Education Committee

Oral evidence: Mental health and wellbeing, HC 1114

Tuesday 8 February 2022

Ordered by the House of Commons to be published on 8 February 2022.

Watch the meeting

Members present: Robert Halfon (Chair); Apsana Begum; Miriam Cates; Brendan Clarke-Smith; Tom Hunt; Dr Caroline Johnson; Kim Johnson; Ian Mearns.

Questions 1 - 46

Witnesses

I: Lord O’Donnell; Lord Layard; Catherine Roche, Chief Executive Officer, Place2Be; and Mouhssin Ismail, Principal, Newham Collegiate Sixth Form Centre (NCS), London.

Written evidence from witnesses:

– [Add names of witnesses and hyperlink to submissions]

Examination of witnesses

Witnesses: Lord O’Donnell, Lord Layard, Catherine Roche and Mouhssin Ismail.

Q1                Chair: Good morning, everyone. Thank you very much for coming today, especially during Children’s Mental Health Week. For the benefit of the tape and those watching on parliamentary television, can I ask you to introduce yourselves and to give your titles?

Mouhssin Ismail: Good morning, everyone. My name is Mouhssin Ismail. I am the principal of the Newham Collegiate Sixth Form.

Chair: I should declare that I am very happy to have visited your wonderful school and seen the incredible work that goes on there.

Lord O’Donnell: I am Gus O’Donnell, former Cabinet Secretary and head of the civil service, but specialising now in trying to convince people that wellbeing should be the goal of public policy.

Lord Layard: I am Richard Layard, professor of economics at the London School of Economics. I have been working on wellbeing. I am much involved in promotion of wellbeing in schools and in treatment of adults and children for mental health problems.

Catherine Roche: I am Catherine Roche, the chief executive of Place2Be, the children’s mental health charity.

Q2                Chair: Again, I should declare that I know you well. You do a lot of work in my constituency, which is really appreciated.

We know that the number of children being referred to child mental health services was increasing steadily even before Covid. In 2020, it rose to 538,564, an increase of 35% from 2019 and 60% from 2018. We know that the report of the Children’s Commissioner, Rachel de Souza, into mental health has found that one in five children are not happy with their mental health, which rises to two in five children for some groups.

What is the extent of the problem? I find it pretty horrific. I go to schools all the time and I ask pupils what problems they face. One after another, they talk about mental health in a way that I have not known for some years. Like my colleagues, no doubt, I have had parents write to me or meet me in surgeries to tell me how their children have suffered during the pandemic. I have heard some pretty awful stories. Can I ask you to give a state of play? Do we have a mental health epidemic among young people in our country, or are we on the way to having one? Perhaps I could start with you, Catherine.

Catherine Roche: It was an issue before Covid; it continues to be an issue through Covid, and I expect that it will continue beyond. You know the stats from NHS England. It has gone from one in nine to, consistently, one in six. In our experience across the 400 schools in the country where we have teams embedded, we are seeing really severe needs. From the NHS waiting lists, we know the demand that is there.

Chair: Richard?

Lord Layard: Certainly, the thing has got much worse. When the last complete survey was done in 2017, just over 10% of children and young people were considered to be diagnosable. That rose very sharply in the survey that was done in 2020. It is important to recognise that this was always a major problem that we were not treating properly, irrespective of Covid. Of course, Covid has added to the importance of it.

Q3                Chair: Is there a mental health epidemic, potentially, among young people?

Lord O’Donnell: I would say that there is an extremely serious problem. The reason that I am nervous about the words is that, because we have neglected this subject for so long, the data are pretty awful. It is a bit like when I was in government back at the start of the coalition period. We were talking about the wellbeing of the nation, but we did not have any data. We started collecting it at the end of 2011, and we now have very comprehensive data over a number of years.

To me, one of the great things your Committee could do would be to say, “Let’s be sure that we can answer that question really reliably and know whether we are making progress against it, so that we are able to say, ‘Here is the state of the nation now.’” Most of the patchy data that we have absolutely support what you are saying: that there is a growing problem.

There is also a kind of causal link. If you think about what has been going on in the allocation of money, particularly from local authorities, you see that since about 2009—it goes back a long way—early intervention spend has been reducing. The number of youth centres and things of that sort has been coming down. The net result of all of the work on prevention, which is the key to all of this, is that, after a lag, you start to see the problems of failing to prevent and people coming through. That is where you are seeing the epidemic, as you say, in child mental health. The reason that I am nervous about this is that I do not know whether it was there before, because the data from earlier periods are rather poor.

Q4                Chair: Mouhssin, can I add to the question I asked? How do you think that these difficulties impact on children’s educational attainment?

Mouhssin Ismail: First, I echo everything that has been said. From a school perspective, and as a school within a multi-academy trust, we are seeing an increase in demand for in-house counsellors and referrals to CAMHS. That is definitely taking place. I hear that especially when speaking to colleagues.

You asked about the impact on students and their attainment. There are lost days in school. Students are unable fully to commit to their learning. There is underachievement in their progress scores and academic success, which inevitably has an impact on their future careers and on progression and transition.

Q5                Chair: Mouhssin, one thing that really struck me when I visited you was that you said that you were cautious about using terms such as “mental health”. You talked about “mental resilience”. Mind defines resilience as the “capacity to adapt in the face of challenging circumstances… Resilience isn’t a personality trait—it’s something that we can all take steps to achieve.”

How do you define mental health, wellbeing and resilience? Can you set out some of the things that you do in your school and how those could be replicated across the board by other schools, which may be doing some of them? Can you explain what you mean and what should be done?

Mouhssin Ismail: Your first question was around mental resilience and using the term “mental health”. We need to separate acute mental health issues, which require referral to CAMHS, from the pathologising of the slings and arrows of daily life. We need to be careful that young people do not catch on to words and then use them automatically to deal with things that are typically in what we would say is a pressurised environment—external demands on our environment at particular times and the mechanisms that we have in place to be able to deal with those things.

These are some of the things we focus on in schools. We take a whole-school approach, which is important. When you came to the school, you saw that in the private study facilities we set up exam desks to reduce the anxiety for students when they have exams, because they are studying there all the time. We talk about focusing on processes. We do a lot of work around examining how elite sportsmen and women deal with pressure in pressurised environments and look at how they cope with and manage that. We talk about managing processes, rather than final outcomes. Doing some of those things can help and support young people in the first instance so that they have the necessary tools to be able to deal with some of the issues.

Chair: Would anyone else like to comment on that? Perhaps I will start with you, Catherine.

Catherine Roche: I completely agree with what Mouhssin says about separating out. Wellbeing and mental health is something that all children, and all of us, should have. Children should grow up with that and it should be embedded in our school system. Where there are mental health problems, we should have access to specialist support.

Place2Be supports a whole-school approach, which we describe as “promoting positive mental health and wellbeing”. That goes right from the school leadership—the policies, the procedures and the approach that you have in the school to having good mental health—to having skilled class teachers who understand behaviour and recognise that it is the way children can communicate, and having specialist support for children who need it.

Q6                Chair: Can I add something before the other two witnesses answer? We know that in Finland, for example, they do an extraordinary amount of work on the social development of children—social capital, not just academic capital. We also know that Finland’s academic results are pretty remarkable. What role does resilience play in supporting mental health? What should we learn from Finland?

Lord O’Donnell: The Finnish example is a classic example, where they actually look after the wellbeing of the kids. Some people say that there is a dichotomy between caring about wellbeing and caring about exam results. I dismiss that completely. The evidence is very clear that kids with higher wellbeing do better in exams. They also do better in their future incomes and their future wellbeing. There is massive research that backs all of that up. I will be happy to go into it, if anyone wants to.

Picking up on what has been said, I think of it in this way. Once you start using positive words and positive psychology, you say, “What are the drivers of wellbeing?” There are lots of drivers. We know that one of the drivers of very low levels of wellbeing is mental health issues. That is No. 1 among adults, so having really good facilities to deal with mental health problems is massively important for the low-level wellbeing kids. That is the way I look at it. I am trying to get wellbeing up. One of the things is mental health.

Then there is the question of what language you use. I like the language of positive psychology, the IPEN stuff and all of that. Finland is one example—the Netherlands is another—of where they take measurement of the wellbeing of kids at school seriously. The #BeeWell programme in Greater Manchester is a massive survey that is happening now. Over 90% of schools are signed up to it and it will get results from 40,000 kids soon—at the end of March, I think—which will tell us an enormous amount about how good we are at measuring this. We can then think about ways to improve it.

Q7                Chair: Can you explain what happens in Finland, for the benefit of people watching and listening?

Lord O’Donnell: In Finland there is a very different system. For a start, they start formal school much later. The early pre-school is different. There is a lot more emphasis on total development and bringing people through. I think the phrase used much more in this country is “whole school”. As you rightly say, when we look at the PISA numbers, the wellbeing levels of our kids in school are absolutely horrific.

Q8                Ian Mearns: Of course, the staffing infrastructure in Finland is quite different as well. The number of professionals with different specialisms within each school setting is quite different from the vast majority of schools here.

Lord O’Donnell: Totally, yes. All I will say is that there are lots of lessons from Finland. You should get an expert from Finland to come and tell you about them. It starts from the business of thinking that the outcome is a very different kind of outcome from the one we have.

Q9                Ian Mearns: I am afraid to say that I have been on this Committee long enough to have visited Finland on a different inquiry in the past. There are counsellors, social workers and educational psychologists attached to virtually every secondary school.

Lord O’Donnell: I went to Finland to talk to them about setting up a nudge unit—a behavioural insights team—and why we wanted to change behaviour. For me, it was all about improving wellbeing. When that got back to them, they said, “Actually, we do quite a lot of that already,” which is true.

Chair: Richard, do you want to answer?

Lord Layard: Following up on that, our findings are that, if you are trying to explain whether somebody has a life that they find satisfying, the best predictor of that in childhood is not their academic qualifications but how they were in terms of their emotional health, measured at just one moment in time—16. The power of that in setting the course for a person’s future life and enjoyment of life is extraordinary.

The second issue, obviously, is, can schools do anything about that? There is a lot of scepticism, which is completely misplaced. We have taken the Avon longitudinal study, which is just the Bristol area, and seen to what extent the wellbeing of the children is affected by which school they are currently in, as a secondary school, at 16, and which primary school they went to. We find that the schools explain as much of the variation in wellbeing among the children as anything to do with the parents. It is really important for your Committee to stand for the view that schools are completely crucial for the wellbeing, both as children and as future adults, of the people they are caring for. That is to say that they matter.

What can be done? If we take the British framework, we actually do not have a bad framework. We had PSHE. Unfortunately, it was downplayed from 2010 onwards. PSHE is an enormous opportunity to do something serious for children, if you have a really well-defined curriculum with really good materials. You cannot rely on the inspired teacher. You must have really good materials, and you must have teachers trained to use them.

We were involved in a trial of the first four years of secondary education. It was called Healthy Minds and was a randomised trial across 32 schools. We found that it had a really substantial effect on the wellbeing of children.

We do not have to tear up our system. We have school assemblies. We have all of the framework. We just have to use it to promote wellbeing. As Gus said, it has to be a clear goal of the school. It has to be a criterion for the inspection of schools. The extraordinary thing is that the Independent Schools Inspectorate gives equal weight to personal development and academic achievement when it inspects schools. Ofsted does not. That really needs addressing.

Of course, there has to be some information base. It probably cannot be compulsory. The way it works in South Australia, for example, is that the schools are offered a system for measuring the children’s wellbeing. It is made easy because a questionnaire is provided centrally and the processing is done centrally. The information is then distributed back to the schools. We should have a system for measurement like South Australia’s. I am quite sure that it would take off, because there is huge demand from teachers to know what they are achieving, from parents and from everybody else.

Then, of course, we must have a good method of teaching it. In the so-called wellbeing school movement, this is a crucial issue when teachers are interviewed for appointment, for example. Do they sign up to the idea that wellbeing is a major objective of education? We must have that kind of framework. We will probably come on to this later, but where, even so, the system leaves some children in distress and trouble, we must have really good treatment systems. Shall I say something about that now?

Q10            Chair: We will come on to that a bit later. My final question for now is about the issue of a longer school day. I am not talking about children learning Latin until 9 o’clock at night. The Welsh Government are trialling a longer school day in 14 schools. Becky Francis of the Education Endowment Foundation said that it could “be an effective lever in improving learning and attainment outcomes.” There are some statistics, albeit old, published by DCMS and others, that suggest that if you have enrichment activities it helps not only children’s mental health but their educational attainment. Can I start with you, Mouhssin? What do you think? Is it practical? Would it work?

Mouhssin Ismail: Can I touch on a couple of points that Richard raised? Ofsted has criteria for personal development, in paragraph 241 of the handbook. Ofsted judges schools on personal development. Mental health and mental wellbeing are part of that analysis.

It is also about having structured schools. Strong structures in schools, with clear behavioural expectations that are communicated clearly and then rigorously enforced through behavioural systems, create a climate where young people can be safe and secure in school, which adds to the mental health and wellbeing of young people.

Your question about enrichment and after-school clubs is a really important point. Lots of schools already do that. In our conversations previously, I said that most headteachers would welcome the opportunity to do that. The perennial issue is funding and who will be able to pay for it.

When I was in school there were lots of clubs in the local community that were able to send volunteers to run some of those sessions. My PE teachers did not have the expertise in the sport that I loved, which was cricket, but because we had someone who was connected to a local cricket club, I was able to be invited to the club and continued to have opportunities. Lots of my friends had similar opportunities.

I think there is a missed opportunity in secondary schools to utilise youth centres. In Redbridge, we have Frenford youth club, which is a fantastic hub with state-of-the-art facilities, but I do not think that schools utilise its experience and resources enough. I know for a fact that the CEO there, Irfan Shah, would be more than willing to reach out to schools to run some sessions. Using and utilising the sports facilities and sport coaches around to have extended days would remove some of the burden that schools are facing in workload and finances.

Chair: Can I put the same question to Catherine?

Catherine Roche: Developing the whole child—looking at school as a place where you engage with art and wider cultural activities—is hugely important. The challenge is how to make it work financially. For staff in schools—

Q11            Chair: In principle, do you think it is a good idea?

Catherine Roche: It is probably down to what else is available within the local community. It really is. It depends.

Chair: Can we hear from Richard and Gus?

Lord Layard: I think it is an excellent idea. Obviously, the danger is that it would just be used as an excuse for yet more exam preparation.

Q12            Chair: I am talking predominantly about enrichment.

Lord Layard: Absolutely. It is a great idea, if it is strongly linked to the introduction of wellbeing as an objective for schools. The idea appeals to parents. If it is linked to wellbeing, that is a double whammy that is worth achieving and going for.

Lord O’Donnell: There is a mass of examples. Pro Bono Economics, of which I am chair, has done some brilliant work with Place2Be, which is fantastic. We have done some work with Magic Breakfast, which brought people in. I see the nods; a lot of you know about this. There is a real issue. If you give kids better breakfasts, their attention is better and their exam results go up. All sorts of good things happen.

Like Mouhssin, my school had extracurricular activities. I would have died if they had made me do more Greek—sorry, Prime Minister, but I had had enough. There was sport. There was volunteering. There were things like chess and football. There were all sorts of different things. I love the idea of using volunteers to come in, because you have the fixed costs; you have a school, you have the facilities, so you can bring people in. I do not want to add to the burden on teachers, because I think that they are doing a great job. We want to combine those two forces. We know that the volunteers’ wellbeing goes up. That is the really interesting thing. They love doing this. They see results.

As a parent, I would love my kids to have a choice about the things they do after school. Some of them will want to do cultural things. Some of them will want to do things that we might think are less developing but are more interesting, such as understanding issues to do with gaming and artificial intelligence. There could be all sorts of different things. Different kids have different abilities. We need to expand those activities.

Chair: I will now bring in my colleagues, starting with Miriam.

Q13            Miriam Cates: We have covered some of the things I was going to ask about, so I want to dig a bit more deeply into a couple of things that have been raised, starting with Richard and Gus.

You mentioned PSHE and its potential to teach the kinds of skills and resilience that will help children with wellbeing and mental health. It seems to me that at the moment PSHE is a wild west. It is being used in various ways, in various schools, to teach contested political ideologies, in many cases, rather than what we would traditionally have called the virtues: resilience, perseverance, humility and tolerance—the kinds of things that actually give children the foundation for good, lifelong mental health. Richard, what reforms could be made to PSHE to achieve its potential as something that could do what we have just said, rather than being this wild west?

Lord Layard: There are lots of things. To start with the long term, it is incredible that it is not a specialist subject in secondary schools. That is No. 1. If you have to be a specialist historian to teach history, you have to be a specialist life skills person to teach life skills. It must also be a sizeable chunk of the preparation for every single primary school teacher. It should be a small chunk of the training for every secondary school teacher, but it should be a specialism as well.

Of course, there must be a clear framework for the curriculum, with back-up materials available—not just one set of materials, but all kinds of materials. Promoting the development of materials is an active issue for the funding of research and development by the Department, through universities. Obviously, there must be strong support from the centre for quality and the promotion of that through inspections and support. You have to lift this from being one of the least prestigious jobs in the Department for Education to being the most prestigious job in the Department for Education, because it is at the forefront of progress.

We should mention one basic point that I do not think anybody has mentioned. If you want to improve academic standards, improving wellbeing is one of the best ways of doing that. This is not rhetoric. This is the result of about 200 trials of wellbeing programmes—proper randomised trials—where researchers measured the impact of the wellbeing programme not just on wellbeing but on academic performance. Actually, the effect on academic performance is as big as the effect on wellbeing. We absolutely have to overcome the idea that it is either/or. It is both/and.

Chair: If witnesses would like to intervene, they should put up their hand or let me know, as you did, Mouhssin.

Mouhssin Ismail: I agree with everything Richard has said. The only thing that I would add is that the multi-academy trust model that we now have in schools is a fantastic vehicle for mobilising professional capital and centralising some of the things Richard talked about. By codifying the curriculum and then distilling it across the multi-academy trust, you can get consistency and sharing of resources and understanding. The multi-academy trust model is a good vehicle for doing that and achieving some of the aims Richard was talking about.

Q14            Miriam Cates: That is great. The second thing I want to pick up was about Ofsted’s focus on academic results. In comparison with other countries, we have an incredibly narrow focus on the purpose of school as being to get good A-level results to get you into university, which is apparently the only key to success. It seems to me that that in itself has a detrimental impact on young people’s wellbeing, because they have this one chance of success, and if they fluff their exams that is it—they are a failure. Obviously, that is my interpretation of it. To what extent do you agree? To what extent do we need to diversify our understanding of success in this country, alongside direct improvements to PSHE, whatever it may be, in order to increase overall wellbeing and reduce the pressure on children?

Lord O’Donnell: Your two questions are very related. If you think about it, the exam results that get you into university and all the rest of it, which people think lead to higher incomes, are things that we measure. We have exams. We measure them, maybe not as perfectly as we would like, and somewhat subjectively. Where is the measurement of PSHE? Where are we measuring the wellbeing of the kids—the outcome of all of that? Are we getting across the values that we want to get across? That is not really there.

That has to be part of it. There is this model in people’s heads: “I’ve got to go to a good school. I’ve got to get really good A-levels so I get into a good university and go on to get a high income, and that makes me happy.” That is such a wrong model. There is some brilliant work that Richard has done. There is also a lovely paper by Jan De Neve and Andrew Oswald—using US data, unfortunately—in the Proceedings of the National Academy of Sciences that looked at incomes at age 29 and people’s wellbeing earlier. Basically, if you improve their wellbeing, it gets you there. That is more important than qualifications. They even looked at siblings, so they got rid of all of the socioeconomic effects. There is a really good causal story there. The causation is both ways. If you improve people’s wellbeing, they have higher wellbeing, which is brilliant in itself, but also leads to their getting better jobs and having higher incomes. Of course, it goes the other way around; the higher income feeds back into wellbeing.

We should never underestimate that causal thing. At PwC, I talk to them a lot about employment strategies. Employers are looking for people who have good interpersonal skills and things like that, so they are doing a lot more recruitment of people who do not come through the standard university thing. As an aside, I asked Warwick, which I went to, “How do we determine the relationship between your A-level results and your degree?” They said, “Don’t be daft. In economics”—which I did—“they all come in with three A*s. There is no variation in their A-level results, so we can’t tell you the answer.” I asked, “Do you think that A-levels are a good predictor of how well they will do?” They said, “We don’t know. There is probably something a lot better. But, actually, it’s great, because no one’s going to argue.” If we could come up with something better, that would help a lot.

Miriam Cates: Catherine, can I bring you in?

Catherine Roche: I was going to make the point about what employers need and thinking about the workforce in the future. Social skills, the ability to work in teams and good communication skills are all aspects of good mental health and are necessary in the employment market.

Q15            Kim Johnson: Good morning, panel. I want to pick up a point that Mouhssin made earlier about early intervention and prevention. A lot of local authorities would have delivered a whole range of services to provide that level of support. However, nearly 12 years of austerity have had a major impact on schools and communities. What do you think needs to happen to provide a level of support at that early stage to support young people with their mental health and resilience?

Mouhssin Ismail: There are two different stages to that. Ipsos Mori released a report a couple of days ago about understanding public attitudes to early years. They were talking about the support needed for parents and providing them with additional areas and places where they can have strong mental health and mental wellbeing, because they do not see the two as different. You cannot have children with strong mental wellbeing and at the same time parents who do not. Lots of work needs to be done around that, with provision there as well.

In relation to schools, one of the things we have been able to do is buy in counsellors to be able to support young people within school. As I said at the start, the demand is outstripping the supply. Unfortunately, we do not have enough capacity to be able to meet all of the students’ needs within school. Even referring to CAMHS, we are finding that the waiting lists are significantly long and students who need support and help are not getting it in a timely manner.

Clearly, there needs to be work at school level on the stuff that we talked about—training teachers and being able to have conversations. At my school we have mental health ambassadors constantly giving information, advice and guidance. When we have to make referrals, there need to be people who are experts and can step in and support schools and young people.

Q16            Dr Johnson: Thank you, panel, for the very interesting answers so far. I want to ask you about physical education and experiential learning. Last year there was a focus on the Duke of Edinburgh’s award due to the sad death of Prince Philip. There was a discussion about where that had come from through Kurt Hahn’s principles of education. He very much took the view that young people need to be pushed slightly beyond their boundaries and challenged, and then to see that they had managed to achieve that challenge, thus boosting their self-esteem and their ability to recognise that they can do things they think they cannot do. I wonder whether we have lost that in aspects of our education system, and whether you think it would help wellbeing if we were to return it to a widespread educational forum.

Catherine Roche: I think that is back to the point about resilience. Resilience is the ability to be able to cope with challenge. Pushing yourself outside your comfort zone is a good thing for a child to be able to do. You then realise that you can learn from that, and are able to deal with setbacks, because they will happen. That really is part of wellbeing. For some children, you might do that and achieve that through sport. Something like the Duke of Edinburgh award with the multitude of activities that you can do is a really good thing.

Mouhssin Ismail: One of the things we talk about at school is being fearless learners, and vocal learners as well, with stickability about finding things that are challenging and difficult. Within the curriculum and in lessons we develop that resilience through a number of micro ways. For example, we have a no hands-up policy, which is becoming ubiquitous in most schools now. Students are selected. Removing fear about answering questions and then teachers being able to unpick, and all the little things that build up a student’s confidence and resilience through the school day, as well as the big things like going on Duke of Edinburgh or cadets, lend themselves to it. We should not underestimate the daily interaction that teachers have with their students in developing mental resilience and mental wellbeing.

Yes, I applaud, and it is great to have, all the big-ticket stuff, but having calm, structured schools, high-quality learning and teaching and a rigorous curriculum all make a big difference to learning as well.

Lord O’Donnell: Physical activity dominated my life at school. It was far more important for me to play football than to do exams, which was probably a bit of a mistake. I am a massive fan of more physical activity and broadening that scope. I remember going to a school in Liverpool where it was all about the girls doing lots of dance classes. They did not have so many other sports that they were doing, but they were very keen on dance. They would get them into that. There was lots of physical activity. That leads to better health and better outcomes all round. I am a big fan of there being more emphasis on that, particularly when you look at issues like child obesity.

The cost-benefits of these things are massively high. I say this as a former permanent secretary of the Treasury. These things are great fiscally because they save you lots of money down the track. If you get someone in the right place there is less crime and fewer health problems. Ill people who do not have qualifications and end up going down a route of crime or whatever are really expensive to society, and they are not great for themselves. There is a double hit.

Most of the cost-benefit studies that we have done in PBE about prevention activities give you very high numbers, like six to one. The problem with all of this is that we are talking about spending money now to save money later. That is always difficult. I remember that at the Treasury we were inundated with spend-to-save initiatives. That is the crux of it, which is why you get this issue with local authorities. There are problems now, which mean that you cut back on the things you can now, and the future voice does not register. One of the problems with democracies is that the unborn do not vote. Therefore, you have an issue about there always being some kind of bias towards the present. Good Governments should offset that bias.

Q17            Ian Mearns: There is a problem in that, inasmuch as it is a great idea moving money upstream to do the preventive work for the future, and I totally agree with that, but the problem is convincing Treasury officials that you can do that while also dealing with the problems that we already have now, which need to be dealt with because the people who have the problems now did not have the benefit of that upstream funding in the past. Is that a hump that we have to get over? How do we deal with that?

Lord O’Donnell: In some cases it is a hump if you have underinvested in prevention for a while, with a lag that is going to hit you. It makes sense to borrow to spend more now and get rid of the hump later. The Treasury is always open to these things. I am a bit defensive about this. One of my first jobs was with Norman Glass on the Sure Start programmes in Treasury. When you show them the cost-benefit ratios of these things, the main thing is that you have to be hard-headed about it. You have to put the evidence base.

Chair: Richard?

Lord Layard: I would like to follow up on the support issue that was raised. The people in the most trouble are the people with diagnosable mental illness. We are talking about well over 10% of our children. I suppose one of the most shocking things—certainly in the top half dozen shocking things about our country—is that only a third of those children get any form of specialist support, which is much worse even than the situation for adults. It is unbelievable that we have that situation.

CAMHS has such a high threshold that, unless you are stabbing your sister or something like that, even if you are sent, you are assessed as not bad enough to be treated. Until recently, there has been no proper, professional treatment for anybody below the CAMHS threshold. That was similar to the situation for adults, but over the last 15 years we have developed a system of improving access for adults to psychological therapies for a lot of common mental disorders. It has been pretty successful. It grew very rapidly from the start.

The Government were urged to do a similar thing for children. The Green Paper has mental health support teams in schools to be developed on the same model as the adult programme, with a proper psychologist leader and trained workers, but working in schools rather than in clinics. That is a very good thing. I do not know if it was the Treasury or not, but the ambition of the Green Paper was to cover a third of the country by 2022-23 over a five-year period. That is an incredibly low ambition. I would have thought that one of the most important things that your Committee could do would be to say that in the next Parliament we have to cover the whole country with proper mental health support teams in schools. That is really essential. It is so easy to justify, even in terms of savings.

For example, Martin Knapp and his colleague David McDaid wrote a paper. Some Committee asked for it, but I cannot remember which. I can send you the paper. It showed the savings because of the impact of, particularly, behavioural problems, and ADHD, somewhat less so. Let’s go through the mental health problems. There are behavioural problems, often linked to ADHD, with a completely disorganised approach to work as well as behaviour. That is about half of the 10%. The other main half is anxiety, of which the most important is social phobia. Social phobia is the main reason for absence from school. It is barely recognised as an underlying cause. Then, of course, depression comes in during the teens. These problems are having a terrific impact on families. We all have relatives who have children in this situation. It is a major issue in our society, but when do you read about it on the front page of a newspaper?

Q18            Dr Johnson: I have two questions. First, you mentioned sport, Lord O’Donnell. Sport is really important. I went to visit a school in my constituency—St George’s Academy in Ruskington—to watch the Jon Egging Trust, who were doing a JET programme with disadvantaged young people in that school. It was about teamwork, co-operation and social skills.

It was a truly fantastic thing to watch and to see how well the children were benefiting from it. The problem was, obviously, that the numbers are limited. The issue in scaling it up appears to be time in school to do it. Do you think the way we organise children’s time in school, and in particular whether the balance between sitting at a desk learning and the more practical doing activities, is not quite as it should be? Do you think we could get better academic results and better wellbeing results if we were to rebalance that?

Lord O’Donnell: All the arguments we have been making say that, yes, if you get the wellbeing up, the exam results follow. Certainly, it is getting the mix right of sedentary activities versus getting out there. All of these things are associated with social skills with other people, learning to co-operate and learning to lead teams. It is all of those things. That is what all of these kinds of areas, and sport too, to be honest, give you. I am definitely a big fan of having that mix of things.

I genuinely think that the future will be about our interpersonal skills. If you think about what AI is going to do, it will be a lot of the individual things. There are all those people training as accountants, but a lot of the things that are going to be done by auditors are actually going to be done by AI. A lot of people are getting qualifications that will not be useful.

What is difficult will be spotting where the actual numbers do not make much sense, and being able to think about the humans who are putting in those numbers and the kinds of things they might do, on what constitutes fraud for example. We are going to need the personal skills of understanding humans much more in a world where a hard chunk of routine operations will be done by AI.

Chair: Mouhssin, do you want to come in?

Mouhssin Ismail: Yes, I want to pick up on that. One of the things we have not mentioned is the importance of having someone on the governing board who has responsibility for some of the matters that we are talking about.

In relation to social skills, we have managed to reach out to lots of companies in London who are more than happy to send mentors to run sessions on developing soft skills. That is another untapped area that schools could really utilise, but it requires the schools to be on the front foot, to be able to make contact with the corporate social leads and to be able to plan what that looks like. A lot of the time schools rely on the companies to dictate what the programme or provision should be. If schools could say to them, “This is our wish list. How much of it are you able to do?” you would be surprised at how many companies were actually willing to come in and do that.

We would also be able to tap into their CPD programmes. Companies tend to have fantastic professional development. They tend to be ahead of schools most of the time. They have been willing to give it to us for free. They send people into our schools to train our students and our staff, simply because we send an email and ask for it. Again, there is an opportunity for schools. I think the MAT model really allows that to happen because they can capitalise on their bargaining position, their reach and their influence.

Q19            Chair: You are lucky because you are in a city, so you are able to access that. Another area would not have those things.

Mouhssin Ismail: I completely understand, but in our unique situation, in schools in London that still have that, there are obviously opportunities to do it.

Q20            Chair: Going back to Caroline’s question, do you think the balance between learning at a desk and wellbeing activities is right at the moment, or should it change?

Mouhssin Ismail: I concur with everything that was said, in that if you have strong mental health and mental wellbeing you are going to have strong academic results. However, as somebody who has benefited from a strong academic background and has used education as a vehicle for social mobility, I value strong academic study. The change in Ofsted’s guidance around focusing on curriculum development and the breadth of curriculum as opposed to just academic success is a welcome addition to allow us to incorporate some of those things in the school curriculum.

Ian Mearns: Replicating the model that you have talked about would be very difficult in other parts of the country. In the north-east of England, for instance, there are only about 1,000 companies with more than 50 employees. The sort of corporate capacity to deliver that across an area like the north-east of England would be very difficult from the perspective of business. I know that you are situated in a poor area of east London, but you are in close proximity to an awful lot of assets of that nature by comparison.

Q21            Dr Johnson: I have a final question, which is about parents. School is very important in a child’s life, but parents in my view are more so. People will be spending a lot more time with their family than they will in their school. With the issues and problems that you have just described in our children’s mental health, what can parents do? What information can we provide them with? What support can we provide parents with in schools to help parents support their children?

Lord Layard: That is a very interesting question. Obviously, the lever we have is the school system. In wellbeing schools, parents are involved in deciding what the objective is for their children, which is their wellbeing. There is a code which the parents subscribe to, as well as the teachers and the children, for the values of the school and how you are to proceed.

There is more that could be done. It is very interesting that you raise that question. Obviously, the other lever we have is the NHS. Parents are constantly turning up at general practices not knowing what to do about their children. A better mental health educated set of general practitioners would help. As you know, one of the most peculiar things about general practice is that at least a quarter, or more, of their time is spent on mental health issues, but the only training they get in mental health is in severe mental illness, and those are mainly not the people who turn up at general practice. I think we should be using general practice as a lever.

We should also be educating children to be future parents. I want to say a word about where we have got to now. We were talking about the importance of personal factors at work. It is great that you raise the issue of non-work, which is more of our life than work. We do not want to be dragged down into the position where we only justify things by their impact on work.

We are really talking here about producing people who are themselves happy and make other people happy. That is really what this is about. Therefore, it involves a great deal of self-knowledge and ability just to manage yourself in such a way that you appreciate and enjoy your life. It also involves turning you into a decent person in your relationships, especially with your family as a child and as an adult.

In the Healthy Minds programme that I mentioned, we do not do just the standard SRE topics like social and emotional learning, sex and health, but things like media management. How do you manage your relationships with social media? That is incredibly important to your mental equilibrium. We do things like understanding that some people you meet, and maybe even you, go through periods of serious mental illness. We do mindfulness training to enable you to calm your mind. We do training for you to be a future parent. The whole person is what we are trying to produce, not just a future worker.

Lord O’Donnell: Could I add one key point? If you are a parent, what do we tell you about, “What school should I choose?” We publish detailed league tables of exam results. That is what we give parents. We say that is what is really important. If I said to you as a parent, “I would love to get my child to a school where they most improve the wellbeing of their kids,” how would I know? I would not have a clue. Until you start measuring these things, you are not going to get there.

Q22            Dr Johnson: I dispute that the only levers we have are the education and health services. Actually, lots of parents contact me who are very worried about their children and what support they can give their children. If we had research and evidence into what parents can do to support their children, we would be able to say to parents, “These are the things that you can do at home to help,” and empower parents to help their children, because nobody is going to love a child more than their parents.

Catherine Roche: The role of parents is hugely important, especially in primary schools. We often immediately go “mental health” and head for secondaries, but in primary schools it is engagement, input and, as you say, helping parents to see what they can do themselves, especially for lower-level issues before they escalate and become more serious. With early intervention prevention for a primary school, it is much easier to engage with parents. We see that with our teams based in schools. Parents are often willing, when you are there in a non-judgmental way to be able to provide advice and guidance. This is where technology can greatly help us.

Richard picked up on the evidence about behaviour and cost, and mentioned the cost of behaviour problems. That is one of the most costly routes. The evidence shows that, if you work with parents and help them with parenting skills and a structured approach, it can help to alleviate the challenges and conduct disorder.

With technology we have produced an online training programme. The key thing is to show parents how to do it. It is not a theoretical, “Have a conversation with your child,” but modelling how you can do that. Give them some of the language and vocabulary. It really works. We are building up the evidence base around that, because parents can play a huge role before issues escalate.

Q23            Chair: Do you have the data on the improved parental outcomes?

Catherine Roche: There are other studies, and we are working on that ourselves with our parenting skills programme.

Q24            Chair: If you can send it to us, that would be helpful.

Catherine Roche: Yes.

Q25            Tom Hunt: We talk about spending money now to save money later. There is probably no better example of that than investment in special educational needs. We are doing work concurrently on an inquiry into prison education. We found that about 40% of people in prison have special educational needs. It really illustrates the importance of doing that.

I am somebody who is very appreciative of the fact that not all young people’s brains are wired in the same way. I was dyslexic and dyspraxic. I sat at the back of a classroom with eyes glazed over, not understanding why I could not process information in the same way as other people. I engage a lot with young people with autism and other disabilities. They feel there is a lack of understanding in the classroom for their particular condition and the way their brain works. Not being understood contributes towards their mental health problems. If they feel like the system is failing them, they turn against that system, which, I guess, feeds into that point about our prison education inquiry.

To what extent do you think, particularly for young people with special educational needs and disabilities, failings potentially in special needs provision are contributing not just to them not achieving their potential academically and in living in the world, but also to their mental health problems?

Catherine Roche: It is so important for class teachers to be able to understand each individual child, and to have the time, training and understanding around child development. It comes back to teacher training and thinking about each individual child and how you engage and listen, and their behaviour. If you are sitting at the back of a classroom with your head down and not engaging or are getting frustrated because of the way things are going in the classroom, a class teacher has to understand that that may be about your own needs, and take time to understand, and then put in place, what is needed for you to be able to engage or to communicate in a different way.

Mouhssin Ismail: To add to what Catherine was saying, it is about training and recognising some of the signs, and not treating all the behaviour as behavioural issues rather than maybe an underlying issue that needs to be investigated. Expert help needs to be sourced. Obviously, schools have designated SENCOs as part of the SEND code, and within that there is an obligation for schools to be able to intervene and support young people with SEN. Undeniably, if young people’s special education needs are not being met, it could obviously reach into mental health and mental wellbeing as well.

Lord O’Donnell: Sometimes they are not picked up, as has frequently happened, and the result is that kids get excluded. That is a really bad route to go down.

Q26            Tom Hunt: A really important thing is early diagnosis. I am involved with a few other colleagues in trying to make it that every primary school kid, potentially at the age of seven, gets diagnosed for dyslexia. Of course, it should not just apply to dyslexia but to everything else. Frankly, until you know what you are dealing with—both yourself and your teachers—it is very hard to be understood. Not being understood and knowing that you are a bit different, but you do not know why, is incredibly important.

I want to make a final point about social media, which was touched on earlier. This seems to me very significant, particularly when it comes to things like bullying. I left school when MSN Messenger was the main thing. When I went to university, Facebook came along. I never really experienced it in a big sense.

I can imagine that, if you were the victim of bullying at school back in the day, at least when you got home you could feel there was a bit of escape, but with social media and all the different devices some young people must feel that they can never escape. To a large extent, it is hard to do anything because social media is what it is, but what further work do you think could be done to try to protect young people from some of the harms of the online world in which we live?

Mouhssin Ismail: You are absolutely right. I think Sam Freedman wrote an article recently about whether social media is moral panic or mental health crisis. He came to the conclusion that in the absence of any further evidence there is a strong link between social media and mental health and mental wellbeing issues at the moment.

Schools are cognisant of that. There is lots of work taking place through tutor time, mental health ambassadors and PHSE sessions, educating young people around the dangers of social media, and as part of keeping children safe in education and our safeguarding duties. In the Ofsted handbook, there is clear reference to schools having robust policies that are implemented consistently, and a zero-tolerance approach to issues of bullying. At the same time, it is about making sure that the victim is supported. Where you find that the person who is doing the bullying is in school, you should provide education and support for that young person as well.

Schools are already doing quite a lot in that field but obviously a lot more can still be done, especially with the links that I have just talked about in terms of relationships.

Q27            Chair: On the social media issue, which I was going to ask about later, when I visit schools and speak to pupils, every time I ask them, “What is causing your anxiety or problems?”, they say, “Social media, social media, social media.” I think that the social media companies bear a lot of responsibility for this. TikTok is almost like crack for kids. It is sexualised content. They have these images all the time, which the kids are trying to adopt. It is not just TikTok but some of the other companies as well.

Should there be a social media tax? For example, if you taxed them 2% you would raise £100 million, which you could use for mental health resilience and the funding for some of the activities for a longer school day. Is it your assessment that social media is damaging for children? Is one of the answers having a special mental health tax, if you like, on social media companies to deal with this? Maybe we could start with you, Richard.

Lord Layard: It is a very attractive idea, but I am not sure that it would do much for the problem. It would be a good place to get some money from.

There is no doubt that it is a major source of increased mental health problems. There is very good work in the States by Jean Twenge. There are at least 10 proper, randomised and controlled experiments, where people go off Facebook and you see that their happiness improves. It confirms that this sudden spike in mental illness is so coterminous with the spike in the use of social media that it is quite reasonable to think that it is a major factor at work.

One should think about it as just one in a series of new technologies that have enormous positive features and enormous negative features. I always think of the motor car. The motor car was killing 7,000 people in 1930 in Britain. At that time, nobody could have imagined how the whole life around the motor car and the use of the road would be regulated. It was thought to be a basic part of human freedom to ride the road when you wanted and to have the car you wanted. How could anybody regulate the car you buy?

In 50 years’ time, this will be a highly regulated area. There will be all sorts of rules. Can you put on how many people like a picture? Can you have a system for counting the number of friends? All of the things that are causing such horrendous pain will be, in one way or another, regulated. It has to happen, but it will take a lot of research and a lot of argument to find out what the crucial levers are, but it has to be.

Lord O’Donnell: I agree with Richard that the answer is smart regulation, but it is very difficult at the moment because these are new media. They evolve. You can think about trying to clamp down on one area and then, as you say, TikTok comes up, from a very slow base, incredibly quickly. Things change quite radically. We need to think what basic things we could do.

With the roads, the first nudge they did was to put a line down the middle of the road so that people would stick to their one side. It was something as fundamental as that. That was a clear nudge. We need to think about things that behaviourally will get people to use social media in a better way. More regulation is absolutely going to be part of it. Some of the things that go on—the trolling and the bullying—are just horrific. I never had to live with this, as you were saying, Tom. I am a bit older than you, so there was not even any Facebook.

Mouhssin Ismail: The biggest issue that we are seeing in schools is to do with social media and parents not having awareness of what their children are up to with social media until 2 or 3 o’clock in the morning. We know that 75% of 12-year-olds have access to social media platforms. I am not a policy expert, but for me it seems that the solution has to be to try to reduce, or at least regulate, access to social media platforms for students up to a particular age, and to educate the parents and the young people at the same time.

It is similar to what we did with cigarettes. Now, a large number of young people do not smoke any more; it has dropped off a cliff. It has to have that kind of approach, where we explore the dangers of social media and make them clear both to students and to parents. Lots of them do not know what their children are up to on social media, on phones in their bedroom. They think they are studying until 12 o’clock in the morning.

Catherine Roche: For some young people social media is a way of connecting with friends and peers. I agree with what everybody has said. It goes back to resilience. We need to build the resilience of young people in the real world so that they can reach out to a trusted adult or peer and use social media positively. It is here to stay.

Q28            Dr Johnson: What use do you think phone policies are or can be in schools? I know that my daughter loves me not for the fact that I have put a block on her phone so that it cannot be used after 10 o’clock and before 7 o’clock without her specifically texting my phone to ask for permission to use it at that time of night, and then I can give her an hour or 15 minutes or open it up completely, depending on what I think. Would more widespread awareness of that technology help?

When we looked around senior schools, we talked to them a lot about the access to phones policy. They vary quite a lot. I know that a former Secretary of State suggested that children should not have their phones in the classroom at all. There was a lot of media discussion about that. Would it be beneficial for children to hand their phones in when they arrive at school, and get them back when they leave?

Mouhssin Ismail: I support the banning of phones in schools. I do not think it is going to solve the problem because, ultimately, they can have their phones in the evening. But in school, to allow them to concentrate and focus on what they are doing, which is to get an education and to participate fully in school life, I would remove all phones from schools.

Q29            Chair: Do the children put phones in lockers?

Mouhssin Ismail: Mine are sixth-form students. At 16 to 18, we allow them to have phones in certain areas, but for most secondary schools in the multi-academy trust there will be a blanket ban on mobile phones. If it is seen, it is confiscated.

Lord O’Donnell: There is one trick from the behavioural work that would be useful, which is sorting out what the defaults are. As we did with auto-enrolment on pensions, you are defaulted in now as opposed to having to think about, “Do I want to save for a pension?” It has made a massive difference, far more than the billions we were spending on tax relief.

You can think about getting the defaults right on the way phones and social media are set up, and people will have to explain why they are moving away from those defaults—human inertia will try to keep them where they are—so that it is defaulted that the parents are in charge of certain things and the parents have to change it. Exploring ideas like that will be useful, but in the end you are going to have to regulate. You were talking about cigarettes, Mouhssin, but the way we did that was by putting the price up massively and by increasing the tax. We cannot easily do that with social media.

Q30            Dr Johnson: Essentially you are suggesting that when a phone is purchased, it is identified as a child’s phone or an adult’s phone and then it is set up in a particular way accordingly.

Lord O’Donnell: I am not an expert in this area. I would say get the experts, get David Halpern and the behavioural insights team to look at it, and sort out how you could do it.

Catherine Roche: You also have to teach young people. I am a parent, and you find that the restrictions change at 13. You no longer have the control that you had in the way it is set up. We have to teach young people how to manage it well rather than just put controls around it, because at some point they are going to be adults. At some point, we have to let go.

Chair: They will get round the controls, most probably.

Catherine Roche: Absolutely.

Chair: They will just turn on VPN or whatever.

Q31            Kim Johnson: Panel, it is nearly five years since the publication of the 2017 Green Paper on children and young people’s mental health and the establishment of mental health support teams in schools. I would like to hear from each of you about what you believe has been transformative with those teams and what more needs to happen. What evidence is there that they are actually working? I will start with Catherine first, please.

Catherine Roche: I think it is important. There were three parts of the Green Paper, the first being the training for the designated mental health leads in schools, which has only just started. We have the commitment for funds being pushed out for one third of the schools in the country. We really need that to progress for the other two thirds because it is a key part of a school being able to make the best use of the resources through the mental health support teams.

The support teams are a good development, but as Richard said earlier there need to be more and we need to gather the evidence on how well they are working on the ground. Some of that is down to local implementation. Are they connecting with the services that in some cases, and Place2Be is an example, are already working in schools so that we make best use of the resources, and that the teams are additional to what is already on the ground?

Lord Layard: To have a good service there are two crucial steps. First, you have to train the workforce because the workforce was not there. That has been set in motion, led by Peter Fonagy, and has gone fairly well. The problem there has been that due to funding, I must say quietly, the decision was that the level of skill would not be high. For adult improving access to psychological therapies, you have two types of therapies—so-called high intensity and so-called low intensity. For children, the only therapies at the moment are low intensity. That has to be changed. I know they are beginning to try to change it.

The next step is to set up a service that is professionally managed, in the sense that there is, first, a really good system of supervision so that people take their cases to a supervisory conference and there is a proper supervisor of the whole service. I think that has gone fairly well. It is right that the thing is within the NHS. It has to be managed like an NHS service, where they understand how to have that kind of supervisory structure.

The other crucial issue in mental health is measurement of outcomes. The outcomes are being measured in mental health support teams, but they are not being measured in CAMHS. That is a shocking thing. There is a general lack of outcome measurement in mental health services in Britain, except in IAPT and mental health support teams. If you can get measurement of output in CAMHS, that would be a very helpful outcome.

The main problem has been the incredible slowness and lack of energy that has been behind it, which reflects the Green Paper itself. As I say, it was not ambitious. The Green Paper objectives are more or less being delivered, but they were not ambitious enough. If your Committee can insist that the programme becomes nationwide by the end of the next Parliament, I think that would be very good.

Kim Johnson: Thanks, Richard, and thank you for raising that point about CAMHS. Gus, do you have anything further to add?

Lord O’Donnell: I endorse everything that Richard has just said. They were very unambitious goals. There is no emphasis on outcomes. Anything you can do to push this nationwide will be massively important.

Chair: That is one reason why we are doing this today. We will question Ministers.

Kim Johnson: Mouhssin?

Mouhssin Ismail: I have nothing further to add.

Q32            Kim Johnson: Catherine, we know that there have been issues about inequalities across the board in terms of mental health. Marginalised and disadvantaged groups have been impacted by Covid, particularly in relation to the digital divide, the increase in poverty and bereavement. What I would like to hear from you is what needs to happen to make sure that those children and those areas are better supported.

Catherine Roche: We need mental health support in the schools. We know that there is a disproportionate impact for children who are in disadvantaged areas. We know how adverse childhood experiences and the layers of those challenges build up, which means that children are then at greater risk of developing severe mental health problems and at a greater risk of exclusion from school. Having support specifically in those areas of particular disadvantage is what is needed.

Q33            Kim Johnson: At the moment, we are dealing with a bit of a postcode lottery, as identified in the Children’s Commissioner’s report yesterday. If you are a child in the Isle of Wight, £165 will be spent on you, but if you are a child in Knowsley, only £18 will be spent. What needs to happen to ensure that there is levelling up right across the board so that every child has access to the same level of support services that are needed?

Catherine Roche: Emphasis and accountability around investment in children and young people’s mental health services. It is having visibility of that and accountability for it.

Q34            Kim Johnson: The other point I want to raise is the gendered impact for some girls. We know that sexual harassment in schools impacts on young women. Again, what needs to happen to make sure that those issues are effectively dealt with, and that young women’s mental health is not impacted because of some of these issues?

Catherine Roche: There is a whole range of issues around inclusion. We talked earlier about the PSHE and RSE curriculum. There is a whole range of issues, whether it is about girls’ sexuality, different cultures or racism. All of those areas are hugely important and can be integrated in a structured PSHE curriculum.

Kim Johnson: Thanks Catherine. Richard, do you want to raise a point?

Lord Layard: Obviously, from children’s point of view, the mental health of their parents is incredibly important. There are whole areas of mental health problems that are simply not covered at all by the NHS, such as domestic violence. There are good treatments for domestic violence that are simply not available on the NHS. There is drugs and alcohol treatment. Basically, somehow or other, it was mainly outside the NHS. It is mainly drying out, but it does not tackle the long-term psychological problems that lead to drugs and alcohol.

We have to have a major expansion of mental health services for children and adults. The phrase we talk about is “achieving parity of esteem”. There is a simple logic about parity of esteem. It means that one lot is behind the other lot. If you were to achieve parity, this lot has got to grow faster than that lot. The share of national health expenditure on mental health has to rise. I hope you will soon be confronted with an amendment from the Lords to the Health and Care Bill that says that that proportion has to rise. It would be very good for children if you could support that.

Lord O’Donnell: Working with the current Government’s stated aims, the levelling-up White Paper makes it clear that inequalities and wellbeing should be tackled. That relates back to the parents and therefore their children. That is a hugely important part of it.

When you are talking about where the money is going to come from, I think, Chair, you mentioned volunteering, and people have talked about it. The social capital that we need is relatively small. It would be good to increase that social capital, by which I mean community groups, volunteering groups and the help around schools. It is all of those sorts of things.

If you look at how the Government are allocating the money on their levelling-up stuff, it is nearly all on physical capital; it is about roads and transport and stuff like that. Actually, reprioritising to give more towards social capital and communities will make a massive difference. That is one of the things that I will be arguing very strongly. When they say that there is no money, I will say, “Actually, you could do this. You could reprioritise.”

Q35            Chair: Have you told Michael Gove this?

Lord O’Donnell: I would say it is a consequence of his levelling-up White Paper that they should be doing that. I am working with a commission, as you know, on unleashing the potential of civil society. It is one of our strongest conclusions. If you read the stuff that, probably, Andy Haldane put into that levelling-up White Paper, I think it backs that up very strongly. I know, Chair, that you have argued it as well.

Kim Johnson: Did you have anything to add, Mouhssin?

Mouhssin Ismail: The only thing to say in terms of inequality and serving young people from disadvantaged backgrounds, given the limitations and impediments we have, is that the most important thing is for them to be in school with their teachers, having structure, which, as Michael Wilshaw said, liberates young people. It is having consistency and someone they feel safe to be able to speak to. I think Rachel de Souza said that. They are not looking for something radical but for people they can have conversations with, where we can intervene and then refer when we need to, but there are all the problems that has in waiting times and not enough funding for CAMHS.

Kim Johnson: That is an important point. We know that the children who most need it are, sadly, excluded from school. They are not in the system to be supported. Catherine touched on the importance of teacher training and having teachers who are more aware of mental health and behavioural issues before they are excluded.

Gus, you made some really valid points about the importance of Sure Start, and supporting a whole family approach, cradle to grave, in dealing with these issues. Maybe there should be a word to Michael Gove about supporting Sure Start, going forward.

Q36            Ian Mearns: Gus, can I make a point on what you were saying about social capital and capacity? There is an old truism. I was a local authority councillor in my own local authority for over 25 years, and worked on many different transient financial schemes. You are looking towards volunteers being important to the mix. Unfortunately it was my experience, and I think it has been seen to be true across the country, that the capacity of any neighbourhood from a social capital perspective to meet its own needs is usually in inverse proportion to the level of need. In other words, poorer communities find it much more difficult to gain the social capital to mend their own problems without some significant financial stimulus to bring people in to support that. Would you accept that?

Lord O’Donnell: Totally, and therefore we need to think hard about how you can get volunteers from slightly outside the area to come into that area and help out if the leadership work is not there. You can work with some of the institutions that are local, like football clubs, for example, and getting the players to come down and help out. That sort of thing can be massively useful.

Ian Mearns: I could not agree more, but the difference—this is what the levelling-up agenda is meant to be about—is that in some parts of the country there are levels of relative prosperity with individuals and dots of poverty, but in other parts of the country it is the other way round. Therefore, even within that wider community, the capacity is not there all of the time.

I am dealing with a situation at the moment where my own local authority is in danger of losing an awful lot of sports clubs because the local authority literally cannot afford to cut the grass on the sports pitches. That is how bad things have got in my local authority because of the withdrawal of the revenue support grant.

Chair: I want to bring in Apsana, who has not spoken yet.

Q37            Apsana Begum: Thank you, Chair. I want to quickly ask a follow-up question on the mental health support teams. In your experience particularly, Mouhssin and Catherine, how clear are schools now on the role of designated mental health leads? When the Green Paper came out, it talked about joined-up approaches. Is there a risk that everyone is trying to do everything, and it is not clear who should be doing what?

Catherine Roche: It is the reason I highlighted the importance of training for the designated mental health lead in school. It is a bit like a stool with two legs as opposed to three legs—a key part of it was missing. With training for the designated mental health lead, they are now in a better position to connect and make more from the mental health support teams. Again, I think it is the connection across health and education. The support teams are coming very much from within the NHS system. There is work to do, for example, thinking about what is already operating in schools. In the implementation, there is scope to improve some of the communication and planning that could go in before the teams set off and select the schools they are in.

Mouhssin Ismail: The issue around training is important. From our perspective, we have not seen a clear enough connection between the mental health support teams, but I can only speak for my own context. In that sense, while we have a designated senior leader who is responsible for mental health, that is pretty much done mostly because of our own training and CPD rather than an external provider being able to give us additional professional development and support.

Lord Layard: Roughly half the mental health problems of young people are behavioural, as I was saying before, but there has been some resistance from the teaching profession to having the mental health support teams take on those behavioural problems. The teachers feel that is their job.

This has resulted in a very unfortunate pattern, to my mind, on the balance of emphasis in the training programme. We have extremely good treatments for behavioural problems. There is a world-famous programme called the Incredible Years for training the parents of badly behaved children. A wonderful trial was done by Stephen Scott at the Institute of Psychiatry. The children who were treated were seven or eight and were followed 10 years later. They found that rates of antisocial personality had been cut by something like 70% or 80% 10 years later. It is an extraordinarily effective programme.

These are simply not being offered at all in the mental health support teams. It is quite weird. What is particularly weird is that Stephen Scott trained about 4,000 therapists to run the Incredible Years programmes in the years 2008 to 2010. They went into action, but then the funding got cut and they disappeared. They have all gone to do something else. They could be recruited immediately if there was a policy decision to establish the Incredible Years programme as part of the offering of mental health support teams. The amount of money involved is quite small. That would be an enormous boost to its effectiveness, because very often people are at their wits end with what to do about these children.

Q38            Apsana Begum: We have talked about mental health support teams and designated mental health leads. Do you think there should be an NHS-funded counsellor in every school? Catherine, I think you have previously said that there should be.

Catherine Roche: I think there is still a gap in the level the mental health support teams are able to treat at. I look at schools and the role of the trained Place2Be counsellor. The counsellor fills a gap that still exists when there is pressure on the CAMHS waiting list. I would advocate a trained counsellor who is embedded and part of the school system, and then can drive and lead on the whole-school approach, on the parenting and on the skills for the teaching staff.

Mouhssin Ismail: From a school’s perspective, I cannot think of a reason why we would not want to have someone there, so absolutely yes.

Q39            Apsana Begum: I have one final question. The Mental Health in Education Action Group held its last meeting in July 2021. We also had the newly appointed Minister for Children and Families tell us in December 2021 about his explanation and his view of the slower pace of delivery around mental health. He talked about the capacity in the Department for Health. He talked about funding. He also talked about the three years that are needed to train mental health support teams. How much do you agree with those being the factors that may be slowing the pace of delivery in this area?

Chair: Gus, do you want to answer that?

Lord O’Donnell: What were the three factors?

Apsana Begum: Capacity in the Department for Health; funding; and the three years that it apparently takes to train mental health support teams.

Lord O’Donnell: Capacity in the Department for Health surprises me. It is probably true in one sense, in that not enough emphasis has been put on mental health issues. We know that, but civil servants are quite flexible. I imagine they would learn this stuff really quickly.

On the other area, about funding, clearly there is an issue; no question about that. On the training gap, as Richard said, there are lots of people who are trained and there are lots of ways of solving this problem a lot quicker than that. That is the one that I would say I do not really buy, to be honest.

Apsana Begum: Do you want to come in, Mouhssin?

Mouhssin Ismail: No. It is not within my sphere of knowledge.

Chair: I am going to bring in Ian because we are running out of time.

Q40            Ian Mearns: We have heard a lot about the importance of the whole-school approach to mental health and wellbeing. Gus, you were talking earlier about the Finnish model. It is not just about bringing in the right professionals. It is also about the culture within the school itself. There is a cost to this from a financial perspective. How much would it cost to embed this whole-school approach across the whole of the school estate in England?

Chair: Let’s ask the former Treasury official.

Lord O’Donnell: I have to say that the honest answer, which is the answer I gave Ministers very frequently, is, “I don’t know.”

There is one point about thinking of this as a culture that is just about schools; it is about society as well and what we value. We keep emphasising exams and incomes and all the rest of it. If we genuinely care about that, why don’t we train everybody to be an investment banker? They earn a lot more, for God’s sake. What are you wasting your time doing these other things for? We do not think that. We have different values, and we need to follow them through. Part of that will be schools, but the culture of schools cannot change without the culture of society changing as well. That is why I emphasise the business about wellbeing being important for Governments, companies and individuals, and civil society obviously.

How expensive would it be? I say it would be money incredibly well invested. All of the studies that we have been talking about here show big cost-benefit returns. It should be the kind of investment that a good Government and good local authorities would want to invest in, and that a good corporate would invest in. The thing about corporates is that they can invest now for returns that come a lot later.

Q41            Ian Mearns: To a certain extent you have all expressed some frustration about the way in which the Government have taken the Green Paper forward in terms of the pace and the priority that they have given to it. If you all had the fairy godmother’s magic wand and you could get the Government to do something tomorrow, what would it be?

Chair: It is quite a good way to end. It will be good to get one thing from each of you that we can then present to Government. We will start with you, Catherine.

Catherine Roche: Look to the workforce that is already out there. There are a lot of trained counsellors. Ensure that they apply on evidence-based methodology and draw them into the workforce. That will get over the stumbling block of not enough trained people, and—[Inaudible.]— apprenticeships.

Chair: Sorry, what did you say?

Catherine Roche: An apprenticeship for school mental health professionals.

Ian Mearns: The Chair was bound to pick up on the word “apprenticeship”.

Chair: When I hear that word it is like beautiful music. Richard?

Lord Layard: I would say a massive expansion of psychological therapy support for young people through the mental health support teams and that being made a top priority for the next stage of Government activity to level up. As Gus said, levelling up is about levelling up across people, mainly. Most of the inequalities are within regions and not across regions. One of the massive inequalities is simply the number of children in distress.

I want to raise a second idea that goes back to a question that was asked before. How could the Department do better in this area? If it was serious about really wanting to tackle the problem, I think it would set up a wellbeing unit inside the Department, consisting of not only civil servants but professionals, to provide guidance and intervention. Obviously, that is in the health service as well as the education service. If the Department is serious about wellbeing, it would have to have some kind of slightly different structure rather than just a bit of the structure. It would need to have some professionals in there with the civil servants. A lot of it is issues such as those raised earlier about how we can advise schools. It requires a central initiative, such as we have had in the health service. How did we get improved access to psychological therapies? It was an IAPT team in the NHS. You need something comparable with that at the top of the educational system.

Q42            Ian Mearns: To flesh that out, would you be looking at a wellbeing team within the DFE so that every policy that came forward would be wellbeing tested before it was put out into the country?

Lord Layard: It would be that, but it would also be developmental. It would have its own agenda, of course.

Lord O’Donnell: I am going to give you the least sexy answer known to man by saying that it is all about data. I would want us to measure the wellbeing of kids in all schools across the country. Once we start that, it will create the evidence—

Q43            Chair: How do you measure it?

Lord O’Donnell: You measure it the way they are measuring it in Manchester in the #BeeWell programme. They have gone through it. They are doing it now. They had lots of psychologists and others going through it, so it is there. I want to roll that out. That would then create all the evidence. You would be seeing it and saying, “My God, how can it be that this area is so much worse than that area? What is going on here?” Parents would be saying, “How come that in my area all the schools are terrible?” They would be driving the need for all of these things.

Q44            Ian Mearns: From my perspective, the lack of data is Ministers’ get out of jail free card because there is nothing to test it against.

Lord O’Donnell: It is hard to hold anybody to account. If you don’t measure it, you don’t treasure it, to use the cliché.

Q45            Chair: Finally, Mouhssin?

Mouhssin Ismail: In-house counselling and funding for CAMHS so that students are not waiting.

Chair: Can you say that again?

Mouhssin Ismail: An in-house counsellor and also funding for CAMHS so that there is enough and so that students are not waiting loads of time to be able to see someone, to see a specialist.

Q46            Chair: Providing it is all funded, you all support the idea of a longer school day for wellbeing and enrichment. Is that correct?

Mouhssin Ismail: Yes.

Catherine Roche: Yes.

Chair: That’s good. Thank you very much. It has genuinely been a remarkable session. We are very lucky to hear from you, and all the work that you do is really appreciated. Thank you for your time.