorry, can you repeat the end of your question?

Josh Fenton-Glynn: Will the cost of the long-term mental health impact of austerity have a bigger cost over people’s lives?

Connie Muttock: Yes, absolutely. We know it is far more expensive to strip back early intervention services and to intervene later. I think there is a problem across our systems, but we see that especially in the mental health system, where we no longer have early intervention services. It is a system that invests much later and is much more expensive—it is 100 times more expensive to treat a young person in in-patient settings than in the community. We know that it is cost effective to invest in things like youth clubs, youth centres and early intervention support.

Q24        Josh Fenton-Glynn: Very quickly, I will go to Abigail for my last question, which is: do you think that the Government are going for the right things in terms of hitting the drivers of poor mental health?

Abigail Ampofo: I think there are some green shoots of positivity. There has been funding of some initiatives that are going to make a difference: rolling out mental health support teams in schools and young futures hubs are great starts. The announcement of a cross-Government mental health strategy is really positive—that is something that mental health charities have been calling for for years. It is also a brilliant opportunity to get under the cover and make some differences for young people’s mental health.

If we think about the increased prevalence for young women and girls, for example, I think there is a credible argument that domestic and sexual violence could be a contributing factor. It takes other Government Department to respond to that. Being able to access employment also takes other Government Departments. It cannot all sit with the NHS. There is also the education system and the pressure that it is causing for young people.

There have been some positive moves, but you also have opportunities, as Government, to really start shifting the dial and making a huge difference, taking into account how different Government Departments can work together to make change.

Josh Fenton-Glynn: Thank you. I will hand back to the Chair in the brief moment we have a positive note.

Chair: Thank you. I call Caroline Voaden.

Q25        Caroline Voaden: We will now move on to social media. What behaviours are being observed in children as a result of prolonged and potentially addictive screen use? How strong is the evidence linking these behaviours to a deterioration in mental health?

Connie Muttock: We are seriously concerned about what we are seeing in children and young people’s behaviour with social media. We are looking at a generation of young people who are addicted to their phones, and who are spending hours upon hours on their phones every day. Childhood has become more isolated and more lonely, and more time is spent indoors. We are really worried that the impact will ripple through generations to come in terms of how that is shaping the minds of young people.

We need a cultural shift in how we approach social media. There is no other product that we would let be shipped out to people in the way that this has been. We would not let anything that physically harmed young people—to the extent that social media harms their mental health—be in their phones or their bedrooms all the time.

In terms of the evidence, we have a challenge at the moment with the conversation around waiting for the evidence of the causal link between social media and children’s mental health. There is evidence to suggest that there is a clear pattern: children who spend more time on their phones have worse mental health. That was clear in the Amy Orben review that the Government commissioned. We also know that social media has significant impacts on things like children’s sleep, and poor sleep has terrible impacts on our mental health and wellbeing. Children who spend more time on their phones have lower confidence.

But it also catalyses a lot of the broader problems that we have heard described. If we think about girls and young women, sexual violence and harassment have skyrocketed in terms of their experience of it on their phones. So this is also about the way the unsafe content they are seeing is influencing their experiences.

We think we need to stop waiting for the evidence, take a precautionary approach, get children off their phones and place the onus on the tech companies to prove these things are safe, rather than holding out for that causal link.

Jo Hutchinson: The strongest evidence is certainly that excessive time on social media, or screentime in general, is harmful. I agree with Connie that it is strongly linked to loss of sleep. If a young person is using social media for two, three or more hours a day, by the time they have been at school, done their homework and eaten, there is just not enough time for that to happen without it being when they should be either winding down for bed or already asleep. So the link with sleep is very strong in the evidence we do have so far.

There is a little nuance in that evidence, in that there appears to be a U-shaped relationship, whereby the children with the very lowest risk of mental health difficulties are those who use social media, but only for a short time per day—maybe 30 minutes or perhaps 60 minutes at the top end. Those who do not use it at all have a slightly higher risk, and those who use it a lot—two hours and upwards—have the highest risk of all.

Abigail Ampofo: I would like to start my response with something that a young person directly told us: “I think as someone who was thrown out of education because of my health issues and had a period of time when I was completely housebound—I did not leave the house for months on end because my health was that bad—social media at that time, for me, was an anchor because I stayed connected with people online. Without that, I wouldn’t have any connection at all. But I think part of the issue with it being so much of an anchor was that I was more impressionable, because I kind of clung to whatever content I could because it was all I had, and so I was a lot more glued to social media than perhaps I should have been. But there was no alternative, I guess.”

I share that quote with you because the young people we work with have told us quite clearly that, for them, the online space does bring a sense of community, at a time when other spaces for young people have disappeared. But, equally, they are also cognisant of the risks, concerns and worries around social media, as I think we all are.

For YoungMinds, because of what we have heard from young people, our focus really is on putting the responsibility back on to the tech companies and making sure we always think of safety by design. I go back to this cross-Government strategy on mental health: it is a cross-Government response and another opportunity to take into account something that does cause harm to young people if it is not delivered properly.

Q26        Caroline Voaden: I have a quick follow-up for Jo. You talked about girls and young women, but have you seen any evidence that other groups of children are more likely to experience negative or positive mental health effects from social media? Are there any particular groups that stand out?

Jo Hutchinson: In terms of a link with social media, I do not think the evidence is that detailed yet, but there are certainly lots of other groups, besides girls, who are more highly vulnerable to mental health difficulties in general.

Q27        Caroline Voaden: We have heard that disadvantaged children might be more at risk of grooming or effects like that from being on their phones. Is that something you have come across?

Jo Hutchinson: Not in the journal-based evidence that I am focusing on. But it is important to recognise that the testimony of young people, and what they are saying to charities and others involved in the young people’s mental health space, is evidence—it is just a different kind of evidence.

Q28        Manuela Perteghella: My question is for Connie Muttock. The Centre for Young Lives is among many who have called for a regulatory framework for social media, including minimum age requirements for harmful social media platforms, stronger safety-by-design and duty-of-care obligations for tech companies and, most importantly, a public health approach to social media harms.

What does a public health approach to social media—and probably also to gaming platforms, hybrid spaces, messaging apps and AI chatbots, because we are reading lots of evidence about the harms of AI chatbots—look like? Over what timeline would you like to see the Government take action?

Connie Muttock: By a public health approach, or a precautionary approach, we mean that we need to get children and young people off social media with immediate effect. We know, and can see, the significant harms that are playing out on children and young people’s phones and in their lives, and we do not think we should be waiting for tech companies to do anything before we make that happen. In any other industry, we would not let a product out into the world until it was proven to be safe for children, and that is the approach we should take to social media.

I would count AI within that. We really need to take a close look at the experiences children are facing regarding chatbots. Increasingly, they are turning to AI for mental health support, and that is seriously concerning. These environments are designed only to positively reinforce what people are saying, and do not have the mechanisms in place to get young people to urgent help. We therefore think that children should be taken off these platforms as soon as possible. The onus should be placed on the platforms to make them safe before they are allowed back into the hands of children.

But we also need to look at the alternatives. We know that the grip of social media in children’s lives has increased, at the same time as the alternatives for them outdoors, in real life, have been pared back. If you look at the pandemic, children’s social media use skyrocketed just at the time when they had nothing else to do. I think we have a boredom problem for young people and teenagers today, so as part of that public health approach we also need to invest in play, youth spaces and offline alternatives, to help young people have more enriching things to do in their lives than doomscrolling.

Q29        Manuela Perteghella: Following up on this alternative offer, are you also calling for safer online alternatives? If so, what does that alternative online offer look like in practice, and how can it be delivered?

Connie Muttock: Yes, absolutely. I think we should really be listening to the fact that so many teenagers are turning to ChatGPT for mental health help. That tells us that our systems are fundamentally failing them, as they are more likely to get help from AI than from a medical professional, which should seriously concern us.

It also tells us about the type of support that young people prefer. They tell us that AI can be a good pathway for them, in the sense that it is more accessible, more immediate and stigma-free. We think we should be creating safe platforms for young people, but we cannot do that while our wider system of mental health support is fundamentally failing to meet need. You cannot have an AI platform refer a young person on to further support if that support does not exist—that is, if we have a 55% treatment gap.

Q30        Gregory Stafford: I want to continue on that line of questioning for a moment. Ms Ampofo, the Committee has heard some evidence that social media can actually fill a gap in young people’s sense of community, as well as provide learning, creativity and entertainment. Do you find that argument convincing?

Abigail Ampofo: Yes, because I am hearing it directly from young people. If we go back to some of the things that Connie was saying, I think it is absolutely right to say that young people today have grown up in a digital world. This is not new to them; this is their reality.

I do not think it is a case of yes/no. The fact is that it is here, and they are in it. We have to be more intentional about how we do some of our work; AI could give us the opportunity to reimagine and redesign whole pathways, but that requires intentionality. Otherwise, the harmful aspects will still be there, and they will not be addressed.

Q31        Gregory Stafford: Going back to what Ms Muttock just said about offline provision, if offline provision were better or more extensive, would children start to come offline, or have we now crossed the Rubicon? Have we gone too far, and is online now the way to go?

Abigail Ampofo: I do not think I would necessarily look at it that way. Provision has to be better, and we have an opportunity to design provision in the way that meets the needs of different groups of young people. In some cases, that face-to-face provision being really embedded in communities is the right way. But for other people, being able to access provision through an online space, while still maintaining that relational approach, is the right way. It is about how we design the pathways correctly. The focus should not be so much on whether it is offline or online, but on the pathway as a whole.

Q32        Gregory Stafford: You have used the words “we should”. Who is “we”? Are we talking about Government intervention, or is it down to local authorities, schools and the NHS? Who is the “we” in this situation?

Abigail Ampofo: Everyone you mentioned is the “we”—you are absolutely correct.

Q33        Gregory Stafford: Could you give me some practical examples from a Government perspective? What could the Government do that would improve the situation?

Abigail Ampofo: Funding—the Government could provide funding. I think I am a bit of a broken record with this cross-Government mental health strategy, but we could then think about what the legislation also looks like for local authorities, schools and youth clubs. There is a range of ways that lots of different Departments can do this.

Q34        Gregory Stafford: Are there one or two things that schools, the NHS or other public bodies that interact with young people could be doing in the offline space that would make a real difference?

Abigail Ampofo: Yes. If we start with education, what young people and their parents have consistently told us is that the education system, as it stands at the moment, is one of those million pressures. There are opportunities for looking at how assessment is delivered for children. Those stats cause a huge amount of pressure for young people, but are the stats measuring children’s attainment or schools’ attainment? Do we need to have stats? Everything is based on high-stakes exams, but young people are saying, “Actually, they are not even getting us ready for the world of work.” Exams are creating so much pressure in the build-up to them. There are ways to reimagine that.

There is also taking a whole-school approach to mental health. Mental health support teams in schools are absolutely brilliant in the support they can give young people, but that will not make a difference if the rest of the school system is not focused on young people’s mental health and wellbeing—for example, behaviour policies or how teachers respond when a child is struggling.

Gregory Stafford: That is very helpful. Thank you.

Q35        Peter Swallow: Connie, on that theme, may I get your view? We seem to have an ambitious national youth strategy, which speaks to some of the ambitions for getting more support in the real world for our young people, and there is a very live and energetic conversation about social media, but I am not always convinced that we are necessarily linking the two well enough. What is your perspective of the real-world, offline spaces that need to be created if we are to help young people to access support for their mental health in settings that are more regulated and less wild west than some of the spaces on social media?

Connie Muttock: It is fair to say that we have not talked about children and young people’s experiences of those mental health services yet, but we have a system that is fundamentally failing young people. It fails them across the board, from the early intervention stage through to the way that crisis and specialist care is working. There are record high referrals, and children are facing incredibly long waits, while parents and families are at the end of their tether. The system is completely failing in terms of real-life, in-person, regulated and high-quality mental health support.

Two things need to shift: prioritisation and reform within the system. We need to prioritise children and young people’s mental health much more in our health systems. Perhaps we will come to a conversation about where we spend money, how targets shape the decisions made by the NHS and how we need to see reform. At the Centre for Young Lives, we are strong believers in early intervention and prevention, so we need to see a shift, and it is really welcome to see in the 10-year plan a shift towards community interventions.

We need much more of a focus on what that looks like for children and young people: things like having early support hubs, which were mentioned by Alex George earlier; expanding the provision of mental health support teams and making sure they can meet a higher level of need; and bringing some of that specialist mental health support to our youth spaces. In youth centres, for example, youth workers say that they are dealing with really high levels of need, and that they do not know what to do and do not have the capacity to deal with it. We need to bring those professionals into the community where the young people are but, fundamentally, we need to prioritise children’s mental health so that we have the capacity to do that.

Q36        Peter Swallow: Thank you. Jo, the Fonagy interim report suggests a much more complex picture than simply under or overdiagnosis, particularly with neurodiversity. Do you agree with that assessment? What evidence do we have to support that view?

Jo Hutchinson: Yes, I do; I think it is more complex. The thing that really struck me in the interim report of the Fonagy review was that we can very clearly see an increase in distress in young people. To me, that makes it not plausible when some people try to make an argument that young people simply need to toughen up in some sense. It is clear that the symptoms are more severe for young people, and we definitely know that, on the depression and anxiety side, the more severe the symptoms and the distress, the more impaired those young people will be in terms of being able to go to school, benefit from education, move into the world of work, socialise with their friends and so on. For me, that was a key point.

I also think that there is something to explore further in the point that was highlighted about how the structure of services and systems can itself generate more need in young people. That links back to what Connie was saying about early intervention. It is so much more difficult to treat mental health difficulties the longer they have been left to fester, and the longer the young person has been left to come up with their own means of coping, which may not have been ideal but were all they had available.

It is important that we take steps to tackle the capacity issues in CAMHS and the gap in the middle of the range of severity, with children with moderately severe needs having not many services at all. Then, it is about looking at the more preventative picture: the mental health in schools teams and the services at the non-clinical, non-specialist level. The evidence tells us that that is still very patchy. It varies from location to location, and there is no guarantee that any particular young person will be able to access it.

Q37        Peter Swallow: That brings me on to my next point, which not only is highlighted in the review but every MP around this table will be familiar with from our constituency casework: the way that diagnosis is increasingly becoming the gateway to support, rather than happening along the pathway of support being delivered. I am sure we MPs have all experienced constituents telling us how difficult it has been to access an EHCP assessment if they do not already have a diagnosis, despite the legal framework not having it as a requirement. I do not want to confuse neurodiversity with mental health, but there is obviously a connection. From your experience and the work that you have done, what do you think needs to be done to break that link, have genuine early intervention and not be reliant on waiting for a diagnosis to get support in place?

Jo Hutchinson: There are a couple of things. One is that we need to make sure that we are properly resourcing and ensuring sufficient workforce capacity for new services, such as the Experts at Hand service planned in the schools White Paper. That will not deliver on its extremely laudable and suitable intentions if we continue to have big shortages of educational psychologists and other professionals that are needed in the services.

There are other things we can do. Thinking about schools and the education system more generally, it is pretty clear that the current national curriculum and set of assessments are so focused on academic achievement that it has squeezed out the space needed, particularly in primary school, for children’s broader social development. A good deal of that takes place through play, art, music, storytelling and those kinds of activities, which can get squeezed out if you are on a conveyor belt of assessments, particularly if some of those assessments may not be appropriate for the full population of children or are set at the wrong age for children’s development. That is an important preventative aspect to look at—I could go on.

Q38        Peter Swallow: That provides a helpful segue to talk about the Milburn interim report, which highlighted some of the challenges you just picked up on. The Fonagy review and Milburn review both highlight a significant increase in young people who are not in education, employment or training due to mental health conditions. The flipside is probably also true: that being NEET is likely to increase your challenges with mental health. Abigail, what are the young people whom you work with telling you about the connection between feeling that there is not enough opportunity for employment, education and training, and their mental health? You talked powerfully about there being a million pressures. Is this compounding those pressures?

Abigail Ampofo: We deliver a helpline for parents and carers. Around 11% of our calls are from parents who have a young person in their life who is not able to go to school. That is usually due to their mental health and not being able to get the support they need for that child to go back to school.

That has increased quite considerably since the pandemic. Before then, far fewer of our calls were around children and young people not going to school. When we talk directly to the young people, school is a big source of stress and pressure that is negatively impacting on their mental health.

I spoke before about the exam system and how that builds up to a huge pressure, which results in children avoiding school. What we are hearing, and you are saying, is that a vicious circle is starting where children are not able to access school and the education system that equips them for the future. We then have huge numbers of young people not in education, employment or training. That bit in school is the part that we have to crack to be able to address problems later on.

Q39        Peter Swallow: Very briefly, do either Jo or Connie want to add something to that?

Connie Muttock: The point you made about the bi-directional impact of being out of employment, education and training is key. We know that young people who are NEET are much more likely to have poor mental health, and the longer they stay out of work, the worse their outcomes are likely to be. That is a significant problem.

There are interventions that work. IPS—the individual placement support programme—has really strong results. It pays for itself and then some.

Peter Swallow: I think my colleague Jess is about to come on to interventions.

Q40        Jess Asato: As we look forward to those final reports from Fonagy and Milburn, what would be the key concrete policy that you would expect to see from those reports to address the drivers of poor mental health?

Connie Muttock: I am going to zoom out and not talk about interventions as the priority for this because it is about prioritisation.

Particularly from the Fonagy report, which will talk about the prevalence of poor mental health and the drivers of those challenges, the problem we are seeing is that we have known about these issues for some time. This Committee met nine years ago; our founder appeared before these two Committees to talk about children’s mental health almost a decade ago. It has taken until now to get a review of the prevalence of children’s mental health problems.

We need to see some tangible shifts to respond to that. We want to see shifts in what we spend on children’s mental health. We spend less than 1% on children’s mental health across the NHS. Mental health more broadly gets only 10%, despite making up 20% of the overall disease burden.

It is about shifting how we prioritise, and it is about targets. We know the health system responds to targets. It is a crying shame that we have really strong targets for elective health and nothing for children’s mental health. We are prioritising bunions over children with serious mental health problems.

It is also about how that system shifts. The Fonagy review in particular is looking at the drivers and the system response. The system intervening later is exacerbating need and making interventions less effective because the longer you wait to respond, the less effective that intervention is.

We also need a response to those two reviews that looks at a truly cross-departmental strategy. I do not want to see a strategy where each Government Department repeats the things that they are already doing. We need a strategy where each Government Department takes responsibility for this generation of young people. The Department for Work and Pensions, DSIT, the Department for Education, the Department of Health and Social Care, and beyond each need to take responsibility for this generation, invest, and have shared accountability to shift the dial.

Q41        Jess Asato: Jo or Abigail, do you have anything to add about your expectations for the outcomes?

Jo Hutchinson: As a result of the final stage of the Fonagy review, I would like to see that work joined up with the work that is going on to develop the schools White Paper priorities around special educational needs and disabilities. I would like to see some funding from Government for shared professional building between education professionals and mental health professionals for children and young people, so they can sit down and discuss, alongside all the evidence, how we can create new systems that do not have gaps between them and holes in them, and do not result in us all just pushing children backwards and forwards from one service to another. I would like to see that being a collective professional endeavour, but it is probably not that likely to happen unless there is structure and funding for it to take place.

Abigail Ampofo: I completely concur with what Connie and Jo have said, definitely on the funding, the accountability and the no wrong front door for children and young people. Probably the last thing I would like to see differently is how we talk about children and young people and their mental health. We are not talking about NEETs as an acronym—we are talking about children and young people who are not in education, employment or training. We should shift our language to be very positive about children and young people with mental health needs.

Q42        Mark Sewards: I am going to ask you a couple of questions about widening access to mental health support services for young people. Connie, I will start with you. The Centre for Young Lives stated that the threshold for accessing mental health services has risen, which has created a missing middle of young people who do not access services until they are at crisis point. How well are the Government addressing that missing middle?

Connie Muttock: We talk about this missing middle. It is worth saying that we fail on all fronts. We fail on early intervention and we fail at specialist and crisis care. There are problems across the system, but there is clearly a problem for the missing middle of children and young people who are told that they are too high need for early intervention services but not high need enough to meet the threshold for CAMHS. That is because our systems are highly overburdened. They are having to rely on very high thresholds because of the scale of children coming forward for their support and their inability to respond.

Take the example of mental health support teams. That is a welcome intervention and there are positive, ambitious plans to scale it up, but it is for mild to moderate needs. We are hearing examples across the country of young people who are being told that they are too complex for those mental health support teams, but they are seeking a CAMHS referral and being turned away. Around a third of CAMHS referrals are closed, so we need to look into the experiences of those young people—what is happening to them and what alternatives are they being offered? The answer is very little, and that leaves children and families at their wits’ end with nowhere to turn.

We need to look at that missing middle. There are interventions that we know work. Early support hubs were mentioned in the previous session. We really need to see commitment from the Government to make sure that there is meaningful mental health support in hubs across the country. We welcome the young futures programme. We recommended it as part of the Commission on Young Lives and we have been working with the Government on that programme. We really want to see a robust mental health offer within that; it cannot just be a wellbeing offer. Otherwise, we will have the same problem of young people being referred on and referred on, with the waiting lists just expanding.

We need to meet that middle need meaningfully in the community. Crucially, no child should even know that their needs are too high or too low for this service or that service. They should be oblivious to it, and it should be the responsibility of the health system and the education system, jointly, to find a place and the right support for that young person.

Q43        Mark Sewards: Do you think the Government are doing enough?

Connie Muttock: I do not know. I do not think we are doing enough across the piece and I do not think the Government are doing enough across the board, but this is clearly a gap. We did see the welcome extension of funding for early support hubs. We saw £7 million to extend those 24 hubs for a further year, but that is just one year. Services are thinking about how to hire staff or how to offer support in the longer term, and we want to see not only the extension of that support but the expansion. This Government talked about universal open-access mental health support in every community. We need to see that become a reality.

Q44        Mark Sewards: Thank you. Jo, the EPI has found substantial variation across the country in the range of mental health support services that are delivered outside the NHS. Abigail, YoungMinds has argued that the persistent gaps in provision are exacerbated by the lack of community-based services. What should the policy response be?

Jo Hutchinson: Part of the reason we are seeing such a patchy, uneven picture in non-NHS services is precisely because they are non-NHS services and are often delivered on a voluntary basis by charities—by organisations that live from one small grant to the next and rely on their local authorities still having a budget available the following year. Having that category of early intervention outside the system that is planned and funded centrally means that it is sort of inevitable that we end up with patchiness and inconsistency.

Q45        Mark Sewards: How would you address that?

Jo Hutchinson: What we need is, again, cross-Government; we need a plan that will cover all levels of intervention.  It needs to look at what is happening in the link between CAMHS and schools. There are issues there around consent being a barrier to information sharing. The end result is that schools get less advice from clinicians about what they could be doing in school that would support the young person, and about how mental health needs may be impacting on very educational factors—things like memory, attention, concentration and motivation, which should be bread and butter in schools. If they are not receiving that information and advice because it is too complicated and time-consuming to get consent from the young person to share information, that will weaken the middle out of things. We basically need to look at the whole picture and plan a tiered support system that is governed through the same overall budget and accountability structure, even though doing so is complex because it does not relate to a single Department.

Q46        Mark Sewards: That is helpful. Abigail, how should we address this variation?

Abigail Ampofo: My colleague and Jo have given really good responses. One thing that young people tell us consistently is that they feel that they are going through the wrong doors. We have to get to a point where there is no wrong front door for young people to access the support that they need. The only way to achieve that is if there is one overall coherent plan that everybody is following and delivering, be they a clinical service, a housing service, an education service, social care and so on. There has to be one overarching and cohesive plan.

Q47        Mark Sewards: I have one final question for you all. How should success be measured, and what would meaningful progress look like over the next three to five years in addressing the missing middle and the variation in services across the country?

Connie Muttock: We need to measure two things: our ability to meet need and our ability to bring down prevalence, in terms of young people who have mental health needs and of the scale of that mental health need in how it is shaping their lives—for example, as need reduces, does it reduce their absence from school and the NEET rate? We need to measure ourselves on how we are able to meet that level of need in the community, and, fundamentally, on whether we are shifting things in the lives of children and families, and making sure that they are able to live happy, fulfilling childhoods, as they should be doing.

Jo Hutchinson: The NHS has had a tendency to measure its performance in terms of the number of children that are now being seen in its services, without reference to how many children there are who need to be seen. It can therefore be going forwards in its measurement while we are actually going backwards in the chances of a single child getting the help they need, because the number and proportion being seen are two different questions mathematically. That is important.

The other thing I would add to what Connie said is that we need to look at using the longitudinal educational outcomes data and other Government datasets to consider other long-term outcomes for young people, such as whether they are becoming NEET or struggling to join the workforce, and their long-term health picture over time. Ultimately, we care about children’s mental health in its own right, but also because of the implications that it has for their adult life, so we need to be looking at their education, employment and health outcomes across their 20s and up to at least age 30. Whether what we are saying is happening is one question, but whether it is working is a second.

Abigail Ampofo: I would add just two things to look at. The first is the proportion of children receiving help within their community rather than in hospital care, and the other is young people’s experiences of services. We should be co-designing services with children and young people. How well do they think their views have been taken into account in service design?

Connie Muttock: We need targets not just for the health system, but for the system more broadly. We should be measuring schools on children and young people’s wellbeing. There was a lively debate in Parliament on a national wellbeing measure, which we still really want to see, and the cross-departmental strategy is an opportunity to make that a reality. We need targets on mental health in the same way as we have targets for elective care and other priorities in health, but we also need targets for the Department for Education, schools and the wider community, to shift the dial and make sure the responsibility is shared.

Abigail Ampofo: Sorry, but I am just going to add one more point. We also need to be measuring inequality. Are black and racially minoritised children and young people able to access support and services at the same rate as their peers?

Q48        Joe Robertson: Let me turn now to the modern service frameworks. I think there are two that we are expecting and that are relevant to what we are talking about today. There is the one for children and young people, but also the MSF for severe mental illness. What should they contain that will lead to meaningful improvements in widening access to support? I am happy for any of you to start, but I would like to hear from all of you if I could.

Connie Muttock: We really welcome modern service frameworks, particularly for children but also for serious mental illness. There is an opportunity here to build some consistency, but our priority for the children’s modern service framework is for it to set a clear direction on the shift from intervention at a late stage towards intervention in the community.

We know that there is less confidence among commissioners and professionals about how to deliver that support correctly, in an evidence-based way and in a safe way, to children and young people. We see that play out in social prescribing, in the number of children’s link workers there are, and in the extent to which ICBs commission community-based services for children and young people. The modern service framework is an opportunity to generate greater consistency, higher standards and, in particular, stronger emphasis on bringing support into the community where children are. The only thing I would add to that is that we really want the framework to listen to children and young people about what they want from services, but also to set a clear direction on how local services can do the same.

Q49        Joe Robertson: We expect children and young people’s voices to be fed into that MSF, but presumably you would call for that in the modern service framework for severe mental illness as well.

Connie Muttock: Absolutely. Across the board, we too often treat children’s mental health, or children’s health more broadly, as a second priority in all our measures of success across the health system. That is why they get less funding and why there are less good outcomes for children in terms of their experiences in the health system. We really want the dial to be shifted in the serious mental illness modern service framework, particularly in children’s experiences of crisis and specialist care, the use of out-of-area placements and the use of restraint in these services. We want stronger standards for children with serious mental illness in there as well.

Jo Hutchinson: There are a couple of blind spots that I will point out. One relating to the children’s framework is the gaps in services to respond to children who have experienced trauma. Children are, in a sense, uniquely more vulnerable to this than adults, because they have very little control over the circumstances they live in at home, in the community and so on. Addressing that in the children’s framework would be useful.

It is important to recognise that some forms of severe mental illness are not diagnosed in children, because it is simply seen as too soon to diagnose them. They may be displaying symptoms that indicate that they may end up having a severe mental illness as an adult, but are not getting a diagnosis that might count against a list of conditions that are severe mental illness. It is important to take into account that the diagnosis does not work in quite the same way, and therefore children may be less seen with severe mental illness than adults.

Joe Robertson: Is there anything you want to add to that, Abigail?

Abigail Ampofo: The only thing I will add for both children and young people with serious mental illness is the disparity and inequity, and how we can make sure that black and racially minoritised people are taken into account as a focus.

Q50        Joe Robertson: How could the forthcoming mental health strategy meaningfully deliver the shift towards prevention, early intervention where intervention is needed and community-based services set out in proposals such as the Future Minds road map? I am trying to look at the “how” here.

Connie Muttock: It is partly about the interventions we prioritise. We have talked about mental health support teams and early support hubs but also harnessing the opportunity we have with the youth strategy to get mental health support into those community services. The national service framework is important there because it drives consistency in those services, but the strategy is also about bringing together Departments and thinking about how each of the different reforms coming through—the special educational needs reforms, the youth strategy, the DSIT reforms—can all work towards promoting children and young people’s mental health.

To zoom out a little bit, I also think that, when we talk about prevention, there is a real opportunity for a bit of a cultural shift and a conversation about how we can build the foundations of good health. What does good mental health look like, and what does building the foundations of good mental health look like when we think about children and their experience? We think about children growing up in a home where there is domestic abuse, where their parents might have poor mental health or where there is substance misuse. We also think about a child who is at risk of exploitation in their community or is growing up in poverty.

We heard at the beginning of this conversation about the drivers of mental health, and the strategy is an opportunity to build the foundations on the flipside of that of good mental health starting with those drivers, but then also, as I said earlier, to look at how we can expand early intervention services. That is also about how you shift and prioritise in the system. We talk to local commissioners all the time, and they say, “There is money in the system. It is about how you prioritise it,” and we know that it is much cheaper to invest in those earlier intervention services.

Q51        Chair: We have two minutes before we have the Children’s Commissioner in front of us. I will ask each of you to pick one thing that you are keen to leave with us as the most important thing that we push on in this report.

Connie Muttock: The single thing that this Committee would do well to look at is what has happened over the last 10 years and what we need to do differently next. I mentioned at the top of this discussion that we have had strategies and plans that recognise children’s mental health, and in the years since their mental health and our ability to meet their needs have got worse. We need a conversation about why that has not shifted the dial, and therefore what the Government can do next. That is about prioritisation, spending and movement toward support in the community.

Jo Hutchinson: We need a really clear focus on harm prevention for children, whether that is through child protection or thinking about the education system, the curriculum and assessments and all aspects of children’s lives. Some sort of audit using clinical records to actually work out all the touchpoints where children are experiencing harm would be really useful in developing a good strategy for prevention.

Abigail Ampofo: If one in five children and young people have a probable mental health condition now, up from one in nine back in 2017, I think that, as a country, we have to ask ourselves seriously where we want to be in 10 years and set that as our benchmark.

Chair: Thank you very much, all three of you, that is much appreciated.

Examination of witness

Witness: Dame Rachel de Souza.

Q52        Chair: Thank you very much for being here. Will you very briefly introduce yourself and what the Children’s Commissioner does, please?

Dame Rachel de Souza: I am the Children’s Commissioner for England, Rachel de Souza. I have been the Children’s Commissioner since 2021—I started just as covid restrictions were lifted. I protect and promote the rights of children. One of the key things that I do in this House is bring the voices of children and their experiences. I also have a really fantastic research team and I have data powers, so I have lots of data for you today that I am able to get hold of on mental health. We use data, as well as bringing the voice.

Chair: I am a huge fan of data.

Q53        Helen Hayes: Welcome, Dame Rachel. Thank you for being with us this morning. You are coming to the end of your six-year term as Children’s Commissioner, and there have been significant changes over that time. Can you provide some brief comment to us on how the drivers of children’s wellbeing have changed in recent years? What trends have you seen in your six years as Children’s Commissioner?

Dame Rachel de Souza: That is really interesting. The best way for me to do that is to tell you what children have told me themselves. When I came into role in ’21, I went out and did a major survey, “The Big Ask” and, in fact, we got the biggest survey response in the world. We asked children coming out of covid what their vulnerabilities were, what they needed to thrive and what they wanted for their future.

What is interesting is that, back then, those half a million children told me that their mental health was an absolute top priority. They wanted to get back to school. We had all those huge worries about school absence at that point. Back then, they were very ambitious. They wanted great jobs, and they wanted school to support and help them. That was very much the picture. That was children in every part of this country, including some really vulnerable children—there were some real vulnerabilities. It was that time of explosion, when everyone was talking about mental health.

It is very interesting. Six years on, I am out now in my final year doing my “Big Future” survey. We are hoping to hear from 1 million children this time, so I am sure we will be up in your area. We started up at Hadrian’s wall, and we have been in Carlisle, Birmingham, Blackburn, Preston, Leicester and Nottingham just in the past two or three weeks. We already have 100,000 responses.

It is so different now. What children are talking about feels really different six years on. These are the children who have had the covid shock and the cost of living shock, and we have the whole social media issue, but what are they saying? Just before I started my survey, I was triangulating what I found in my polling. We did YouGov polling of 13 to 17-year-olds and asked, “What are your biggest concerns?” They talked about the cost of living—we didn’t hear that six years ago. They talked about getting a great job—there are real worries about that. They talked about friendship. Mental health was not in the top group. They talked about war and peace in the world. It was a completely different set of frontrunners. That tells you something. Children talk to me a lot about being stuck on social media, being unable to get off it, and wanting to cut down. They have become far more sophisticated in their conversations about what makes them happy, what makes them well and what causes them to be upset.

I have triangulated that by surveying every single headteacher in the country. I have that data for you showing what they think about this. We also do a piece of data on mental health waiting times and prevalence numbers every year, and I have six years of data on that.

In children’s own voices, there really is a feeling that somehow childhood just isn’t as good anymore. They want to get out and play but are not able to. They are stuck on their phones. Money is a big issue. Parental poverty and financial issues are a big problem. It feels quite different. It is also about not being able to get a job.

I will give you two children’s examples that capture that. We have been talking to the kids about AI. One little girl up in Carlisle said, “I want to be an author, but what’s the point, because AI can write the book in 10 minutes.” Then there is a 16-year-old boy saying, “I have applied for 200 jobs and all I’ve got back is an AI response—no person has spoken to me.” That is what is impacting our children, more than that 2021 “we’ve been locked away” and coming out of covid vulnerability. It feels different. That is what I wanted to share with you today.

Q54        Helen Hayes: The point of gathering data and understanding things is to drive change. To what extent do you think that the Government are adequately listening to that data and understanding the concerns that children are bringing to you as the Children’s Commissioner, and to what extent have you been successful through that effort in gathering data at driving an appropriate and fit-for-purpose response to children’s mental health from the Government?

Dame Rachel de Souza: The best way to answer that is from our specific mental health data. I do a report every year. I think the Committee might be shocked. In 2021, we thought probably mental health issues would be at their peak, but here we are six years later, and nearly a million children had an active referral last year to CAMHS. That is double the 2021 numbers.

On top of that, I surveyed every headteacher in the country on their No. 1 concern for their local area. We asked them for their top 5 concerns for their local areas; we asked them how many professionals they had in their schools, because nobody had that data. I was a headteacher for 20 years, and for the past 20 years, you couldn’t map who had a youth worker or who had a counsellor, who had a mental health worker or who had police in the school. Headteachers’ No. 1 concern for their local area was mental health support for children. That was last year—90% of headteachers in this country responded to me, and that was their No. 1 concern.

So what have Government done, and has the response been adequate? I pushed very hard for the roll-out of mental health support teams to try to support schools to be able to intervene early. I am pleased that that roll-out is now at 522% and that that the Government have committed to continuing with that. I have the exact figure—I think there are now 11,800 settings benefiting from a mental health support team, which is up from 10,000 last year. That roll-out is happening.

I am doubly pleased, because most secondary headteachers told me—82% told me; that is all our heads—that they had a counsellor, and I have always worried about governance; I have always worried about, “Where did your counsellor come from? How do you know that they have been effective?” The mental health support teams will allow us to do that, and should cover the far smaller amount of mental health support in primary schools. I would get my focus there and get them in there. That is a good thing.

My data over the past five years has shown that more money is going into CAMHS, so the Government are spending more—but, because need has increased at a far greater rate than the expenditure, it is unfortunately not adequate. We have a million children with an active referral in our last report, so that has doubled. Nearly a third of those closed without treatment last year, although there is a slight improvement on previous years.

The most common reason for referral is anxiety, which fits with what I am saying, followed by neurodevelopmental conditions. They go down the same pathway. One of the big things we need to do is think about the pathway for diagnosis for NDD, because it is the same pathway. That is something that Government could and should do.

The most common reason is anxiety, followed by NDD. One of the fastest growing reasons is autism. I am on the prevalence review and I think the Department of Health really needs to think about what has happened over the past six years. We have been diagnosing ADHD and autism for longer, and the way in which we do it has changed, just through practice. The prevalence review really needs to think about that, as well as the wider impact on mental health.

Average waiting times are around one month, and about 8% of children wait for over a year for second contact with CAMHS. There is also a huge variation in waiting times across the country; children in the Isle of Wight and Hampshire are waiting the longest—those are the two places that have the longest waiting times. The reports have also looked at expenditure at ICB level, and again the expenditure per child is a postcode lottery, ranging from £2,500 per child in north-west London to £550 per referred child in Coventry and Warwickshire.

I think that gives you a sense of the fact that there is still a postcode lottery, there is increasing demand, and more money has been spent. The ways in which we diagnose and call conditions have changed and stretched at the ends, so we need to get that sorted out.

Q55        Jen Craft: I want to pick up on something you said about the wider impact of prevalence on mental health. In your opinion, is the prevalence of diagnosis of ASD and ADHD having an impact on people’s mental wellbeing or mental health?

Dame Rachel de Souza: That is such an interesting question. The prevalence review is looking at what is happening at the adult level, or the underlying population level, where it actually feels like it is staying pretty much the same. However, you are seeing greater child diagnosis in ADHD, particularly in autism and in mental health. There is probably crossover; my anecdotal experience of talking to children in services would say that there is. I think we really need to understand that, and the prevalence review needs to report on that.

Q56        Jen Craft: We have heard a few people today say how key early intervention and prevention is to reversing some of this trend. What does a children’s mental health system that genuinely prioritises early intervention and prevention look like? How far from that are we?

Dame Rachel de Souza: There is a level at which I would hope that it would look almost invisible at the early stages—I do not mean that literally. We need to get support for children where they want support, which is in school or in the places that they go to play, or in how they are experiencing their families and family life.  If we get that bit right and support those professionals to do that bit well, and if we pick up that bit with those early mental health support teams, we should get the problem solved, and we should be able to make a difference there.

I have done guidance on nought to five screentime, and I have just been asked by the Government to do guidance on five to 16 screentime at the moment. Parents and children right across the country are saying to me, “I know that how I feel is impacted by scrolling for three hours a night”, or, “I gave my two-year-old an iPad for an hour before bed. Do you think that is going to change their behaviour?” I am hoping that we can help with the screentime guidance by starting to address things like the age at which you should have a mobile phone, or whether you should take these things to bed.

It is actually about the practical things. When you talk to children across this country, they want to play out, they want to have fun things to do, and they want to have friends. The boundaries of school can protect and support them. We can do so much if we actually focus on childhood and get that bit right, and if we can support that well with those early mental health support teams.

The CAMHS waiting times are another thing, and some of those issues are wider. However, I honestly think we need a bigger focus on these things—that is why I was pleased to do screentime, because politicians often do not want to go there and talk about what a healthy childhood is, and what family life should or could look like. We need to go there, particularly on things like the online world. I have to say that, while we might not have all the longitudinal data yet—we have data showing that time matters—I think that in years to come it will show there is going to be more than just a correlation in what we are doing there.

Q57        Jen Craft: Do you have the data that you need to enable a shift to looking at prevention and increasing wellbeing? If there are gaps, what would you need?

Dame Rachel de Souza: I was pleased to, for example, do the work for the poverty commission. We often talk about children’s mental health or how many of them are living in poverty. We got all the data from local areas around additional needs and support and brought it together in my children’s plan, which we did last year and which informed the SEND White Paper. That allowed us to understand all the other determinants of good mental health. The problem is not me having the data. The problem is Government Departments working together and using the data they have to create a proper joint strategy in education and health to do this right.

Q58        Jen Craft: Do real, practical changes to thresholds and pathways need to be made to allow children to access support earlier, perhaps without requiring a formal diagnosis? The SEND inquiry has wrapped up, but one thing I hear a lot is that people cannot access support for ASD or ADHD without a formal diagnosis. Does something need to change in that regard?

Dame Rachel de Souza: Having both the SEND White Paper and the prevalence review at the same time gives us a moment to do this. We definitely need to get a different pathway for ASD and, particularly, neurodivergence. The demand is there, and it is pulling on all the services. I am slightly worried that mental health is outside the new SEND legislation. That is a worry to me: we are saying that mental health will not be part of how we do SEND. It is not that that is the wrong thing to do, but that we have such limited capacity in schools and other places that I am worried that it will impact children getting the help they need, and that mental health will become a bit of a Cinderella service.

Q59        Caroline Voaden: You briefly referred to the geographical disparity in ICB spending on mental health. I am sure we can all agree that 1% of ICB spend on children and young people’s mental health services does not even touch the sides. Your ’23-24 report talked about using the high-spending ICBs as a benchmark for the additional investment required from other ICBs. How could that benchmarking approach be applied in practice, and how would it impact the lower-spending ICBs?

Dame Rachel de Souza: What we have done so far is almost naming and shaming or praising, because we can see who is really spending and delivering. This is something that the Department of Health and Social Care could grip quite straightforwardly, and direct that it be done. One of the things about health is that it is almost a monolith; to get something done, it has to come as a direction. We need the Ministers to recognise the particular needs of children and recognise that the impact of spending on children has a lifetime benefit. They just need to say that this should be done, and I am confident in telling them that it should.

Q60        Caroline Voaden: Are you noticing different outcomes between north-west London and Warwickshire? Are those directly related to the spend?

Dame Rachel de Souza: That is such a good question, because it is almost impossible to get any data on outcomes—about whether children are more well, or better. I have tried for six years to get some data on the impact of these interventions, and we are still not there. I can tell you what waiting times are, what spend is and what second referrals are. I can tell you that most children last year got referred for crisis. I can tell you all sorts of things. I can tell you about ethnic disparities. What I cannot tell you is outcomes. That is why we need the evaluations.

Q61        Caroline Voaden: So we could potentially say that fewer children reach crisis point here than reach crisis point there, and that might be an indication.

Dame Rachel de Souza: Yes. We can have a look at that and write to you, if you would like. That is very easy for us to do.

Caroline Voaden: That would be great. Thank you.

Q62        Mark Sewards: You mentioned in a previous answer that children want support in schools. Obviously, education settings are at the forefront, alongside parents and carers. What should a core offer of mental health and wellbeing support in education settings look like?

Dame Rachel de Souza: I would like to see a mental health support team, or properly evidence-based and trained counsellor and support, in every school—but it is so much more than that. We do not even have to talk about it; sometimes it is counterproductive if you set your whole school up to talk about it as just mental health, and everything is mental health. When you start talking about wellbeing, that can really impact on children far more. We need to think about training for senior leaders, and all leaders, so that you get the ethos of the school right, so that they are not putting unnecessary and unimportant pressure on children.

I cannot tell you how many 14-year-old girls will tell me, “I was told it was the biggest thing in my life if I did not pass this exam.” It is simple things like that. The evidence base shows us that friendship, and having one or two good friends, is the biggest determinant of good mental health later in adult life. What are we doing about wider activities at school? Pretty much every child I have met in my last few weeks touring the country has talked about the football club, games, chess or arts—the places where they can be themselves. It is recognising that those things have a massive, positive impact on children’s health.

I would then add that we must not ignore those particularly vulnerable children who are also vulnerable to mental health concerns because of their lives. It is because their parents are poor, they have problems at home or they are in care—those vulnerability issues. When I asked headteachers whether they would do more, if we could put the professionals around schools to support those children, the answer from 90% was a resounding yes. They know that that is where children need to be met and want to be met so that we can support their and their family’s wellbeing.

Q63        Mark Sewards: I have limited time, so I will be brief. What role should education providers play to support children and young people who are already waiting for specialist mental health support but have not received it yet?

Dame Rachel de Souza: First, they should know who those children are. That is one of my bugbears. One of the things that I have found in my survey of headteachers—I was one, so I love the profession, but I will call it out when it is not what it should be—was that heads did not necessarily know who those children were, particularly in secondary schools.

I have been a massive proponent of the unique identifier. We really need to get a move on in terms of joined-up data. I do not know why it is going so slowly. It should be, particularly for this Government, the thing that they are most ambitious about. Health could lead that because they are brilliant and they know what to do. If they could get to the end of the five years saying, “We’ve done a fantastic unique identifier so that children do not have to get lost in the system and we know who they are and when they are waiting,” then heads would then know, “Right, we need to ensure that the counsellor or the family worker is checking in. Do we know the story? Let’s get underneath it.”

Instead, many children are lost. Imagine a child whose school does not know that they have just been bereaved—that their closest adult has just died. They are going to end up needing support and care, and the situation could get worse. However, that is a reality—not so much in our primaries, but in our secondaries. They could not give me the numbers.

Q64        Mark Sewards: One final question. You have called for the roll-out of mental health support teams to be accelerated ahead of the 2030 target. Are the Government ambitious enough?

Dame Rachel de Souza: I think the Government are ambitious. I think the problem is the NHS and that things just do not go quickly enough. I think I would challenge the Ministers to be pushing the roll-out of this as quickly as possible. We could do more and we could go quicker, so to answer your question: no.

Q65        Chair: On the unique child identifier, you say that you do not know what the barriers are. Do you literally have no idea, or do you have a suspicion what some might be and where we might be helpful in unlocking those?

Dame Rachel de Souza: It often goes into the “too hard” pile. It is cross-Government, which is difficult. I have not seen enough ambition for it in children’s social care. I am worried that it is more a race to the bottom rather than a race to—

Q66        Chair: What do you mean by “race to the bottom”?

Dame Rachel de Souza: If I was thinking of the unique identifier, I would be thinking, “Let’s digitise the red book. Let’s have really good information for parents about mental health, and then sitting behind that, we can share the data.” I think there is a risk aversion sometimes in Westminster, particularly in my own Department: “Oh, what about the data-sharing problems?” or going straight to the most difficult case, rather than saying, “Hey, we could actually help families, children and parents.”

Q67        Chair: The single patient record is now part of the Bill and is broadly supported. The LGA talks about a “single person record”, which is interesting, although it recognises that that is probably a long way away. Are you working with the Department of Health and Social Care as they develop the single patient record? It strikes me that it could be the basis for this.

Dame Rachel de Souza: We are; I am also working with Manchester to set up a prototype in Greater Manchester of a model for how the unique identifier could be adopted. There are bits of examples around the country of people doing it well, but I got fed up waiting. We are working with GM and they are having a go at doing one that could scale up, because everybody on the ground knows we need it.

Q68        Chair: Can you give us some specific examples of data that you hope you will get from it? You gave us data on mental health outcomes just a minute ago, which is absolutely one type of data, but are there any others that you are champing at the bit to get but cannot get?

Dame Rachel de Souza: My job is particularly focused on vulnerable children and children living away from home. One of the absolutely shocking things that I experienced in my first year in this role was going to a police authority and they gave me a list of children who they had come across as police who were not on any GP’s roll and not on any school’s roll.

Then, when I started investigating where the children who were not at school were, one of the things that I did was to use my data powers to find out information from local authorities: “How many children have you got in your area? And do you know where they are?” Unfortunately, they did not. They knew where most of them were, but there were too many anomalies at the edges.

For me, it is a basic safety need. This one is contentious, but I worry very much about children whose parents have gone to prison and who are left at home. There must be a way of using a unique identifier to support them and that is supportive.

Q69        Chair: Children Heard+Seen, a charity, is in my constituency. I have spoken to them many times about this. You are absolutely right.

Dame Rachel de Souza: We could go on. However, I also think that there is another side. As I have said, we could digitise the red book as the front, but you could be giving your screentime advice to families and to mums there, and you could be seeing dental appointments there.

I ran the Attendance Alliance in Manchester for a few years in this role, to see whether, if I brought all agencies together under the mayoral thing, we could actually move attendance. I had dentists, nurses, doctors, directors of children’s services, headteachers, everyone around the table. They were great. Everybody got involved. We moved and improved attendance, but what was remarkable was that people were saying, “God, I had no idea attendance figures were that bad. I will stop doing appointments and we’ll go and do support schools instead.” It is that place-based talking to each other. But if we cannot model it in Westminster, how on earth are we going to model it in local areas? We have got to do better.

Q70        Chair: I want to come on next to a point that you raised. In our inquiry into severe and moderate mental ill health, we heard very strong evidence that co-creation is how you create something that actually works for the people it is meant to be helping.

I ask the Committee for their patience, but this is so moving. We had a strategy day in Abingdon where youth came together with civic leaders and businesses, and they wrote us a letter—a letter for the future. I will just read a small excerpt from it.

They talked about how young people today are growing up “feeling isolated, angry, anxious, unheard and lost.” They said they feel that there is “nowhere to go, nothing to do, and no-one really fighting for them. When support disappears, problems don’t disappear with it.”

However, they go on to say that they “want today”—that was last Friday—“to not be another meeting.” They want a commitment from us to hear their voices, a commitment to work together, a commitment to create a strategy that actually reflects the reality of young people in their community today—“not assumptions, not statistics alone, but our real lives.” It was genuinely heartbreaking in the room, but also really inspiring.

What I got from the day was that they know what to do. They were bossing; the businesses, the councillors and everyone else in that room were listening to what they were saying. They were coming up with the answers themselves and then the adults just helped to make it work. What scope is there for that here? Do you feel that co-creation with children is possible, and how can we do it in a way that is embedded in the forthcoming mental health strategy?

Dame Rachel de Souza: That is music to my ears. I have 20 ambassadors, who have all applied for the role, with all sorts of different backgrounds, and normally I would not meet a Minister unless I had one of them with me. Only one in five children from our surveys think that those in power listen to them. We have to change that. They absolutely would add ideas, innovation, commitment, sharing and good comms. They are brilliant. Of course you should—of course we should.

Q71        Chair: But how can they be embedded? What needs to change in the system, rather than it being a “nice to have” or, even worse, a tick-box, where they are here as a sort of badge, but, actually, they are not involved in the funding decisions and are often not involved in the final outcomes and re-evaluations? How do we embed them into the system?

Dame Rachel de Souza: Whether you are talking about a local authority or an institution, most have their student voice kind of things, but I think it is about governance. I talk to young people a lot and say, “Be the youth governor on the proper board.” There are all sorts of things we can do to make that happen. Also, in Parliament, we should make no law about them unless we have at least taken their views, had a look at those and thought about them. There are lots of ways, and there are lots of ways that we do it in terms of what we put forward to you all. The voice is clear, and policies about children are better if children have been properly consulted and listened to and have helped to shape the outcomes.

Q72        Chair: What do you want to see in the strategy specifically that will concretely make a difference? You have spoken in the past about a joint framework of accountability between the Department for Education and DHSC. That is very similar to lines that the Health and Social Care Committee has suggested in the past, about section 75 funding arrangements between local authorities and the national health service working better. What concrete, specific policies should we be pushing to make something like that possible?

Dame Rachel de Souza: The first thing I always suggest is a joint outcomes framework. We need to be working towards the same thing, and that should be right across the public sector anyway.

Somehow, we have to get the absolutely most fruitful thing. I want a children’s strand—a strand about children—that involves both health and education, where decisions are made together with both sectors and where that actually runs through. You cannot get two different things—health to education. Education is completely diverse; it took a survey by me to find out where professionals are and what was going on in schools. Nobody knew, because it is so diverse, whereas health has been a monolith. But if we can bring those two things together, we can actually start trying to both build that joint outcomes framework and pick the things that will work. I definitely want a different diagnosis pathway for NDD. I think it is totally wrong just to put NDD and mental health in together. If there was one thing, I think that would be it.

Chair: That was going to be my very last question—so that is the thing that you think would be hugely important?

Dame Rachel de Souza: Yes, that is the specific thing. We were talking about local areas and about the unique identifier; starting with that family hub roll-out, if we can get local, place-based ways of this strategy working through, with a decent outcomes framework, it has a chance.

Chair: Lovely. Thank you so much for your time today, and thank you to both Committees.