Response of the Equality and Human Rights Commission to the Select Committee Inquiry:

Title: / Joint inquiry in response to the Government’s green paper on Transforming young people’s mental health provision
Source of inquiry: / Education and Health Select Committees
Date: / Inquiry announced on 21st December 2017
Written submission requested by the Committees on 31st January 2018

For more information please contact

Name of EHRC contact providing response and their office address:
Claire Lesko & Libby McVeigh
Equality and Human Rights Commission
Fleetbank House, 2-6 Salisbury Square, London EC4Y 8JX
Telephone number: / 0207.832.7836
0207.832.7832
Mobile number: / 0739.319.6607
Email address: /

  1. The Equality and Human Rights Commission welcomes the opportunity to submit evidence to the Education and Health Committees’ Inquiry. Too many young people still do not receive the support they need at the right time and close to home[1]. This prevents young people with mental health problems or a mental health condition from enjoying their rights to health[2],education[3], rest, play and leisure[4] and to a family life[5]. It also represents a significant cost to society. For example, young people with conduct disorder are twice as likely to leave school without any qualifications, three times more likely to become a teenage parent, four times more likely to become dependent on drugs and 20 times more likely to end up in prison.[6]
  2. The United Nations Committee on the Rights of the Child recently called for the UK Government to develop strategies to improve the availability and the quality of young people mental health services.[7] As such, the Commission welcomes the ambition of the Government’s Green Paper to kick-start progress in this area.
  3. We are concerned however by the proposal to roll-out the ‘three pillars’ approach in only 20-25% of the country by 2023 which will leave most young peoplewithout the support they need for the foreseeable future. The Green Paper identifies some ‘at risk groups’ such as young offenders, those with Special Education Needs and Disabilities (SEND) or looked after by the State but it omits others such as asylum seekers and refugees[8] or from theGypsy, Traveller and Roma communities.[9]We are also concerned that the Green Paper does not address a number of key equality and human rights challenges and that the trailblazer approach could exacerbate variation in the availability of support[10] for young people from particular backgrounds and/or in particular circumstances in the short term at least.
  4. The DHCS/DfEshould assess the impactof their proposals on the three aims of the Public Sector Equality Duty[11] (PSED) and on children’s rights. Doing so will enable the DHCS/DfE to develop a more comprehensive approach to transforming mental health services for children and young people, andensure that the ‘trailblazer approach’ focusesonareas with the greatest needs and is tailored to respond to these needs.

Scope and implementation of the ‘three pillars’ approach

  1. We are disappointed by the proposed pace and scale of theroll-outof the ‘three pillars’ approach. We are concerned that the proposals in the Green Paper do not go far enough to address the chronic shortage of community Children and Adolescents Mental Health Services (CAMHS)[12] and that mental health support teams will not be sufficient to respond to the demands of the 68% of children and young people with a diagnosable mental health condition who are not projected to meet CAMHS access thresholds.[13]
  2. Government should consider providing all schools and colleges with additional funding to the Pupil Premium so they can deliver targeted interventions to improve the well-being of students most at risk of developing mental health problems and to support those with mental health problems who do not meet CAMHS access thresholds.
  3. We understand that the severe shortages of specialist professionals may be a barrier to implementing the ‘three pillars approach’ sooner and nationally.To remedy this, we recommend that the DHSC:
  • identify the professions needed to create mental health support teams and to increase the capacity of CAMHS; and
  • add these professions to the shortage occupation list[14] as Government has done for other health specialities such as ‘emergency medicine’ or ‘old-age psychiatry’.

Doing so represents a practical way for Government to demonstrate its commitment to deliver parity of esteem between mental and physical health, but also between adult and children mental health provision.

  1. Weareconcerned that funding for mental health support teams may not be used as intendedif it is not ring-fenced[15] and that the proposal to have only one Designated Senior Leadin each school/college is not sustainable. It would be helpful for the DHCS/DfE to address these matters.
  2. Finally, as acknowledged in the DHCS/DfEeconomic impact assessment, the establishment of new mental health support teams and Designated Senior Leadsmay result in a rise in demand for CAMHS treatment in the short term. We think that this may be the case in the longer term and is also relevant to other agencies such as local authorities’ social services and it would be helpful to understand how this has been factored in and costed by Government.

Equality and Human Rights considerations

  1. It is not clear whether the proposals in the Green Paper have beenassessed for their impact on the three aims of the PSED.Such assessment would help the DHCS/DfE ensure that their proposals are robust and deliver the intended outcomes for allchildren and young people. In particular, an assessment would help:
  • Identify data gaps that need filling to build a more comprehensive evidence base of ‘at risk groups’ of children and young people with particular and intersecting protected characteristics[16]and to better understand how they access and experience mental health support.[17]
  • Explain the potential positive or negative impact of individual proposals and their cumulative impact on children and young people with different protected characteristics.
  • Remind schools, colleges and CAMHS of their duty to collect and publish equality information and how it could help them identify and share interventions that may be more effective in reaching young people with particular protected characteristics and preventing escalation of mental health problems.
  • Clarify the scope of proposed research[18]and identify other areas where more research may be needed.[19]
  1. We understand that DfE recently committed to develop and trial child rights impact assessments.[20] It would be helpful for such an assessment to be conducted on the proposals in the Green Paper and made publicly available.
  1. We note that some of the proposals couldhelp further the rights of children and young people with a mental health condition.The proposal to develop new guidance for schools so they better understand the effect of trauma on children’s behaviour, for example,may help their psychological recovery and social reintegration[21], and the commitment to publish a mental health prevalence survey for young people every seven years from 2018 could help the UK Government implement some of the recommendations made by the Committee on the Rights of the Child.[22]
  1. TheGreen Paper could howevergo further to address other key equality and human rights challenges such as to ensure that:
  • Children and young people in England no longer face food poverty and poor housing which damage their mental health;[23]
  • Children who have not yet started school, those who do not attend mainstreamed education, young people in apprenticeships/traineeships, those not in education, employment, or training, those who do not want to access mainstream services[24] and those are in prisons[25]can access the support they need;
  • Children and young peoplewith SEND, many of whom will also have a mental health condition, are notincreasingly sent to special schools[26]or illegally off-roll home-schooled,[27]and are provided with the reasonable adjustments they need and are entitled to if their condition meets the definition of disability under the Equality Act 2010;[28]
  • Children and young people including young offenders and those at risk of criminal activities do not drop-out of the treatmentthey receive from CAMHS;[29]
  • All of those (mainly girls) who present in hospital with evidence of self-harm receive a psychosocial assessment;[30]
  • Transition between CAMHS and adult services is better facilitated, particularly for those in care and those with complex needs;[31] and
  • CAMHS better engage with young people and their families and take their views into account in planning and decisions about care.[32]

Unless these issues are also addressed through a broader cross-departmental strategy, the impact of the proposals in this Green Paper is likely to be limited.

Education for children and young people and training for staff

  1. We welcome the ‘whole school approach’but we agree with the Office of the Children’s Commissioner for England[33] that there is a need for a broader network of support such as community based drop-in facilities and online counselling to ensure that those who do not attend mainstream education and services are also able to access the mental health support they need.
  2. We support the proposal for every child to learn about mental health and wellbeing in all relevant aspects of the school curriculum, including through national compulsory RSE/PHSE lessons as explained in our response[34]to the DfE’s consultation on changes to RSE/PSHE. We strongly support calls for PSHE to be made mandatory in its entirety in all schools and educational settings from key stages 1 through 4. It would be helpful for the DfE to clarify whether these lessons will also be delivered to children and young people who do not attend mainstream education such as those in Pupil Referrals Units or Young Offenders Institutions.
  3. To complement these lessons, we also suggest that DHSC/DfE and education providers consider other ways they can provide young people with information on how to look after their mental health such as web-based content or lessons run by an outside organisation.[35]
  4. We support the proposal to deliver more training for teachers and the proposal for improving their initial training. It would also be helpful for teachers to receive regular updates throughout their careers on best practice in promoting well-being and in supporting students with mental health problems/conditions.
  1. We echo the callfor Designated Senior Leads to receive standardised trainingand to be trained alongside mental health professionals[36]from CAMHS and from the school/college support team. We agree that this could help reduce inappropriate referrals to CAMHS[37] and improve relationships between professionals in the health and education sectors.[38] We suggest that this training includea clear focus on equality and human rights so all professionals involved in this area:
  • are better aware of the rights of children and young people and their families and of the need to provide reasonable adjustments to those who have a mental health condition which meets the definition of a disability under the Equality Act 2010; and
  • betterunderstand how the PSED can help them identify the needs and issues specific to children and young people with intersecting protected characteristics and design, trial and evaluate targeted interventions to tackle these.

Monitoring improvements

  1. To have a better picture of the pathways, barriers, and good practice at national and regional levels, we suggest that the Office for Standards in Education, Children's Services and Skills (Ofsted) and the Care Quality Commissionframeworks are aligned to assess how well education and mental health service providers:
  • record disaggregated equality information on the prevalence of mental health problems/conditions; students referred to mental health support teams, to CAMHS or to other services; waiting times and refusals; access to interventions/treatments; drop-out and the reason for this; response to interventions/treatments including through monitoring impact on their behaviour (e.g. reduction in bullying and exclusion) and academic attainment;
  • respond to the needs of students who are most at risk of developing mental health problems andprovide reasonable adjustments when necessary.
  1. We believe it is vital that Ofsted recognises and rewards schools for implementing effective mental health support. This will offer incentives for schools to ensure that they have adequate measures in place to support the mental health and wellbeing of students, even if this may affect their results or progress 8 scores[39].

1

[1]Equality and Human Rights Commission (2015). Is England Fairer? The state of equality and human rights 2016. Available at

[2]Convention on the Rights of the Child Article 24; International Covenant on Economic, Social and Cultural Rights Article 12

[3]European Convention on Human Rights First Protocol Article 2; Convention on the Rights of the Child Articles. 28 and 29; International Covenant on Economic, Social and Cultural Rights Article 13

[4]Convention on the Rights of the Child Article 31

[5]European Convention on Human Rights Article 8

[6]The Independent Mental Health Taskforce to the NHS in England (2016), The five years forward view for mental health. Available at:

[7] The UN Committee on the Rights of the Child (2016), Concluding observations on the UK, para 61 recommended for the State Party to rigorously invest in child and adolescent mental health services and develop strategies at the national and devolved levels, with clear time frames, targets, measureable indicators, effective monitoring mechanisms and sufficient human, technical and financial resources. Such strategies should include measures to ensure availability, accessibility, acceptability, quality and stability of such services, with particular attention to children at greater risk, including children living in poverty, children in care and children in contact with the criminal justice system.

[8]Mind (2014).A civilised society.Mental health provision for refugees and asylum-seekers in England and Wales. Available at

[9]Equality and Human Rights Commission (2016).England’s most disadvantaged groups: Gypsies, Travellers and Roma. Available at

[10] Care Quality Commission (2017). Review of young people’s mental health services Phase One Report. Available at

[11] See section 149 of the Equality Act 2010. Available at

[12] In 2016, the UN Committee on the Rights of the Child called upon the UK Government to support and develop therapeutic community-based services for children with mental health conditions. See UN CRC (2016), Concluding Observations, para. 61(d).

[13] NHS England own access target is only for 32% of children with a diagnosable mental health condition to have access to services by April 2019. See NHS England (2016). NHS Operational Planning and Contracting Guidance 2017 -2019.Available at

[14]NHS Employers (2017).Shortage Occupation List. Available at

[15]YoungMinds (undated). Stop the Leak. Available at

[16]For example, evidence from YoungMinds shows that if young LGBT children are at higher risk of developing mental health problems as a result of experiencing prejudice and that 44% had considered suicide, the risk is increased further if a young person is LGBT and from an ethnic minority. See Young Minds, (2016), Beyond Adversity: Addressing the mental health needs of young people who face complexity and adversity in their lives. Available at:

[17] For example, currently the race audit does not provide any data relating to the access, treatment and experiences of young people in relation to mental health services. See

[18]For example, the proposed research in the Green Paper on how to engage ‘vulnerable families’.

[19] For example, the Green Paper acknowledges that Black adults are more likely to be detained under the Mental Health Act 1983 and that around 1 in 10 Black children have a mental health condition, compared to just under 1 in 10 White children, and 3 in 100 Indian. More research may be needed to better understand how mental health problems develop among Black young people compared to other ethnic groups and how these may be tackle through taking targeted actions.

[20]Children’s Rights Alliance for England. State of Children’sRights in England2017. Available at

[21] Article 39 stipulates that States Parties shall take all appropriate measures to promote physical and psychological recovery and social reintegration of a child victim of: any form of neglect, exploitation, or abuse; torture or any other form of cruel, inhuman or degrading treatment or punishment; or armed conflicts. Such recovery and reintegration shall take place in an environment which fosters the health, self-respect and dignity of the child.

[22] Paragraph 61 (a) of UN Committee on the Rights of the Child 2016 Concluding Observations on the UK recommended that State Party ‘regularly collect comprehensive data on child mental health, disaggregated across the life course of the child, with due attention to children in vulnerable situations and covering key underlying determinants. See Committee on the Rights of the Child (2016), Concluding Observations on the UK

[23] Equality and Human Rights Commission (2016), ‘Children’s rights in the UK’, p. 25 Available at:

[24]The National Confidential Inquiry into Suicide and Homicide by people found that a significant proportion of young people (particularly males under 20) were not known to mental health, social care, youth justice, local authority services or the police before committing suicide. See The National Confidential Inquiry into Suicide and Homicide by people with mental illness (2017). Suicide by Young people. Available at

[25] The latest HM Inspector of Prisons annual report which is available at shows that just 4% of young adults (aged 18-21) were unlocked for at least 10 hours per day, and 30% of young adults held in adult establishments were out of their cell for less than two hours a day out of cell. They highlighted that just 16% of boys were engaged in a job, 11% in vocational training and 16% in offending behaviour programmes. Such situation is highly likely to have an impact on their mental health.

[26] EHRC (2017), Disability rights in the UK, pp. 62/63. Available at: