Consultations and briefings

Reform of the Mental Health Act is long over-due to ensure that it is fit for purpose for today, to tackle disparities in the mental health system and to address the unacceptable trend of people with severe mental health difficulties ending up in the criminal justice system.

This briefing particularly focuses on the areas where we believe further amendments to the Bill are necessary for the government to achieve its aim of ensuring that everyone is treated with dignity throughout treatment.

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This briefing proposes recommendations on steps the government can take in managing the current prison capacity crisis and to ensure the safety and wellbeing of vulnerable prisoners.

Specifically, we call for a resentencing exercise for all those serving IPP sentences, improved access to mental health support within prisons, and we recommend that courts should avoid sentencing women to prison during pregnancy unless the imposition of a custodial sentence is unavoidable.

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This briefing specifically focuses on how the government can better support the needs of children and young people in their early years including in their experiences of education and healthcare.

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IPP sentences (indeterminate sentences without a set release date) were abolished in 2012.

These sentences were originally introduced to protect members of the public from those considered dangerous.

However, they ended up being used far more widely than intended, with some having been issued to offenders who committed low level crimes with tariffs as short as two years.

Although the IPP sentence has been abolished, there are thousands of individuals still in prison serving these sentences. As of June 2024, 1,132 prisoners subject to IPP sentences were still in prison.

A wealth of research suggests that IPP sentences are psychologically harmful. 

The BPS is calling for the UK government to urgently introduce legislation for a resentencing exercise for those on IPP sentences.

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The British Psychological Society (BPS) - the representative body for psychology and psychologists in the UK - urges MPs to call for the following in the General Debate on the future of the NHS, its funding and staffing on Thursday 23rd February:

• Ring-fenced funding for the NHS Staff Mental Health and Wellbeing Hubs
• A comprehensive mental health workforce strategy
• Continued funding to help retain staff
• To embed psychology into primary care

Ring-fenced funding for the NHS Staff Mental Health and Wellbeing Hubs

At a time when the NHS is confronted with unprecedented levels of pressure, it is more important than ever that staff can access the support they need to be able to deliver for patients.

Therefore, it is vital that the Government commits to providing transitional ring-fenced funding for NHS Staff Mental Health and Wellbeing Hubs.

The BPS is aware that the question of whether to continue national funding for the Hubs is being considered, with an expectation that commissioning will shift to Integrated Care Boards (ICBs) in the future.

However care must be taken in the transition of funding from NHS England to ICBs as they are in varying stages of development.

Therefore, without transitional ring-fenced funding, these services will come to an abrupt halt, putting the staff members who use them, and the patients who they serve, at risk of harm.

Now more than ever, when patients are facing record waiting times, we simply cannot afford to put the mental health of NHS staff on the back burner.

As things currently stand, anxiety; stress; depression and other psychiatric illnesses are consistently the most reported reason for sickness absence in the NHS, accounting for over 521,600 full time equivalent days lost and 25.5 per cent of all sickness absence in August 2022.

This has increased since July 2022 (20.9 per cent) (NHS Digital. (2023). NHS Sickness Absence Rates, August 2022) .

A comprehensive mental health workforce strategy

We do not believe that the announcement of a Major Conditions Strategy to replace the 10 Mental Health Strategy allows for the level of specification and investment required for the sector.

The BPS urges the Government to implement a comprehensive mental health workforce strategy.

The BPS stresses that, as a bare minimum, this Government must invest more to implement the existing workforce plan.

The workforce shortages have reached a state of crisis and the impact of this on public health has been enormous.

As of July 2022, over 1.6 million people were in contact with mental health services, an increase from 1.2 million in April 2016 (NHS Digital. (2022). Mental health services monthly statistics), and services are struggling to keep up with increased demand.

Those seeking mental health support can experience long waiting times – at the end of 2021, NHS England estimated there were at least 1.4 million who had been accepted for mental health care but were yet to receive it (NHS England and NHS Improvement. (2021). NHS England and NHS Improvement Board Meetings in Common: Item 5: Update on mental health services).

Further, waiting times and staff shortages are having an impact on levels of patient satisfaction with the NHS; in 2021 the proportion of patients who we satisfied with the NHS fell to 36 per cent, an unprecedented 17 per cent decrease on 2020 and the lowest level recorded since 1997.

The main reasons given for dissatisfaction were waiting times for GP and hospital appointments (65 per cent) followed by staff shortages (46 per cent) [Wellings, D. et al. (2022). Public satisfaction with the NHS and social care in 2021: Results from the
British Social Attitudes Survey. The King's Fund. P.5].

Continued funding to help retain staff

We have heard from our members that a lack of career opportunities and a downgrading of Agenda for Change bands for posts are driving staff out of the NHS into other sectors.

Furthermore, additional investment is needed to create more funded pathways for individuals entering sectors within psychology.

For example, there are little to no Government funded placements for the majority of Practitioner Psychologist training routes-including in areas such as counselling or health psychology.

It is important that the Treasury take steps to change this to facilitate closure of workforce gaps, and to create equal opportunities for groups consistently under-represented in the psychology workforce.

To embed psychology into primary care

The BPS urges this Government to make investments to adopt our recommendation to embed psychology into primary care (British Psychological Society (2022). Clinical Psychology in Primary Care- how can we afford to be without it? Guidance for Clinical Commissioners and Integrated Care Systems).

We know from both research and existing schemes that psychologists working closely with GPs can be incredibly powerful and effective in reducing demands on primary care and empowering general practice clinicians to manage the psychological component of presentations that are increasingly prevalent in general practice.

Psychologists not only assist with mental health outcomes and improving health behaviours, they reduce overall demand by helping with long term complex conditions.

Following one trial in Hackney, GPs reported improved capacity to manage patients with complex needs and reduced workload and 75 per cent of all patients showed improvements in their mental health, wellbeing and functioning (British Psychological Society (2022). Clinical Psychology in Primary Care- how can we afford to be without it? Guidance for Clinical Commissioners and Integrated Care Systems).

- The Public Affairs Team 

For more information on these issues, please contact [email protected].

Introduction

The British Psychological Society (BPS), the representative body for psychology and psychologists in the UK, urges MPs to highlight the need for better investment in Educational Psychologists during the Westminster Hall Debate on the specialist workforce for children with special educational needs and disabilities on Wednesday 22 March.

The need for National Government Funding

The BPS is encouraged by the promise of a nationally consistent standard in the Government's response to the SEND Review.

SEND support across England has reached a point that reflects stark inequalities between local authorities.

However, as we mentioned in our submission (BPS Consultation on the SEND Review, 2022), the national Government must assign local authorities with ring-fenced funding in order for this to be deliverable.

More investment is needed to close the workforce gap

The announcement of £21 million for 400 more Educational Psychologists is a step in the direction (Department for Education (2022) How we are improving support for children with SEND), but does not go far enough to close the workforce gap.

Data published by the Government in 2019 showed that in 2017 there were c. 3000 Educational Psychologists working in England, which is equivalent to, on average, one Educational Psychologist for every 3,500 children and young people aged 5-19 in England and one for every 5,000 aged 0-25 (Department for Education (2019) Research on the Educational Psychologist Workforce).

Many of our members report that a consequence of the escalating demand has led to a lack of opportunities for early intervention.

Given that Educational Psychologists play such a crucial role in supporting children with SEND, there must be a greater increase in the number of Educational Psychologists in order to meet demand.

For more information on these issues, please contact [email protected].

This briefing presents evidence across two key areas:

1. the integration between mental and physical health
2. the experiences of the older population in relation to mental health and long-term conditions.

We make several policy recommendations in this briefing, including asking the UK government to ensure that:

• physical healthcare services have sufficient access to an appropriately trained psychological workforce
• mental health services are appropriately supported and resourced to be responsive to the needs of older people (who are statistically at greater risk of experiencing long-term conditions).

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This briefing presents evidence on some of the key challenges that those with disabilities can face when accessing benefits, work, education and healthcare.

We make several policy recommendations aimed at addressing resource, workforce and system issues based on the difficulties that those with disabilities can face when accessing public services.

Specifically, the British Psychological Society are calling for the UK government to:

• provide sustained funding for mental health services so people can get the support they need
• ensure schools, healthcare and employment services have the resources they need to appropriately and sufficiently support those with disabilities
• work closely with psychologically informed professionals and those with disabilities to better understand where more support is needed and where action should be targeted

Read the full briefing.

Background

The British Psychological Society (BPS) is the representative body for psychology and psychologists throughout the UK. We are committed to providing and disseminating evidence-based expertise and engaging with policy and decision-makers. We believe psychology has an important role to play in government policy and in improving the lives of the public.

Impact of bereavement

The death of a parent is a highly stressful life event for a child.¹ Research has shown an increased risk of psychosocial problems and mental ill-health among affected children.²

Although there is an elevated risk for negative outcomes, children can react in different ways following a bereavement and outcomes for an individual can depend on several individual factors such as personal characteristics, mental health, type of death, whether the death is expected and post-bereavement circumstances.³

The age of a child is another individual factor that can affect the process of bereavement. Between the ages of five and seven, children begin to gradually develop an understanding that death is irreversible. However, children who have been bereaved when they were younger will have to re-process what has happened as they develop awareness of the finality of death. In adolescence, grief can impact a person's ability to move from the process of dependence to independence.⁴

In addition to individual factors, systemic factors such as the quality of social relationships and support available to a child during the bereavement process can also impact bereavement outcomes.⁵ Ideally, whilst children are experiencing the emotions of bereavement, they would be supported by a stable and supportive family, with the help of school and community groups to help mitigate negative outcomes.⁶

However, where a young person experiences loss and trauma, school performance can deteriorate, particularly in subjects that require high attentional demand.^7,8 A higher level of post-traumatic stress and lower school performance has been associated with a perception of lack of support from parents, classmates and teachers.⁹

The value of peer support interventions for children following bereavement

Research has shown that the use of educational peer support programmes within school settings can positively support children and young people through grief.¹⁰

Focus groups held with young people following engagement in a peer support programme called Seasons for Growth (an eight-week peer support programme for young people who have experienced bereavement) found that young people who engaged in this intervention reported positive outcomes. This included an increased sense of belonging and connectedness, value from being able to talk about their experiences, and increased emotional literacy in terms of naming and understanding their feelings. Participating in the peer support programme also positively impacted the young people's concentration, confidence and relationships.¹¹

Policy recommendations:

• The UK government should work closely with schools, supporting them to develop clear procedures for helping young people with bereavement and the educational challenges bereavement can present.
• The UK government should support schools and local authorities in accessing training on how to support young people through bereavement.
• The UK government should ensure that schools and local authorities have the resources required to deliver peer support programmes (such as Seasons for Growth).

Specific considerations for children with learning disabilities

Some people with learning disabilities may experience difficulty in understanding the concept of death.¹² Furthermore, grief responses in people with learning disabilities can be missed because individuals with learning disabilities may be unable to express their feelings verbally and, in some cases, behaviour can be assumed to be due to the learning disability or to the personality of the person, rather than to grief.¹³

Policy recommendations:

• The UK government should ensure that staff working in roles that entail supporting children, receive specific training around supporting bereaved children with learning disabilities.
• The UK government must deliver a whole systems approach to supporting bereaved children including those with learning disabilities (recognising that bereaved children should receive tailored emotional support across the different systems they come into contact with including education and care).

References

Bergman, AS., Axberg, U. & Hanson, E. When a parent dies – a systematic review of the effects of support programs for parentally bereaved children and their caregivers. BMC Palliative Care 16, 39 (2017). https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-017-0223-y
2 Ibid
3 British Psychological Society. Educational and Child Psychology (2004) Vol 21(3). How children cope at school after family bereavement. https://explore.bps.org.uk/content/bpsecp/21/3/85
4 Child Bereavement UK. Children's understanding of death at different ages. https://www.childbereavementuk.org/childrens-understanding-of-death-at-different-ages#:~:text=A%20young%20child%20is%20capable,day%2Dto%2Dday%20care.
5 Childhood Bereavement Network and the National Children's Bureau. Grief Matters for Children (2017). https://childhoodbereavementnetwork.org.uk/sites/default/files/uploads/files/grief-matters-for-children-2017.pdf
6 Ibid
7 Streeck-Fischer, A. & van der Kolk, B.A. (2000). Down will come baby, cradle and all: Diagnostic and therapeutic implications of chronic trauma on child development. Australian and New Zealand Journal of Psychiatry, 34, 903–918. https://pubmed.ncbi.nlm.nih.gov/11127621/
8 Yule, W. & Gold, A. (1993). Wise before the event: Coping with crises in schools. London: Calouste Gulbenkian Foundation.
9 British Psychological Society. Educational Psychology in Scotland (2017) Vol 18 (1). Improving health and wellbeing for children and young people who have experienced loss, change and bereavement. https://explore.bps.org.uk/content/bpsepis/18/1/2.full.pdf
10 Ibid
11 Ibid
12 British Psychological Society. Educational and Child Psychology (2004) Vol 21 (3). Children with learning disabilities and bereavement: A review of the literature and its implications. https://explore.bps.org.uk/content/bpsecp/21/3/30
13 Ibid