Written evidence submitted by the Intergenerational Foundation (CYP0015)
The Intergenerational Foundation (IF) (www.if.org.uk) is an independent think tank researching fairness between generations. IF believes policy should be fair to all – the old, the young and those to come.
IF’s mission is to protect and promote the rights of younger and future generations and, as such, researching the progress made on children and young people’s mental health is a key part of our work.
Part of our motivation behind this response is to submit our mental health research as evidence for the inquiry. We have recently built a model which allows us to estimate the fiscal consequences of mental ill-health amongst young people and the results of our research offer a strong economic case for early intervention.
We are also taking this opportunity to raise our concerns with the recently published proposals for the Mental Health Act (which we believe fall far short of the ambitions outlined in the 2017 Green Paper), as well as to shed light on the impact of COVID-19 on the provision of mental health support in schools.
Our response to the inquiry can be condensed into the three following points:
1) The economic case for early intervention
Experiencing symptoms of mental health disorders can have devastating impacts on children and young people. There is now an increasing amount of evidence which suggests that having a mental health disorder during childhood or adolescence can have consequences for the individual throughout their lifetime too. Importantly, research has shown that the early onset of mental health disorders can lead to poorer outcomes later in life, even if symptoms improve in adulthood. For instance, a study by López-López et al. (2020) found that children who experience depression in adolescence are still more likely to become NEET (Not in Employment, Education or Training) than someone who has never had depression, even if they no longer experience serious symptoms once they enter the labour market in adulthood.
Our previous review of the mental health literature revealed that mental health disorders can also impact educational attainment, earnings, physical health and life expectancy.
These findings demonstrate the large cost that mental ill-health can have on an individual; however, these outcomes are also costly for the government as well. Poorer outcomes impact the public spending on health services, work-related benefits as well as incoming tax revenue. In our Costing Young Minds paper, we have built a model which allows us to estimate the fiscal costs of depression. Our findings demonstrate that, before the pandemic, the government was losing approximately £2.9 billion in net tax revenue from a single cohort of individuals with depression between the ages of 16 and 40. This is equivalent to approximately £37,000 per person, which can pay for 350 sessions of Cognitive Behavioural Therapy for each individual – much more than the average person typically needs for effective treatment.
The implication of this finding is that increasing spending on young people’s mental health can help pay for itself as well as generate extra tax revenue which can be used for other purposes further down the line. Furthermore, given that the early onset of mental health disorders can lead to poorer life outcomes even if symptoms improve in adulthood, it means that there is a relatively narrow window of opportunity to take action to avoid the long-term consequences of mental ill-health when experienced during childhood and adolescence. There is therefore a strong case to switch to a model which focuses on early intervention in children and young people’s mental health.
2) The White Paper falls short of the 2017 Green Paper ambitions
The 2017 Green Paper, Transforming Children and Young People’s Mental Health Provision, offered examples of what an effective early intervention approach could look like. The paper addresses not only how we can improve support in times of crisis by prioritising the need to reduce waiting times, but also how we can intervene at earlier stages through school-based approaches.
IF is concerned to find that none of the key proposals from the Green Paper have been incorporated into the recently released White Paper, which outlines the first comprehensive reforms to the Mental Health Act in almost four decades. The only proposals which specifically address the needs of children and young people include making the provision of care and treatment plans a statutory requirement for all children and young people in inpatient care as well as addressing concerns over how much power children should have over decisions relating to their care and treatment. Instead, the White Paper places emphasis on improving procedures related to detentions and inpatient treatment.
IF has two primary issues with the White Paper. Firstly, although the proposed changes to detentions will also benefit younger generations, they are only relevant to a minority of children and young people. In 2019–20, 1,172 detentions under the Mental Health Act involved children aged 17 and under, which accounts for under 10% of under-18s. Other interventions that could help address severe mental health problems and achieve wider coverage – such as more funding for professional counselling and therapists or to reduce waiting times – were noticeably absent. This is particularly worrying given that one of the Mental Health Research Goals 2020-2030, which was led by the Department of Health & Social Care, is the target to “halve the number of children and young people experiencing persistent mental health problems”.
Secondly, there is a heavy focus on responding to mental health problems once they reach the point of crisis, and no proposals focus on early intervention. In comparison, the Green Paper proposals focused on training and supervising Mental Health Leads and Mental Health Support teams in schools with the aim of providing help to school children experiencing even mild to medium symptoms. IF believes that the White Paper misses a key opportunity to level up our approach on mental health.
3) Our progress on mental health has been set back by COVID-19
Unfortunately, the COVID-19 crisis has reversed some of our progress with children and young people’s mental health. Early evidence has suggested that the prevalence and severity of mental health disorders amongst children and young people have risen during the COVID-19 crisis. According to NHS digital data, the proportion of 5 to 16 year-olds likely to have a mental health disorder has increased from one in nine in 2017 to one in six in July 2020.
Despite this decline in mental health, a large proportion of students have not been able to access support from their school. A YoungMinds survey, conducted with 2,011 young people with a history of mental-health conditions between mid to late September 2020, demonstrated that around 40% of young people claimed that their school had no school counsellor available to provide support. This suggests that many schools are not meeting minimum standards of providing therapists and counsellors required under statutory law.
Furthermore, our earlier estimate of the fiscal cost of depression from our Costing Young Minds paper was derived using pre-COVID data. It is likely that, without serious intervention in the mental health of children and young people, the fiscal loss associated with depression will be higher post-COVID as a result of the increase in the prevalence and severity of mental health disorders.
Moving forward, urgent action is needed to ensure that schools have sufficient funds to follow through with their legal responsibilities and to avoid the expected pressure that mental ill-health is expected to place on public finances.
The key points raised in this consultation response can be summarised as follows:
● There is a strong economic and moral case for early intervention. Research has shown that the early onset of mental health disorders can lead to adverse outcomes for children and young people not only now, but also throughout their lifetime, even if symptoms improve in adulthood.
● The impact that mental ill-health has on life outcomes will have consequences on public finances. Prior to the pandemic, the government was losing £2.9 billion in net tax revenue from each cohort of individuals with depression between the ages of 16 and 40.
● The proposed reforms to the Mental Health Act in the White Paper do not offer support to children and young people before they reach the point of crisis and make no mention of the 2017 Green Paper goals. It is important that these White Paper proposals are revised to incorporate in legislation a model that focuses on early intervention.
● Research has suggested that a large proportion of schools have not been able to meet their statutory obligation to provide mental health support for school children. More funding is desperately needed to address this problem.
 López-López, J.A., Kwong, A.S., Washbrook, E., Pearson, R.M., Tilling, K., Fazel, M.S., Kidger, J. and Hammerton, G. (2020): Trajectories of depressive symptoms and adult educational and employment outcomes. Bristol: Cambridge University Press
 Bui, M. (2020): Costing Young Minds: The fiscal consequences of the lack of spending on young adult mental health. London: Intergenerational Foundation
 Department of Health & Social Care and Department of Education (2017): Transforming Children and Young People’s Mental Health Provision: a Green Paper. London: DHSC and DoE
 Department of Health & Social Care (2021): Reforming the Mental Health Act. London: DHSC
 NHS Digital (2020): Mental Health Act Statistics, Annual Figures 2019-20. Newport: ONS
 National Institute for Health Research (2020): Mental Health Research Goals
2020-2030. London: NIHR