Woman's Hour - Teenage Mental Health

Episode Date: June 28, 2019

Over the last two weeks we’ve been looking at teenage mental health - we’ve talked to doctors, teachers, parents and to teenagers themselves. Last year referrals to Child And Adolescent Mental Health services were at their highest level ever. How have we got to this point? How can the situation be improved? We ask a panel of experts – Claire Murdoch, National Director for Mental Health, NHS England, Lisa McNally, director of Public Health in Sandwell, Sarah Hughes, chief executive of the Centre for Mental Health and Emma Thomas, Chief Executive of Young Minds. Presenter: Jane Garvey Interviewed guest: Claire Murdoch Interviewed guest: Lisa McNally Interviewed guest: Sarah Hughes Interviewed guest: Emma Thomas Producer: Lucinda Montefiore

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BBC Sounds. Music, radio, podcasts. Hi, this is Jane Garvey and this is Woman's Hour from Friday the 28th of June 2019. This is a programme about teenage mental health and about how we approach it and about what kind of help is available, should be available, will be available. We know that referrals to child and adolescent mental health services were at their highest ever level last year. We have assembled an expert panel. You'll hear from them and we'll also, at the end of the podcast,

hear your emails as well. But over the course of the last couple of weeks, regular listeners will know that we have talked on Women's Hour to doctors, to teachers, to parents and to teenagers suffering themselves. I would wake up every single morning and just not want to face the day. It's like there's so many things just shooting around at once and you don't know which one to go to. It's all like, ah, all fuzzy. Sometimes I get very, very stressed out.

Other times I kind of go into a mood of being lonely and sad. I remember I was sat watching the TV with my parents with my dinner on my lap. I was just sat and I couldn't do anything. I was like, I can't eat, and I was looking, and then I had these really poignant suicidal thoughts, and it was like, I've never had that before. It was uncontrollable.

Well, they are the teenagers. We want to hear from you. Get involved on social media at BBC Women's Hour. You can email the programme via our website, bbc.co.uk slash womenshour. And if you go to the website now, there are already links up for organisations that may well be helpful to you if you're going through an experience like the ones you're going to hear about over the next 45 minutes or so so the experts we have with us claire murdoch a registered mental

health nurse for over over 30 years claire yes good morning 35 years you were telling me about now as you said a couple of minutes ago to me the buck stops with you you are the national director for mental health in nhs england so it's great to have you with us. Lisa McNally is a psychologist, Director of Public Health in Sandwell in the West Midlands. Welcome to you. Good to see you. Sarah Hughes, former social worker, now the Chief Executive of the think tank, the Centre for Mental Health. Welcome. Good morning. And Emma Thomas is here, Chief Executive of the charity Young Minds. So a whole range of different experiences and we are really really keen to get everybody involved including you at home at BBC Women's Hour if you've got an experience or a

question for the panel today. So the latest figures show that one in eight children have a diagnosable mental health condition. Now is there really an increase in appalling mental distress in this country or are we simply better at talking about it at identifying it and in the best of circumstances getting the right help for it can i just start with you claire um you and i are a similar age i don't remember levels of mental distress in my own peer group growing up like the one we appear to have now what do you say about that well i think the latest prevalence survey shows that there's been a small but significant increase in mental health prevalence so i think we have to be careful how we understand and talk about

what's happening with the mental health of our young today we We have seen a 68% increase in referrals to CAMHS services in the last five years. And so something is changing. 68% increase in five years. Yeah. And I think it would be interesting to see what other panel members think. But we have a long term plan now for the next five years in the NHS, which will see hugely significant investment and change going into services so that we can better deal with those referrals. But I wonder, and it would be interesting to see what listeners think, we're in a post-post-war generation where we don't have to button it down, soldier on and live miserably with life's ills.

We have social media, which we do know is affecting the mental health of our young. They say so. I think wider society has to play a role in creating a mentally healthy... Sorry to interrupt. Wider society, yes. Social media, maybe that's being used a bit too often as a catch-all cause of the problem. And perhaps those of us who are parents might be ducking our own responsibility here. What would you say about that?

Yeah, I think everybody's got a part to play. So I do think, you know, pop stars, footballers and others have a part to play in not pushing diet lollipops at our young. I think parents need to be supported and educated better and differently. And we need to do more to help them do that. I think we need to be supported and educated better and differently. And we need to do more to help them do that. I think we need to work more closely with schools. I mean, I think the good thing is that we're having this discussion. I spoke to a 14 year old recently who said they teach me to make pizza at school, but not how to look after my mind. And I thought that was a really powerful comment. And for for me it symbolized

that we need to do more social media is a good thing as well we need to use it properly parents are obviously fantastic as a mother myself some of them are well as a mother myself I know that you know I can do a great deal to support my child but sometimes I might need the help and support. So I think that our long-term plan, the NHS long-term plan, that will see us over the next five years spending 2.3 billion ring-fenced pounds on mental health. But where does that fit into the general budget for the NHS? Well, so the increase the government have given the NHS for the next five years is £20.5 billion. And £2.3 billion of that ring-fenced, I think it's the only part of the budget that's being ring-fenced in this way... Which means protected, can only be used.

..means can only be used for that purpose. And Simon Stevens at the NHS board meeting, which is public, yesterday reinforced that again, said that not only is the £2.3 billion of the £20.5 billion ring fence for mental health, but the share of that £2.3 billion needs to grow at a faster rate for children and young people than for other areas of mental health investment. So a clear, huge priority for the NHS is the mental health and wellbeing of young people. Sarah, the think tank,

the Centre for Mental Health, is there enough money being spent? Well I think I really want to echo what Claire has said in terms of the huge investment into the NHS long-term plan is extraordinary and an absolute achievement for those who've been lobbying for this for a long time, decades indeed. I think we're talking about a whole system approach. So the investment into NHS clinical pathways is incredibly important, but we're talking about children's lives, and their lives consist of schools, families, communities, their digital lives.

So we're talking about mental health in all of those places. And I think there is a bit of a kind of imbalance in terms of really understanding the nature of children's lives and exactly how mental illness manifests, in fact. Because I think we're talking very much about when they get to the NHS pathway, that's when they need the clinical intervention. But children live most of their lives elsewhere. And I think I would like to see kind of much more conversation about what's happening in schools, what's happening in communities. In fact, the stuff around parenting is really important. Parents don't really automatically know what to do

and yet the kind of funding for parenting programmes and all of those sorts of things has been restricted for some time. You're working with the young people through the charity Young Minds, Emma Thomas. I was really interested in what Amanda Spielman said recently, the Chief Inspector of Schools, when she really went on about anxiety at school brought on by the exam system, by the incredible pressure that some pupils feel about the exam system and the way they're made to prepare for it and made to strive for it.

Is there a danger that we are too often medicalising everyday struggles and that schools do play a part in this? I'd agree with Sarah. I think whether or not it's medicalised, if a young person is going through distress, that is still distress. That distress is real. It's absolutely real to them. and if they're in a position where they're not able to understand

that that might be normal and that they can be supported to see a way through that or get wider support then there's a genuine need about that and what we hear from teachers and in fact some of your contributors have talked about and from parents and from young people is that they do

feel that the pressure around academics is having a real impact on young people today and in fact I think there was a girl guide survey from last year that showed that more young people were more their young girls were experiencing stress through exam pressure and through school than they were through social media so I do think we need to be very careful that social media isn't seen as the one area that we can tackle. There are some changes, but we do, as Sarah said, there's a wider society shift we've got to see,

our education system, the social inequalities that young people face. Lisa, you're on the front line, effectively, of this in public health. You're in Sandwell in the West Midlands, but before you moved to Sandwell, you were somewhere rather different, weren't you, geographically and socially speaking? Yes, so I was in East Berkshire and Bracknell Forest

which was a much more affluent area people had more money greater incomes bigger houses it was a very different place. And fewer problems? Certainly in terms of health and care, the demand was less. You know, poverty, economic issues are a big factor in this. The rate of mental health problems, for example, among young people, and indeed adults, goes up the more poor people are. You know, it's a common pattern we see. So certainly the need is greater in more economically stretched areas. What sort of help are you in a position to offer in Sandwell right now? So from a public health point of view, we're all about prevention and early support. My colleagues on the panel have spoken quite rightly about how we must see mental health in the context of young people's lives. So in local government, we will run everything from youth services, we commission school nurses,

we, in Samwell, we have a programme called the Wellbeing Charter Mark, which is all about social and emotional learning in schools. So it's all about trying to equip young people with the support and the mental resilience, if you like, the ability to cope with things. What you just outlined there doesn't sound like austerity to me. Well, if you consider that we have lost 60% of our budget in local government, so we're trying to make things go an awful long way. But I wouldn't want you to tell the people in Samwell that they are not living in austerity.

They might have something to say to you. Sarah, what would you say about that? Well, this is really interesting because I'm trying not to get political, but I will. It's probably inevitable, so go on. So effectively, I think the government will hold the position that austerity is over. And I think certainly the rest of the world hasn't got the memo. So we're still in a situation where we are seeing quite extraordinary restrictions on public health spend.

You hear from teachers all the time about the impact of austerity in terms of their budgets, not just in terms of resources, but their ability to meet wellbeing needs. I think thinking about school exclusions is a really good example of where austerity kind of has a direct impact on young people being excluded, the opportunities for them to get the kind of appropriate help is limited, and school exclusions has a lifelong impact. And very rarely do people kind of recover in an easy way from that experience. Emma? Well, so I think we've talked about is it worse than it was.

What we've seen in the last 10 years through austerity is that you've seen children's centres have been cut. You've seen the Children's Commission has shown that a third of local authorities have cut those low level of intervention support, whether that's school nurses, local counselling provisions. And you've also seen the youth sector really affected, so the number of youth workers. So I think in terms of the support that might have been around a generation who are facing some major challenges has also not been there during this last 10 years. We want to mention teachers. You mentioned teachers, I think, Lisa. Theresa May did announce that every new teacher in England is going to be trained in how to spot early warning signs of mental illness. That does seem like a quite a big responsibility for teachers. What do you think about that?

I think what teachers would tell the people that make those decisions is that spotting the mental health problem is one issue, but having the options for support to then do something about it when that mental health problem is spotted is the most important thing. Teachers every day are spotting emotional distress. But as you said, with the cuts in school nurses, the youth services, with less and less counselling being available because of cuts to budgets, teachers haven't got options to do anything about it. Well, can I just ask you then, Claire, this ring-fenced billions of pounds that's going to go for mental health, is it going to sort out exactly the issue that Lisa's just mentioned?

Well, it will take us... Lisa says she doesn't believe it, I can tell. Well, it will take us a step of the way forward, and I'll give an example around what we're doing with and for schools and colleges of further education in a moment. But firstly firstly I just want to go back to the local authority point so in my experience most local authorities have done really well with the cuts they've been faced with and are committed to this earlier intervention work but we are all worried about school nurses who've played such a major part in child welfare and health, including mental health over the years.

And I think we do need to see, and we're all hoping that we will see in the next budget or in the autumn review or whenever it happens, a settlement for local authorities that lets them invest in these vital services. In terms of school-aged children, I think we are doing something that's very significant and important right now. This year we'll see the rollout in parts of the country of 59 new schools-based mental health support teams. They'll also work in colleges of further education as well. And those schools employing hundreds of new therapists so currently we're training 500 therapists right now in schools based and college-based intervention you're not going to be able to cover the entire country no every single school will not have these these provisions it's a step forward but it's a really important step forward because we are expanding the workforce by 22% in recent years and including now. And will those particular services be available in the areas of most acute

need in terms of poverty? So I can say that we're announcing the next wave. So we've had wave one, which is going live, as it were, in September. We'll start seeing its first children and families alongside teachers and other health professionals in school, including primary care. So that's great. Next week, we'll announce the next wave. And we've looked in detail at this health inequalities question so that when we've been selecting these sites together with the Department of Education we've looked very hard at what they will offer to their more deprived communities or those areas of greater need and I can say that I feel very positive that in the areas where they exist and we'd like to do it everywhere and that's the journey we're on but in the areas where they exist the health inequalities question the integrated work the partnership work with third sector,

local communities, teachers, education, will be incredibly important. Quick word from you, Sarah. Well, I think that's really important to acknowledge that that work has been extraordinary and we are seeing evidence of improved health outcomes. We have some of the best mental health care in the world and that is definitely true. Early intervention into psychosis, absolutely true. I do come back to the inequality stuff, which is not just health inequalities, economic inequalities. If you're providing the best early intervention in psychosis treatment to a young person, if they're going back to a homeless kind of bedsit environment or where their families are financially burdened.

It's like putting water into holy buckets. So I think we need to have a balanced approach. We can't have the best mental health care in the world without having a good community environment for our children and young people. My concern when I think about people living in the circumstances you outline there would be that they are actually the people, the children in many cases, least likely to be able to voice their own concerns about their own well-being. And they'll probably be not necessarily surrounded by people who are prepared to listen. The middle classes, they may even have a few quid.

They'll be able to access help of some kind, won't they? Well, absolutely. And I think there's something that happens to young people we're talking about things like conduct disorder so behavioural difficulties for children that kind of exceed what you would normally expect a child to experience so aggressive difficult challenging behaviour and we see you know a large number of children with this condition and often not really understood within the context of mental distress but very much a behavioural approach which then means that they don't get the treatment that they need and so that there is a huge

emphasis certainly NHS England are really concerned about this and talk about this a lot about how actually do we meet the needs of children who can't have their needs expressed or indeed understood. So we can train teachers in spotting the signs, but they really need to understand, you know, in some depth, what the differences are and where then they need to go. That's the voice of Sarah Hughes. She's the chief executive of the think tank, the Centre for Mental Health.

Also on the programme with us this morning here on Women's Hour, we've got Emma Thomas, chief executive of the think tank, the Centre for Mental Health. Also on the programme with us this morning here on Woman's Hour, we've got Emma Thomas, chief executive of the charity Young Minds, Lisa McNally, who's director of public health in Sandwell, and Claire Murdoch, who's national director for mental health, NHS England. And we're talking about teenage mental health, something we've been discussing on the programme over the last couple of weeks. CAMHS, Child and Adolescent Mental Health Services. Here's one listener's email. My daughter's 15. She's stuck between primary and secondary care

criteria levels. She needs help, but she's been refused CAMHS help twice as her self-harm and her eating disorders aren't severe enough. It is not enough she starves, is covered in scars or has felt suicidal. That's one desperate parent. You can hear that, can't you, in the email. Here is the voice of a GP. She's frustrated after seeing troubled parents and teenagers and basically feeling that she has nothing to offer them except a long wait for what she calls CAMH.

There's a lot of sort of lip service paid to mental health and a lot of we've done a mental health initiative and we've raised awareness and I don't really care to see any more posters or adverts. I'd like to see some proper funding put back into CAMH, some recognition that family therapy is an important part of it, that the allied disciplines are crucial, that occupational therapy is is important that practice nursing which has been decimated is essential there's hardly any community psychiatric nursing anymore that was incredibly valuable but they've taken out the whole there's some recognition that specialist services need money but they're the they're the last point of the pyramid and they're absolutely funneled down. So we have weightiness.

And there's some awareness that GPs can deal with lots of things, but very little kind of funding or training available. And actually, it's not so much training. You need the actual stuff. And it sounds like a boring, much-raised political point, but you can't look after people if you don't have people there to do the looking after you know you can raise as much awareness as you like but there's one doctor in a room with nowhere to refer to it doesn't really help me or anyone else to be aware she couldn't really have put it any more clearly claire first of all let's deal with the waiting times why do they i mean they vary widely i can tell that from the emails that we've had coming into the programme. But many people are desperate in those weeks and, let's be honest,

sometimes months before they can get help from CAMHS. Why is that still happening? Yeah, so across the country we see unacceptable variation in waiting times to access services, mental health services for children and young people. The average mean waiting time is seven weeks. That's just too long if you're in a crisis situation and it can be much higher. So a point fully accepted. A couple of things.

In the long-term plan, we are seeking to double the numbers of children and young people that we see. So you see how many? We currently see about 345,000 a year. In England? In England. In new models of care and the money that's going in over the next five years, the first year being this year, we expect to see about £370,000 more. That will include those schools-based teams we 22% increase in workforce in CAMHS. If you're starting from a lower base than you'd like, and we have been doing, that may not be as much as we need. It isn't. But that's a really significant increase. We have seen financial investment grow between, in the last three years, over the three years, 6%, 11% and 20%.

So we're seeing that growth but i accept when you're in an area where you're waiting too long you're trapped between primary and secondary care that's not good enough we are doing two things we that i'm personally very excited about we this year are trialing a one and four week waiting time standard what does standard for community mental health services for children and young people so sorry you say you're trying so let me give you so we we've got some pilot areas where we're looking at making the maximum wait four weeks for a referral to cam services not crisis obviously they need to be within the day immediately but for more routine referrals can we see children and young people within four weeks what we've been doing the last two years if i might is we introduced a one week waiting time standard for eating disorders for

urgent referrals and a four week waiting time standard for routine referrals over the last two years i don't want to interrupt but i think it's important a lot of listeners have mentioned the fact that their children are not quite ill enough and in fact they'd get help more quickly if they were iller or made themselves iller which is really risky isn't it which is why you have to have a standard for urgent referrals but it's really why it's important that you capture what capture what might be defined as routine referrals. Because often what sits under routine is great need, great distress. And although that person may not need to be seen that day, they do need to be seen quickly, which is why starting to roll out or to implement in more local areas

a kind of a test for what would it take, what's the workforce, what's the money, what's the way of operating, what's the service model that will let us see our young for routine referrals within four weeks. I feel for GPs because they have, what's the length of the average GP appointment? Seven minutes, I think, officially, isn't it? How can you explain a mental health problem in seven minutes? And what sort of training do GPs routinely have, Claire, in mental health? Yeah, so clearly what you can do in seven minutes and what sort of training do GPs routinely have Claire

in mental health yeah so clearly what you can do in seven minutes is limited but actually many GPs have had training on many why only many and not everyone well so I think a very live debate at the moment and Professor Tim Kendall who's our clinical lead for the mental health program is talking to the education authorities, is talking to the GPs about should we make mental health training compulsory for all doctors? It does slightly boggle the mind that it isn't, I have to say. What would you say about that, Sarah? Well, it definitely boggles the mind.

And we published a report recently about the importance of GPs having access to that training in order to prevent suicide, actually. That's a direct kind of factor in terms of the mental health of our nation, suicide prevention. I think the question about waiting times and the gap between primary care and secondary care, we call it the missing step. But just explain primary and secondary. OK, so primary care would be gps maybe um access to psychological therapies talking therapies secondary care is definitely specialist care so

much more for for much more complex conditions and often we see a gap in the middle and we call it the missing step at the centre for mental health and that's that's very much because the system often doesn't provide services in that gap. You often find charities that do, so charities like Young Minds, like Local Minds and others, who kind of wrap around the child or the young person or the adult at that point. But there are examples around the country where I live, Cambridgeshire and Peterborough, for instance, there is a service called Prism, which is not prison, Prism,

which is about an enhanced primary care service, which really works for those people who drop out of the system consistently. But who puts you in touch with Prism? The GP. The GP would know about Prism? The GP would know about Prism, but they would do an immediate referral. Just one moment, Emma, I know you want to get in. One listener just says, Claire, and I'm sure this is not untypical, seven week wait, try 18 months, still waiting in East London. Your NHS guest is delusional if she believes that seven weeks is the longest people wait.

No, I actually said seven weeks is the mean average and many people wait way longer. 18 months would not be untypical. And that those waits are unacceptable. So please, you know, I would hate people to think that I'm saying seven weeks is the norm. Certainly, I know you're not complacent about this by any stretch. No. Emma, go on. I think what we do know is that two thirds of those young people who've got a diagnosable need are not able to get the support. And so if that's a GP who's faced with supporting them or a parent, and what we hear all the time,

are parents who are at their wits end and they are seeing their child's health deteriorate because they're not at that threshold or potentially through the weight and as Claire said we you know that's not good enough and we're seeing the impact on young people. I think one of the key challenges is that the GP that Sarah has described knows that there is other provision if we talk about social prescribing as a way forward what we don't make at the moment whether that's to a GP to a parent or even a young person themselves, to know that there are charities services available. And you if you aren't at that threshold, you essentially sent away until you are at that point of needing it because your needs escalated. We don't create an alternative space of saying here's a great charity. Here's a great app. Here's a really good provision that could make a difference to you.

Lisa, what about solutions like apps? I know some people will think, well, I don't even know what they are. But for some young people, this might be, first of all, a cost-effective way of dealing with getting help in the short term and maybe something young people will be willing to access. Yeah, so there is a big place for self-help here you know looking after one's emotional well-being obviously if someone's in acute mental distress yeah an app isn't probably going to cut the mustard it isn't however um there are i'm a bit skeptical about the about the current fascination with technology to solve our problems,

when actually what kids need is a supportive person in their life to help them cope with what are quite extreme circumstances. You know, in where I work, we have girls, for example, who happen to go to school when they have their period without sanitary products because they can't afford them in Sanwell. So we have a program to try and end period poverty. We have kids who are being bullied at school. We have kids who are living with parents who are either abusing each other or them or addicted to alcohol. Kids' mental distress and sometimes what we call mental illness and sometimes over-pathologise is actually a very rational, understandable reaction to the circumstances they find themselves in.

And until we stop seeing this as purely just a medical issue about treatment and health services, we're never going to get anywhere. Quick word from you, Sarah. I think that's what's really interesting. The snowflake generation is bandied around all the time, isn't it? It's the kind of mantra of some of our populist debaters about mental health. When we're talking about resilience and young people, I think they are already resilient. When we're talking with young men in London who are, you know, in the criminal justice kind of world, you know, their resilience is extraordinary, actually, in terms of what they have to deal with. So we really need to move from this very unhelpful debate of, you know, our children not coping. When you're talking about a girl going to school without sanitary products, I mean, how is she expected to be resilient under those circumstances?

So I think we really do need to think about how we're talking about these issues. Our children are not less strong than I was when I was a child. No, I don't think anyone's suggesting that. Well, I think Piers Morgan is. Well, he isn't here, and how we miss him. The parents we heard from earlier in the week, I just want to play a couple of these clips, because they're very powerful interviews, actually.

Here is the dad of a daughter with an eating disorder. Really, I had no frame of reference. There was nothing I could think of, and I just used to lay in bed at night, and if I got two hours sleep a night, it was a lot, because you just, how could I do this? What do I need to do? How can I get over it? Who can I talk to? Do I want to phone the Samaritans?

Is it a sign of weakness, et cetera, et cetera? And in the end, you just say, oh, sod it, I've just got to do it. I've just got to talk to somebody. And this is the mother of two young people, both of whom have had mental health issues. I've been like a psychiatric nurse, a psychologist, a rehabilitation youth worker, a friend, a mum, a sister, you know, everything that she's needed, and likewise for Finn.

But there comes a point, I'm 58, I feel like I'm 108, when you run out of steam. And it's all just been too much. And I feel diminished and broken by the system. And as a parent, you've just got to find it in you somewhere to get back up again and keep fighting. Emma, where can parents go, perhaps in that, it sounds a terrible period of time, when you're waiting to get expert help for your child? So there's a range of different services that might be out there. So if you're concerned about the eating patterns of your child, there's a great charity called BEAT.

If you are worried about them having maybe suicidal thoughts, then an organisation like Papyrus is very good to help. Young Minds, we have content for parents on our website and we also have a parents helpline. We would say that for parents they also just are often when they come to us very much at their wits end and so being able to talk to someone who understands, who can empathise and say you are doing the right thing actually is a really important part for them to be able to offer the support for their child and to enable them to cope. So I think it is being able to support themselves as well as their child that they're particularly concerned about. While you wait or a child waits for a CAMHS appointment will they see the GP every week? Should they see the

GP every week? What treatments if any can a GP offer somebody waiting for a CAMHS referral? Well, I think we heard from one of your GPs earlier who talked about almost seeing parents coming back on a weekly basis. What should they? I think when someone has no one else to talk to, then unfortunately their GP is probably the only person placed to do that. Even though that GP may not have had any training in mental health? I think if the parent has identified that as an individual that they want to continue to talk to or continue to put pressure on and say please refer my child then that is giving that parent a means of feeling they are doing the best for their child but clearly you would want them to be speaking to someone who really understands

what they're going through which is why certainly from our helpline point of view we have volunteers who've been there who's been through the experience we also put people through to professional counsellors so that they probably get access to a therapist a counsellor which they may never get the opportunity to do within the current system. This is a desperate time must I don't speak from personal experience unfortunately fortunately for me, but this must be a truly terrible time for any parent, Claire, as that dad so brilliantly expressed. He was, as I would be, utterly out of his depth.

What the hell do you do as a parent while you wait for some expert to give you proper help? Well, I mean, firstly, I just want to say to the dad that I recognise that men especially can, he said, see it as a sign of weakness to ask for help. So in particular, I do want to say to men and the partners of men listening, it's actually a sign of strength to ask for help. So I want to commend him. Obviously, we've got this huge push on to double care and treatment yeah but we're still we're still waiting i appreciate those initiative underway of course no and and for individuals and families in

the meantime that doesn't help them i do want to commend people to a lot of the work that the charities do i've got charitable colleagues here now because the quality of support that's available, the quality of advice that's available, also on the NHS Ingram website actually, is extremely good. The work we're rolling out through schools isn't just for teachers and the pupils really. It needs to be family centred. It needs to operate around primary care as well

so that if you're a child in areas that have schools-based counselling and not everywhere does at the minute but that's part of what we're trying to get in place everywhere people working as teams in an integrated way make all the difference to parents so one of their big stresses I know is feeling they have to go to multiple different agencies and we have to stop doing I'm really keen to try and get some practical help for parents and we should say that there are there is an article actually with five bits of advice from emma thomas and from sarah hughes who are two of our guests that's available on the warmers our website right now but emma can i just ask you i mean should you just take time off work

if your child is is ill and um they need somebody with them and you're waiting for your cams referral what are you supposed to do just stay at home with them if you're able I mean most people aren't most people aren't and um and I suppose part of it is coming up with um a plan with your child and talking to them openly and seeing what's right for them because you know some young people may not feel um that having their parent around the pressure for them to whether it's come out of their room to deal with it is the right thing so I think each circumstance needs to be according to what's right for that parent and that child. I think for one parent, I think it was the clip we just heard,

was able to talk to his employer and be able to get support for them. And I think we are seeing an absolute shift now in terms of employers recognising whether it's about their employees' mental health or understanding that they need to be looking after their children's mental health, that they need to be making reasonable adjustments to allow those people to be, whether it's leaving early to make those appointments. I think it's also finding other people that your child might be able to talk to.

So I think we do have to celebrate young people are amazing at coping and actually also amazing at supporting each other. So what we see all the time from the young people we work with is how that they are looking to support each other and we know that if that child has a trusted friend or someone they can open up to whether there are some really good charities that are specifically for young people so something like the mix allows an online forum where people young people who are experiencing problems can connect with others in a safe and appropriate way. So there are services that are specifically for a young person to help them. But you appreciate that actually in some situations,

parents will simply have to make themselves available 24-7 to be at the side of their profoundly distressed child. And they're going to experience huge emotional distress themselves in seeing that. Of course. And that's what you're seeing in many of them. As I say, when we hear from them is they are absolutely at their wits end. And, you know, regular callers and there is good charity provision. I think we're all seeing the pressure on us at the moment because there are good plans. And I absolutely agree.

You know, I think the ambitions that Claire and her team have got, but we know they won't be in place. And at the moment it is falling to charities and we are often struggling to cope with that demand. I wanted to mention that there are positive aspects to this. People do have periods of their life when they are extremely unwell, physically or mentally, and it can end, and you can come out the other side. And we need to acknowledge that often, I should say, with the help of specialists. And we have had emails, too to praising CAMHS to the skies. That is worth saying that some people have been hugely helped by CAMHS. Here's an email from a listener who's only 19. She says, in my early teens, I suffered with my

mental health a lot. I became very anxious and introverted. A lot of the time I felt misunderstood, which made it very difficult for me to speak to new people but a turning point for me was going on the NCS that's the National Citizen Service Programme the summer after my GCSEs I think it's actually going on right now this I was in quite a low place when I decided to go on the programme but it allowed me to meet new people going through similar issues and it helped me with my social anxiety I graduated and I enjoy my life much more and I'm able to do things I never thought I could such as being in big groups and being with other people. So that's just one example of a young person who went through something came out the other side. On the whole we don't hear enough of those stories so can we get from you Lisa some positivity here because I know you yourself

went through a tough time as a teen or an adolescent um it landed it it lasted longer than that i think um so yeah um i self-harmed um as a young person um i've got the scars to show for it quite um quite literally um i remember one and this went right into my career um into my early career. I remember one time I was taken to an emergency clinic at the Maudsley and I got quite bad and they wanted to take me into the ward to stay. And the only reason I managed to persuade them that I shouldn't go into the ward is because I had to be on that ward the next day to assess the patients I was working as a psychologist in the same trust it became all-encompassing I managed to keep my career just but it affected everything about my life and you are a health professional yes and you yourself came up against the kind of prejudice yeah that

we yeah yeah so i was once told by a clinical psychologist who was my manager to cover my scars up because it wasn't a professional look um it's very difficult it's only in recent years i've been able to talk about my history in terms of my mental health but i found it important to blur those lines between those of us that support people's mental health and those of us that need support sometimes it's the same people yeah well we all we can't say often enough we all have mental health we all have mental health and we all we all should be ambitious about it that's why as a public health professional i see mental health as my primary aim my primary aspiration it's a false economy not to support mental health as my primary aim, my primary aspiration. It's a false economy not to support

mental health. Because as we heard in your example, people are having to take time off work, kids' educational outcomes are being affected, which then has a knock-on effect on employment rates. It's such a false economy not to invest in especially young people's mental health. For me, there wasn't a lot of support in my early years. But eventually I got it and came through the other side. And I don't think I wish it away, to be honest. Well, it's made you the woman you are. And I'm sure you're more effective in your role.

Thank you so much, Lisa. That's Lisa McNally. We also heard from Sarah Hughes, Chief Executive of the Think Tank, the Centre for Mental Health, and from Emma Thomas, Chief Executive of Young Minds. And there will be more in the Woman's Hour podcast available later. I just want to end with you, Claire, because we did say the buck stops with you. And I guess you have to be around my age to appreciate how far we have progressed in this area. I remember growing up, there'd be the occasional vague reference to somebody struggling with their nerves. We've now moved on

to a national conversation about mental health. Members of the Royal Family talking about their own mental health challenges. Unthinkable 35, 40 years ago. We've raised awareness, but you can raise awareness all you like. There has to be the help once you've made people aware of their

very real challenges. Yeah. So we have a great plan. Thank you to colleagues who helped create that plan and people with lived experience and parents who helped create that plan. The money for it is Ringfence, which is extraordinary in the NHS. We've heard all this. It will happen, will it? And it will happen. I really believe it will happen. And we've seen signs of movement already. I mentioned some of those earlier.

But I do want to say to listeners, in the intervening period, the reason we're taking those extraordinary steps as the NHS is because we know the need is there. We know the waits are unacceptable. We know that people need help now. And we'll be working with colleagues across the voluntary sector, the NHS, local authority, education and industry to do better today. Claire Murdoch, who is NHS England's National Director for Mental Health.

And as I emphasised at the beginning, she's been there. She is a registered mental health nurse. She has done that for over 35 years. Well, Lisa is still here. So is Sarah and Emma. I should say Claire hasn't fled the building. She's got a meeting she had to go to. So we're very grateful to her

for being with us on the live programme. Your emails have flooded in. Now that flooded is a sort of well-worn phrase used by broadcasters, but honestly, they really have this morning. So thank you. And it's important that we just, I'll just read out as many as I can and then we'll see what our panellists have this morning. So thank you. And it's important that we just, I'll just read out as many as I can

and then we'll see what our panellists have to say. This is from Jackie. The message that all teenagers are receiving is if you fail your GCSEs, then the rest of your life is ruined. And some really believe this. In fact, many teenagers are most worried about letting their parents and teachers down.

They are too young to carry this weight of responsibility, says Jackie. Rachel says, as a teacher, I'm well equipped to spot the signs. So I completely agree with Lisa. But there is nowhere to refer to children to that can offer the help for them when they're struggling. No help for their families either. Jane says, I have three children who've gone through GCSEs and A-levels. The pressure to achieve and do up to 30 exams at the age of 15 or 16 is ridiculous. Children aren't tested so severely in other countries

and appear to be as competent as children educated in the UK. And this is an interesting one from Joe. Isn't it ironic that teachers are being trained to spot signs of mental ill health, whilst also being the ones responsible for inflicting educational pressure, which might contribute to mental health problems? I ask, as a teacher, how do we fulfil both sides of our obligations? I actually think, Sarah, that is a really interesting point from Joe. Absolutely. I think we've got a double bind there, which is, you know, teachers are being faced with implementing really tricky educational policy whilst at the same time supporting a vast array of needs with children and young people. I think that's where we have to apply pressure on education policy. And I'm afraid until we do that and see some, and leave us some really big changes around examinations at five, six years old,

we're not going to have the kind of widespread impact that we really need to see. And so there's absolutely right. I mean, there's no getting away from it, frankly. Go on, Emma. And Young Minds has been running a campaign called Wise Up, which is very much about balancing the education system. And we've seen some changes as a result with the Ofsted framework,

but it really hasn't gone far enough in order to kind of look at that whole school approach. And also, as Sarah said, to put pressure beyond that, which is it's fundamentally our education system, and you've had contributors saying the expectation at such a young age has got to be wrong. But has it got worse? There was expectation, frankly, on me when I was 16.

Well, I think for a lot of people now the expectation in terms of one of your um contributors said unless you get 11 gcses you have no opportunity we've seen people who've gone to university who have struggled to get jobs in supermarkets i think the sense that your education would and your results would have given you job opportunities felt very true and when i was growing. It really doesn't feel true for young people now. Right, OK. And this is from an anonymous listener, and this is very distressing.

My 14-year-old was suicidal last July. She saw a GP and was referred to CAMHS. She finally got an appointment in October last year, which was just for a diagnosis. I asked her if she had a plan, she did, and told me that she would go on an urgent waiting list well we're still waiting i was told to take it at a and e if she got worse in the end i spent two thousand pounds on private treatment but she's still on that waiting list i mean that is just excruciating i mean first of all i kind of um want to reach out

to that parent and say i'm so sorry that she's experiencing such a bad time it must be uh horrid on so many levels i think that's where we really need our gps and and and um to kind of step up in that situation i think we really need to understand that parents are having these very complex and challenging conversations with their children and often don't know how to have them this parent obviously did know how to say to her child do you have a plan that act that question is really important because then that activates um systems and processes in this instance she's fallen through the gap very clearly yeah i mean that the idea that you could just pop to a and e no it No, it doesn't work that way.

It isn't a solution, is it? Although I do know that that is exactly what people are told. And at the moment, that is the only option really for young people. So A&E is never going to be the place if you're in crisis. It will actually, you know, for many young people we work with make worse. So I think where we're talking with the long-term plan, there's some very good aims around community-based crisis havens, drop-in centres but we're a long way off. So what sadly I think we're going to see is that more young people may be in this situation and we have to make sure that there's more community support. Something I wish we'd had time to discuss with Claire Murdoch

is the geographical locations of the help that is eventually made available. And there are cases in which children, very young children, are sent right across the country, hundreds of miles away from home. I mean, Sarah, that's got to be completely untenable. Well, it's an appalling state of affairs. And I think Claire would agree and has said so very publicly on many occasions. And the long term plan is absolutely trying to deal with that very fact. But we are talking about 23-24 in terms of when all of these things might be realised. So we've got 2023 yeah so we have got a bit of time to go really and so it demands local areas to really think carefully

about how they're applying their funds and so the ring fencing of the of the new money is so incredibly important for this very reason. But it comes back to local authorities are not a silent observer in this conversation. And unless they're sitting at the table in terms of really applying this money and really thinking about service design, we're still going to become bumping up against the same challenges, I guess. Here's another example. We're in the depths of despair trying to keep our 14-year-old daughter safe after she attempted to take her own life last Monday. Now, she's been self-harming for over a year.

Things took a more serious turn last week. She's autistic and we are told that our local CAMHS do not have counsellors trained in dealing with autistic spectrum disorder young people. There are no schools in our area that can manage and meet her needs. We are now looking for her third school place. To have her home and to not be able to guarantee her safety is quite simply hell on earth. And the professionals are telling us they have no one trained to help her. Our hearts are broken.

Can anybody think of anything positive to say to that person? I confess I'm... No, I think our hearts are broken hearing it actually i mean i think it's devastating and you know what they must be going through as a family and the pressure and that parent to be in that position supporting someone like papyrus may be an organization that can offer some support for them um in terms of um the suicidal thoughts and that level but i yes i absolutely feel for them. We have made a set of recommendations

in a report we published last week through the Children and Young People's Mental Health Coalition looking at learning disabilities and mental health. And we've made a range of recommendations to local systems about how they could improve. It's not going to help this family. But we want local cams and children young people services to understand that learning disability and mental health absolutely intersect

they come together and they can create a perfect storm of very very problematic outcomes higher levels of self-harm and suicide and so we really need urgent action on a local level to attend to these to these issues education need to come to that to that table too when we were talking about the kind of people kind of young people most vulnerable to a mental health problem we did attend to these issues. Education need to come to that table too. When we were talking about the kind of people, kind of young people most vulnerable to a mental health problem, we did talk about, Lisa, you certainly emphasised austerity, poverty, basically poor homes in every respect. And by the way, there's emotional neglect at all levels of society, by no means restricted to people on lower incomes. But what about the risk factors when either parent themselves

has a mental health issue? Yes, so there is a link there for many reasons. Of course, growing up as a child in an environment where a parent is struggling will have an impact. So certainly people who live in a family where there is mental health issues will be more vulnerable themselves and it can be difficult to reach out sometimes young people will feel guilty for talking about their mental health when the maybe a parent is struggling with an addiction or a mental health problem but again we just have to be able to ask people to speak up and seek help

and then hope that we can put the right help in place. Yeah. What do you think about the notion that, yes, we've raised all the awareness imaginable, but in a way we are creating false expectations, maybe. People think the help is out there. You know, there's Prince Harry there and he's talking about the help he's had and how much better he feels. Well, I mean, you don't have to be a cynic to think well yes but you could get that help yeah that would be helpful i'd love to hear one of the royal family talking about cam's waiting lists well of course politically they they can't say that but i take your point or any public figure any public figure um but i think awareness raising i don't want to demonize awareness raising it's very useful it's very important but it's not a replacement for support provision.

I think it's having the impact of making us all realise that we all have mental health. So I think there is something positive that we've seen recently about acknowledging we all have mental health and so tackling the stigma. But I think we are in danger of encouraging people to talk and there is no one there to talk to or to listen to them and creating you know both community-based services so one of your caller talked about the NCS program national citizenship program you know we run training for their leaders to make sure they understand well-being so it's I think how do we support the trusted adults and young people's community so that they're better able to spot and support at an early stage in order that if they are opening up and talking to someone, it's going to be someone that they trust who is able to then at least to have a productive conversation at that point.

Here is one positive email from a listener who says, last year my daughter was taking her GCSEs. She had been a very capable, confident girl, but she did become really anxious. Uncontrollable shaking, which then led on to self-harm. Our struggle to get her help and the feeling of despair has been explained by many of your guests on Woman's Hour. At the time, I was desperate to hear stories

from people whose children had passed through the phase and were OK, but I didn't hear any. Please tell other parents, yes, take it seriously. Work to get your child help, but some children do grow out of it. We're not complacent. But our daughter has stopped cutting herself and is now in a good place and was very difficult to do and you need to find other ways of coping with the emotion and the stress that self-harm gave you but it's possible people come out of it and as I said earlier it made me the person I am and there is for so many people a way out of this if we can only get the right support in place so there is hope there there really is well we started the conversation we've got to keep it going and as

you say people have got to keep raising issues and maybe we should all raise expectations and hold politicians feet to the fire when it comes to getting the money there and of course we also have to pay our taxes that would also help um which is something that sometimes people forget yeah absolutely we all have to put into this we all have to treat this as everyone's issue everyone's business paying taxes volunteering for local services getting involved in communities we all have a role to play don't we often say it takes a village to raise a child that applies in terms of children's mental well-being as much as anything else that's my favorite saying of all because i think there's no there's there's no um better

truth than that actually that the reality is is that we all need to wrap around the children in our communities and um you know when when you know even if you don't have children you will be a contributing member of that community and and really understand that we all have a part to play in somebody's well-being i think is is really an important shift. So whilst mental health awareness has kind of really taken us forward, I think it's now about the role of communities and society as a whole to kind of come in and get to the point where we're moving people away from accessing kind of acute services because we've intervened early enough and the kind of prevention agenda has to be something that we all sign up to thank you all very very much really appreciate it sarah emma and lisa fantastic to have your input this morning uh and of course

during the podcast and weekend woman's hour is two minutes past four tomorrow afternoon the highlights of the week and then we're back live of of course, two minutes past ten, Monday morning. Is the daily grind getting you down? Fancy taking a break and going out into nature this summer? Then look for Go Wild and BBC Sounds, a place for some of the best nature programmes from Radio 4. Get some inspiration for your next adventure, no matter how big or small.

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